Prevalence and functional impact of musculoskeletal pain among university students in seven Arab countries and its sociodemographic and lifestyle associations

Musculoskeletal pain (MSP) represents a major public health challenge globally, particularly among university students who are in a critical transitional phase of life characterized by intense academic demands, lifestyle changes, and increasing reliance on digital technologies. Sedentary behavior (SB) has been identified as a potential risk factor for MSP; however, evidence from the Arab region remains limited. This study aimed to determine the prevalence of MSP in nine body regions (neck, shoulders, upper back, elbows, wrists/hands, lower back, hips/thighs, knees, and ankles/feet) across four time points (lifetime, past 12 months, past month, and today), to assess the impact of MSP, and examine the association between SB and MSP. A multinational cross-sectional study was conducted among 4300 university students in seven Arab countries (Egypt, Yemen, Iraq, Sudan, Jordan, Syria, and Palestine), using an online Arabic self-administered questionnaire. Convenience and snowball sampling methods were used to recruit eligible study respondents. MSP was assessed using the Arabic version of the Extended Nordic Musculoskeletal Questionnaire (NMQ-E). SB was assessed using sedentary behavior questionnaire (SBQ). Chi-square tests were used for univariate associations. Binary logistic regression was used to identify factors associated with any MSP in the past 12 months, and to identify predictors of high SB. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were reported, and a p-value < 0.05 was considered statistically significant. The prevalence of MSP in at least one body region was 84.0% (lifetime), 71.3% (past 12 months), and 64.9% (past month). The neck (49.3%) and lower back (37.3%) were the most affected regions in the past 12 months. Among those affected, preventing usual activities (range: 48.8%–71.7%) and taking medication (range: 37.6–48.2%) were the most reported impacts, while hospitalization remained relatively low (3.2–14.2%). Female sex (aOR = 1.98, 95% CI 1.69–2.31), chronic diseases (aOR = 1.90, 95% CI 1.44–2.49), MSP family history (aOR = 1.96, 95% CI 1.56–2.47), moderate SB (aOR = 1.56, 95% CI 1.32–1.84), and high SB (aOR = 1.42, 95% CI 1.16–1.72) were significantly associated with MSP in the past 12 months, while sleeping 6–8 h was protective (aOR = 0.79, 95% CI 0.67–0.92). This study found a high prevalence of MSP among university students in Arab countries, particularly affecting the neck and lower back. Higher SB, chronic diseases, and a family history of MSP were associated with MSP, whereas adequate sleep appeared to be protective. These findings support the need for university-based strategies that reduce prolonged SB and promote musculoskeletal health, including ergonomic education, active breaks, adjustable study stations, and more active learning environments.