The Role of Family Functioning and Socioeconomic Context in Multisite and Chronic Musculoskeletal Pain in Adolescents: Generation XXI Cohort Study

Objective We examined whether family functioning relates to multisite and chronic musculoskeletal pain in adolescents, a key etiological stage for chronic pain, considering socioeconomic and childhood adversity factors (ACEs). Methods Data from 1,473 participants were analyzed using the Luebeck Pain Screening Questionnaire at 18 years. Multisite pain was defined as pain in ≥2 sites; chronic musculoskeletal pain as pain in any musculoskeletal site lasting >3 months. Family functioning was assessed via the Brief Family Relationship Scale and categorized as poor, fair, or good. Socioeconomic indicators were collected at baseline, and ACEs at age 13. Results The prevalence of multisite pain was 43%, and chronic pain was 23%. Logistic regression analyses showed that good family functioning was associated with lower odds of multisite pain (OR 0.49; 95% CI 0.37, 0.65) and chronic musculoskeletal pain (OR 0.62; 95% CI 0.45, 0.86). Socioeconomic indicators had limited effects, though higher maternal occupation was linked to greater multisite pain (OR 1.38; 95% CI 1.02, 1.87). Stratified analyses revealed no significant interactions. Conclusion Good family functioning was associated with a lower risk of adolescent pain across socioeconomic contexts.