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Open Access Highly Accessed Research article

An international survey of pain in adolescents

Michael Steven Swain12*, Nicholas Henschke23, Steven James Kamper24, Inese Gobina5, Veronika Ottová-Jordan6 and Christopher Gerard Maher2

Author Affiliations

1 Department of Chiropractic, Faculty of Science, Macquarie University, Sydney 2109, Australia

2 Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia

3 Institute of Public Health, University of Heidelberg, Heidelberg, Germany

4 Department of Epidemiology and Biostatistics, EMGO + Institute, VU University Medical Center, Amsterdam, The Netherlands

5 Department of Public Health and Epidemiology, Riga Stradinš University, Riga, Latvia

6 Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Research Unit Child Public Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

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BMC Public Health 2014, 14:447  doi:10.1186/1471-2458-14-447

Published: 13 May 2014



A common belief is that pain is uncommon and short lived in adolescents. However, the burden of pain in adolescents is unclear because of limitations in previous research. The aim of this study is to estimate the prevalence of headache, stomach-ache and backache in adolescents and to explore the extent to which these three forms of pain coexist based upon a representative sample of adolescents from 28 countries.


Data were analysed from three consecutive waves (1997/98, 2001/02 and 2005/06) of the Health Behavior in School-aged Children: WHO Collaborative Cross-National survey (HBSC). Prevalence estimates are based upon adolescents who reported experiencing headache, stomach-ache or backache at least monthly for the last 6 months.


There were a total of 404,206 participants with a mean (±SD) age of 13.6 (±1.7) years (range 9.8 to 17.3 years). The prevalence of headache was 54.1%, stomach-ache 49.8%, backache 37%, and at least one of the three pains 74.4%. Girls had a higher prevalence of the three pains than boys and the prevalence of pain increased with age. Headache, stomach-ache and backache frequently coexist, for example, of those with headache: 21.2% had headache alone, 31% suffered from both headache and stomach-ache, 12.1% suffered from backache and headache, and 35.7% had all three pains.


Somatic pain is very common in adolescents, more often coexisting than occurring in isolation. Our data supports the need for further research to improve the understanding of these pains in adolescents.

Pain; Adolescent; Prevalence; Epidemiology; World Health Organisation; HBSC