Family history of pain and risk of musculoskeletal pain in children and adolescents: a systematic review and meta-analysis

Key points

1. 01Longitudinal data (5 studies, n=42,131) show children with a family pain history have 58% higher odds of MSK pain (OR 1.58, 95% CI 1.20-2.09)
2. 02Cross-sectional data (18 studies, n=17,274) show even stronger associations (OR 2.02, 95% CI 1.69-2.42)
3. 03Risk increases with more family members affected: one parent OR ~1.6 versus both parents OR ~2.0
4. 04Sibling history of pain was associated with the highest odds among subgroups (OR 1.99, 95% CI 1.48-2.66)
5. 05When a family member had consequential pain (treated, disabling, or care-seeking), child odds were 94% higher (OR 1.94, 95% CI 1.35-2.80)

How it was conducted

Design

Systematic review and meta-analysis of observational studies (longitudinal and cross-sectional)

Studies included

29 studies total: 6 longitudinal and 23 cross-sectional, from 14 countries

Participants

Longitudinal studies: n=42,226; cross-sectional studies: n=48,119

Population

Children and adolescents aged under 19 years at baseline

Exposure

Family history of musculoskeletal pain in a parent or sibling

Primary outcome

Report of musculoskeletal pain in children, with or without disability or care-seeking consequences

What they found

• Longitudinal meta-analysis (5 studies, n=42,131): OR 1.58, 95% CI 1.20-2.09 for family history of MSK pain predicting child MSK pain (moderate quality evidence)
• Adjusted longitudinal estimate (4 studies, n=41,844): OR 1.53, 95% CI 1.13-2.06
• Cross-sectional meta-analysis (18 studies, n=17,274): OR 2.02, 95% CI 1.69-2.42 (moderate quality evidence)
• Adjusted cross-sectional estimate (12 studies, n=13,998): OR 2.04, 95% CI 1.64-2.54
• Maternal history subgroup (5 studies, n=7,515): OR 1.61, 95% CI 1.33-1.93 (very low quality evidence)
• Paternal history subgroup (4 studies, n=5,059): OR 1.59, 95% CI 1.26-2.00 (very low quality evidence)
• Both parents with pain (2 studies, n=4,450): OR 1.95, 95% CI 1.56-2.44 (very low quality evidence)
• Sibling history subgroup (2 studies, n=1,449): OR 1.99, 95% CI 1.48-2.66 (very low quality evidence)
• Any family member (parent and/or sibling) subgroup (5 studies, n=3,652): OR 2.61, 95% CI 1.76-3.88 (moderate quality evidence)
• Consequential family pain (treated, disabling, or care-seeking) subgroup (5 studies, n=3,748): OR 1.94, 95% CI 1.35-2.80 (low quality evidence)
• Parental spinal pain predicting child spinal pain (16 studies, n=14,432): OR 1.98, 95% CI 1.64-2.40 (moderate quality evidence)

Limitations

• Only 5 longitudinal studies were available, limiting assessment of publication bias and causal inference
• Cross-sectional studies cannot rule out reverse causation (child pain may influence parental pain reporting)
• Subgroup analyses (mother, father, sibling) are mostly very low or low quality, so estimates are uncertain
• Substantial variability in how exposure (family pain type and location) and outcomes were defined across studies

Why it matters

For patients

If a parent or sibling has musculoskeletal pain, a child in that family has meaningfully higher odds of developing pain too, which may warrant earlier attention to modifiable lifestyle and psychological factors.

For clinicians

Asking about family pain history during pediatric assessment can help identify children at elevated risk of musculoskeletal pain and flag opportunities for early biopsychosocial intervention.

For readers

This meta-analysis quantifies what clinicians have suspected: MSK pain runs in families, though the mechanisms (genetic, behavioral, environmental) remain unclear and family-level interventions have not yet been tested.