Factors associated with musculoskeletal pain in the spinal column of children and adolescents: a cross-sectional study with network analysis.

OBJECTIVE: The aim of this study was to analyze the relationship between musculoskeletal spinal pain and individual, behavioral, and contextual factors in children and adolescents. METHODS: A cross-sectional study was conducted with 189 children and adolescents (10-16 years), of both genders, enrolled in public and private schools in Belém, Pará, Brazil. Musculoskeletal pain and postural habits were assessed using the Back Pain and Posture Evaluation Instrument for Children and Adolescents, a validated questionnaire for this population. Network analysis using the EBICglasso estimator explored associations between individual (age, gender), behavioral (physical activity in school and leisure contexts), and contextual factors (school type and postural habits related to daily activities and electronic device use) and the presence of neck and low back pain. RESULTS: The prevalence of low back pain was 62.6% and neck pain 65.4%. Low back pain was negatively associated with family history of pain (r=-0.14) and positively associated with female gender (r=0.19) and neck pain (r=0.12). Sitting posture during electronic device use was negatively associated with neck pain (r=-0.19). Gender and age showed higher centrality, indicating greater influence within the network, while physical activity showed a negative influence on pain outcomes. CONCLUSIONS: Musculoskeletal spinal pain was highly prevalent and associated with multiple interrelated factors. Network analysis highlights its multifactorial nature and provides relevant insights into key variables that may guide integrated health promotion and early prevention strategies in pediatric populations.