Does Familial Aggregation of Chronic Low Back Pain Affect Recovery?: A Population-Based Twin Study

Familial and Genetic Influences on the Common Pediatric Primary Pain Disorders: A Twin Family Study

The primary pain disorders of childhood are highly prevalent but have infrequently been studied collectively. Genetic influences have been suggested to be causally implicated. Surveys were sent to 3909 Australian twin families, assessing the lifetime prevalence of growing pains, migraine, headache, recurrent abdominal pain, low back pain, and persistent pain (not otherwise specified) in pediatric twins and their immediate family members. Comparisons between monozygous (MZ) and dizygous (DZ) twin pair correlations, concordances and odds ratios were performed to assess the contribution of additive genetic influences. Random-effects logistic regression modelling was used to evaluate relationships between twin individuals and their co-twins, mothers, fathers and oldest siblings with the subject conditions. Twin analyses of responses from 1016 families revealed significant influence of additive genetic effects on the presence of growing pains, migraine, and recurrent abdominal pain. The analyses for headache, low back pain, and persistent pain overall did not conclusively demonstrate that genetic influences were implicated more than shared environmental factors. Regression analyses demonstrated varying levels of significance in relationships between family members and twin individuals for the tested conditions, with strongest support for genetic influences in growing pains and migraine. These data, together with previously published association analyses, suggest common causal influences including genes.

Family History Influences the Effectiveness of Home Exercise in Older People With Chronic Low Back Pain: A Secondary Analysis of a Randomized Controlled Trial

OBJECTIVE

To investigate whether a family history of low back pain (LBP) influences patient outcomes and treatment effects following home exercises in older people with chronic LBP.

DESIGN

Secondary analysis of a randomized controlled trial.

SETTING

Local community.

PARTICIPANTS

People older than 55 years with chronic LBP (N=60).

INTERVENTIONS

Participants in the intervention group completed video game exercises for 60 minutes 3 times per week for 8 weeks. Participants in the control group were instructed to maintain their usual levels of activity and care seeking behaviors.

MAIN OUTCOMES MEASURES

Participants indicated whether any of their immediate family members had a history of "any" LBP or "activity-limiting" LBP at baseline. We collected self-reported measures of pain, function, pain self-efficacy, care seeking, physical activity, disability, fear of movement and/or reinjury, and falls efficacy at baseline, 8 weeks, 3 months, and 6 months. We performed regression analyses to determine whether a family history of LBP predicted patient outcomes and moderated the effects of home exercise.

RESULTS

Participants with a family history of any LBP were less likely to be highly active than those without a family history (odds ratio, 0.08; 95% CI, 0.01-0.42; P=.003). Home-based video game exercises led to improvements in function in those without a family history of activity-limiting LBP (β=1.78; 95% CI, 0.56-3.00; P=.006) but not in those with a family history (β=-0.17; 95% CI, -2.56 to 2.21; P=.880) (interaction P=.049). A family history of LBP did not influence the remaining patient outcomes or treatment effects.

CONCLUSIONS

A family history of LBP appears to negatively influence physical activity levels in older people with chronic LBP. Further, home-based video game exercises appear to be beneficial for older people with chronic LBP that do not have a family history of LBP.

Influence of family history on prognosis of spinal pain and the role of leisure time physical activity and body mass index: a prospective study using family-linkage data from the Norwegian HUNT study

OBJECTIVES

To investigate the influence of parental chronic spinal pain on prognosis of chronic spinal pain in adult offspring, and whether offspring physical activity level and body mass index (BMI) modified this association.

DESIGN

Prospective cohort study.

SETTING

We used family-linked longitudinal data from the Norwegian HUNT study collected in HUNT2 (1995-1997) and HUNT3 (2006-2008).

PARTICIPANTS

A total of 1529 offspring who reported spinal pain in HUNT2 were linked with parental data and followed up in HUNT3.

OUTCOMES

We estimated relative risk (RR) with 95% CI for recovery from chronic spinal pain, and also from activity limiting spinal pain, in offspring related to chronic spinal pain in parents. We also investigated whether offspring leisure time physical activity and BMI modified these intergenerational associations in spinal pain.

RESULTS

A total of 540 (35%) offspring were defined as recovered after approximately 11 years of follow-up. Offspring with both parents reporting chronic spinal pain were less likely to recover from chronic spinal pain (RR 0.83, 95% CI 0.69 to 0.99) and activity limiting spinal pain (RR 0.71, 95% CI 0.54 to 0.94), compared with offspring of parents without chronic spinal pain. Analyses stratified by BMI and physical activity showed no strong evidence of effect modification on these associations. However, offspring who were overweight/obese and with both parents reporting chronic spinal pain had particularly low probability of recovery from activity limiting spinal pain, compared with those who were normal weight and had parents without chronic spinal pain (RR 0.57, 95% CI 0.39 to 0.84).

CONCLUSION

Offspring with chronic spinal pain are less likely to recover if they have parents with chronic spinal pain, particularly if offspring are overweight/obese.

Familial factors predicting recovery and maintenance of physical activity in people with low back pain: Insights from a population-based twin study

BACKGROUND

It is unknown how familial factors influence the recovery from low back pain (LBP) and the maintenance activity behaviours. We aimed to investigate whether individual and within-family physical activity (PA) and sedentary behaviour influenced recovery from LBP, and maintenance of PA and sedentary behaviour in people with and without LBP.

METHODS

Longitudinal logistic regression analyses were performed on adult twins from the Washington State Twin Registry. First, individual and within-family (based on co-twin data) sufficient PA (at least 75 min of vigorous-intensity PA, or 150 min of moderate-intensity PA per week) and high leisure sitting time (≥3 hr/day) were our exposure variables (baseline). LBP within the past 3 months at follow-up defined non-recovery (outcome). Second, within-family sufficient PA and high leisure sitting time were our exposure variables(baseline) and our outcomes were individual PA and sitting time at follow-up. All analyses were adjusted for follow-up length (range: 1-7 years) and confounding variables.

RESULTS

Individual and within-family PA and sitting time were not associated with recovery. Within-family PA and sitting time predicted individual maintenance of PA (OR = 1.47, 95% CI: 1.17-1.84, n = 1,388 twins) and sitting time (OR = 1.41, 95% CI: 1.10-1.82, n = 1,534). Within-family PA and sitting time had the strongest effects on those without (OR = 1.79, 95% CI: 1.33-2.41, n = 788) and with LBP (OR = 1.90, 95% CI: 1.32-2.76, n = 698), respectively.

CONCLUSION

Having active family members increased the likelihood of continuing to be active (particularly for those without LBP), while having sedentary family members increased the likelihood of maintaining sedentary behaviours (particularly for those with LBP).

SIGNIFICANCE

This study was the first to investigate how familial activity behaviours influence recovery from LBP and ongoing activity behaviours. People with LBP living within a sedentary family likely require specific interventions to reduce their sedentary behaviours.