Prevalence and tracking of back pain from childhood to adolescence

Bullying Involvement and Physical Pain Between Ages 10 and 13 Years: Reported History and Quantitative Sensory Testing in a Population-Based Cohort

We aimed to quantify the prospective association between bullying and physical pain in a population-based cohort of adolescents. We assessed 4,049 participants of the 10 and 13 years waves of the Generation XXI birth cohort study in Portugal. Pain history was collected using the Luebeck pain screening questionnaire. A subsample of 1,727 adolescents underwent computerized cuff pressure algometry to estimate pain detection/tolerance thresholds, temporal pain summation and conditioned pain modulation. Participants completed the Bully Scale Survey and were classified as "victim only", "both victim and aggressor", "aggressor only", or "not involved". Associations were quantified using Poisson or linear regression, adjusted for sex and adverse childhood experiences. When compared to adolescents "not involved", participants classified as "victim only" or "both victim and aggressor" at age 10 had higher risk of pain with psychosocial triggers, pain that led to skipping leisure activities, multisite pain, pain of higher intensity, and pain of longer duration, with relative risks between 1.21 (95% confidence interval: .99, 1.49) and 2.17 (1.57, 3.01). "Victims only" at age 10 had lower average pain detection and tolerance thresholds at 13 years (linear regression coefficients: -1.81 [-3.29, -.33] and -2.73 [-5.17, -.29] kPa, respectively), as well as higher pain intensity ratings (.37 [.07, .68] and .39 [.06, .72] mm), when compared with adolescents not involved. No differences were seen for the remaining bullying profiles or sensory measures. Our findings suggest that bullying may have long-term influence on the risk of chronic musculoskeletal pain and may interfere with responses to painful stimuli. PERSPECTIVE: We found prospective evidence that bullying victimization in youth: 1) is more likely to lead to negative reported pain experiences than the reverse, 2) may have long-term influence on adverse pain experiences, and 3) may contribute to pain phenotypes partly by interfering with somatosensory responses to painful stimuli.

Clinical examination and imaging resources in children and adolescent back pain

Back pain is a relatively common complaint in children and adolescents. The pediatric patient presenting with back pain can often be challenging, and there are many well-known organic diagnoses that should not be missed. In younger children, an organic cause of back pain can often be found. However, back pain in older children and adolescents is often "non-specific." The differential diagnosis of back pain in children includes neoplasms, developmental, and inflammatory conditions. Basic steps should include an in-depth anamnesis, a systematic physical examination, and standard spine radiographs (anteroposterior and lateral). Nevertheless, advanced diagnostic imaging and laboratory studies should be included when indicated to avoid missing or delaying a serious diagnosis. If other types of imaging tests are necessary (magnetic resonance imaging, computed tomography, bone scan, or single photon emission computed tomography), they should be guided by diagnostic suspicion.

Development of the Young Disability Questionnaire (spine) for children with spinal pain: field testing in Danish school children

OBJECTIVE

The objective of this study was to finalise the development of the Young Disability Questionnaire (YDQ-spine) to measure the consequences of neck, midback and low back pain, relevant for schoolchildren aged 9-12 years.

DESIGN

A cross-sectional field test of the YDQ-spine was carried out.

SETTING

Danish primary schools.

PARTICIPANTS

Children aged 9-12 years from all Danish schools were invited to complete the questionnaire.

METHODS

Eight hundred and seventy-three schools were invited to participate. Consenting schools received information material, instructions and a link to an electronic version of the prefinal YDQ-spine. Local teachers distributed the electronic YDQ-spine to children aged 9-12 years. Descriptive statistics and item characteristics were carried out. Item reduction was performed using partial interitem correlations (scrutinising correlations>0.3) and factor analyses (items loading>0.3 were retained) to eliminate redundant items and to obtain insight into the structure of the questionnaire.

RESULTS

A total of 768 children from 20 schools answered of the questionnaire and 280 fulfilled the inclusion criteria of having back and/or neck pain (36%). Multisite pain was reported by 38%. Partial interitem correlations and factor analyses resulted in elimination of four items which were considered redundant leaving 24 items in the final YDQ-spine with an optional section on what matters most to the child. The factor analyses showed a two-factor structure with a physical component (13 items) and a psychosocial component (10 items) in addition to one standalone item (sleep).

CONCLUSION

The YDQ-spine is a novel questionnaire with satisfactory content validity measuring physical and psychosocial components (including sleep disturbances) of spinal pain in children aged 9-12 years. It also offers an optional section on what matters most to the child allowing targeted care in clinical practice.

Thoracic Spine Pain in High School Adolescents: A One-Year Longitudinal Study

Thoracic spine pain (TSP) is a common condition in the general adult population, with a similar prevalence in children and adolescents. An in-depth understanding of risk factors can assist in the identification of potential targets for effective prevention strategies. This study aimed to determine the incidence of TSP and ongoing TSP and identify its predictors in high school students. This longitudinal study was conducted in 2017 (baseline-T1), and follow-up surveys were completed in 2018 (T2). The variable "thoracic spine pain" was observed using the Nordic questionnaire, and associated variables were observed through the Baecke questionnaire and the Strengths and Difficulties Questionnaire. Statistical association methods were used for bivariate and multivariate logistic regression analysis. Among the participants, the one-year prevalence (ongoing TSP) was 38.4%, and the one-year incidence (new TSP) was 10.1%. Significant risk factors for ongoing TSP were adolescent females (RR = 2.14), in the age group of 15 to 18 years (RR = 1.41), clinical mental health problems (RR = 3.07), borderline mental health problems (RR = 2.02), mental health problems, sitting while using a tablet (RR = 1.93), distance of the eye from cell phone screen of or more than 20 cm (RR = 1.69), distance of the eye from the PC screen of or more than 30 cm (RR = 1.53), cell phone mobile use duration of or more than 3 h (RR = 1.60), tablet use time of or more than 3 h (RR = 2.08), and semi-lying prone position while using the cell phone (RR= 1.47), and these were also significant predictors of TSP episodes. Significant risk factors for new TSP were adolescent female sex (RR = 1.88), level, clinical mental health problems (RR = 4.26), borderline mental health problems (RR = 2.07), semi-lying prone position while using cell phone (RR = 1.71) or tablet (RR = 2.31), and mobile phone use duration equal to or greater than 3 h (RR = 1.72). We conclude that there is a high prevalence of TSP in high school students, which is associated with the female sex, mental health problems, and use of electronic devices for an inappropriate duration in an improper position.

No associations between C-reactive protein and spinal pain trajectories in children and adolescents (CHAMPS study-DK)

Preliminary evidence points to a link between C-reactive protein (CRP) and spinal pain in adults. However, there is a paucity of research in younger populations. Therefore, we aimed to determine associations between CRP and spinal pain in childhood and adolescence. We identified trajectories of spinal pain from childhood to adolescence and investigated the associations between CRP and trajectory subgroups. Six- to 11-year-old children from 13 primary schools, were followed from October 2008 and until 2014. High-sensitivity CRP collected at baseline (2008) was measured using serum samples. The outcome was the number of weeks with non-traumatic spinal pain between November 2008 and June 2014. We constructed a trajectory model to identify different spinal pain trajectory subgroups. The associations between CRP and spinal pain trajectory subgroups were modelled using mixed-effects multinominal logistic regression. Data from 1556 participants (52% female), with a mean age of 8.4 years at baseline, identified five spinal pain trajectory subgroups: "no pain" (55.3%), "rare" (23.7%), "rare, increasing" (13.6%), "moderate, increasing" (6.1%), and "early onset, decreasing" (1.3%). There were no differences in baseline high-sensitivity CRP levels between spinal pain trajectory subgroups. Thus, the heterogeneous courses of spinal pain experienced were not defined by differences in CRP at baseline.

The Effect of comprehensive rehabilitation on Lithuanian adolescent's nonspecific low back pain, depending on the duration: Nonrandomized single-arm trial

OBJECTIVE

To determine pain and functional changes during comprehensive rehabilitation (CR) in adolescents with nonspecific low back pain (NLBP), and to determine the optimal CR duration.

METHODS

The study included 106 adolescents (39 boys [36.8%], 67 girls [63.2%]), 14 to17 years old, with the following inclusion criteria: duration of NLBP for at least 12 weeks; conservative NLBP treatment was effectless; pain intensity using the visual analogue pain scale (VAS) ≤ 7 points; disrupted daily activities; ability to understand and answer the questions; written consent to participate voluntarily in the study. The pain was assessed using the VAS scale, functional changes were assessed using the Oswestry Disability Index (ODI), 12-Item Short Form Survey, Hospital Anxiety and Depression Scale (HAD), and physical functional capacity and proprioception (Proprio) were assessed using an isokinetic dynamometer. The participants performed a comprehensive pain rehabilitation program consisting of physiotherapy, TENS, magnetotherapy, lumbar massage, and relaxing vibroacoustic therapy. The active CR cycle lasted for 22 sessions (with intermediate measurements after 5 and 16 sessions), after which we performed passive observation for another half a year. Five measurements were performed.

RESULTS

Pain, functional assessment, and physical capacity were improved with CR. Statistically significant improvement became apparent after 5 CR sessions, but statistical and clinical significance became apparent after 16 CR sessions. In the distant period, after the completion of CR, neither statistical nor clinical changes occurred.

CONCLUSIONS

CR is effective in reducing pain, and improving functional state and physical capacity quickly and reliably in 16 CR sessions, which is sufficient to obtain clinically satisfactory CR results. Good results were achieved during CR and neither improved nor deteriorated spontaneously in the distant period. This study shows a possible mismatch between NLBP intensity and impaired functional state in adolescents.

The intervertebral disc during growth: Signal intensity changes on magnetic resonance imaging and their relevance to low back pain

Life-time prevalence of low back pain (LBP) in children and adolescents varies from 7% to 72%. Disc changes on magnetic resonance imaging (MRI) have been reported in up to 44% of children with earliest observations around pre-puberty. In this longitudinal cohort study, our objective was to determine the natural history of disc changes from childhood to early adulthood, and the possible association of these changes to LBP. Healthy 8-year-old schoolchildren were recruited for this longitudinal study consisting of a semi-structured interview, a clinical examination, and an MRI investigation at the age of 8-9 (Y8), 11-12 (Y12) and 18-19 (Y19) years. The interview inquired about LBP without trauma. T2-weighted sagittal MRI of the lumbar spine was acquired. Life-long prevalence of LBP was determined, and the disc signal intensity (SI) at the three lowest lumbar levels was assessed both visually using the Schneiderman classification (Bright-Speckled-Dark), and digitally using the disc to cerebrospinal fluid -SI ratio. Possible associations between SI changes and LBP were analyzed. Ninety-four of 208 eligible children were included at Y8 in 1994, 13 and 23 participants were lost to follow-up at Y12 and Y19, respectively. Prevalence of LBP increased after the pubertal growth spurt reaching 54% at Y19. On MRI, 18%, 10% and 38% of participants had disc SI changes at Y8, Y12 and Y19, respectively. No significant associations between self-reported LBP and either qualitative or quantitative disc SI changes were observed at any age. Life-time prevalence of LBP reached 54% by early adulthood. Disc SI changes on MRI traditionally labeled as degenerative were seen earlier than previously reported. Changes in disc SI were not associated with the presence of LBP in childhood, adolescence or early adulthood.

Narrative review of the prevalence and distribution of acute pain in children in the self-care setting

Acute pain among children is common, yet it may be underestimated and undertreated if the pain is not recognized. Assessing and managing pediatric pain can be complicated, and as such, measuring the prevalence of acute pain in children can be challenging. We sought to provide a consolidated review of the available data on the prevalence of commonly occurring acute pain in children in the self-care setting. An extensive literature search was performed to determine the prevalence of acute pain at multiple bodily locations in children aged between 3 months and 18 years. We considered the influence of age, sex, and sociodemographic factors on prevalence estimates. We also sought to identify some of the challenges involved in assessing and managing pediatric pain, thus shedding light on areas where there may be clinical and medical unmet needs. In general, a high prevalence of acute pain in children was detected, particularly headache, menstruation-related pain, and dental and back pain. Older age, female sex, and lower socioeconomic status were associated with increased pain prevalence. Risk factors were identified for all pain types and included psychological issues, stress, and unhealthy lifestyle habits. Owing to the heterogeneity in study populations, the prevalence estimates varied widely; there was also heterogeneity in the pain assessment tools utilized. The paucity of information regarding pain prevalence appears to be out of proportion with the burden of acute pain in children. This could indicate that clinicians may not be equipped with an optimal pain management strategy to guide their practice, especially regarding the use of developmentally appropriate pain assessment tools, without which prevalence data may not be captured. If acute pain is not accurately identified, it cannot be optimally treated. Further investigation is required to determine how the information from prevalence studies translates to the real-world setting.

Neuromechanical Responses to Spinal Manipulation and Mobilization: A Crossover Randomized Clinical Trial

OBJECTIVE

The purpose of this study was to compare the immediate effect of spinal manipulation (SMa) and spinal mobilization (SMo) on muscular responses, spinal stiffness, and segmental spinal pressure evoked pain in a population of participants with chronic middle back pain (MBP).

METHODS

In a crossover randomized trial, 2 experienced chiropractors assessed whether volunteers were eligible for the protocol according to a list of specific inclusion and exclusion criteria. Individuals with MBP participated in 2 experimental sessions within 72 hours. During the first session, participants randomly received a SMa or SMo delivered by an apparatus using a servolinear motor. During the second session, the other modality was delivered. Spinal stiffness and pressure-provoked pain intensity outcomes were assessed before and after each therapy, and muscular responses were recorded during the treatment using surface electromyographic sensors. Signed-rank Wilcoxon tests for muscular responses and generalized model for repeated measure for spinal stiffness and pressure-provoked pain were used for statistical analyses.

RESULTS

Among the 32 potential participants, 26 (mean age 29.9 [±9.14], 15 women) completed both sessions. Between-group differences were observed for the muscular response amplitude (P < .001), and indeed the normalized RMS muscular response was found to be higher during SMa than SMo. Similar results were observed for pressure-provoked pain intensity at the level of therapeutic modality application (P = .002) as a higher decrease in pain was found after SMa (47.9 [±22.8] to 36.6 [±23.7]) compared with SMo (47.2 [±23.2] to 45.5 [±24.3]). No between-group differences were found for spinal stiffness change, nor for terminal (P = .08) and global spinal stiffness (P = .06).

CONCLUSION

In a controlled environment, spinal manipulation and mobilization generated different muscle responses and had different immediate effects on pressure-provoked pain intensity for subjects with MBP.

The relationships between physical activity, lumbar multifidus muscle morphology, and low back pain from childhood to early adulthood: a 12-year longitudinal study

We investigated the longitudinal associations between physical activity (PA), lumbar multifidus morphology, and impactful low back pain (LBP) in young people. Nine-year-old children were recruited from 25 primary schools and followed up at age 13, 16, and 21 years. We measured PA with accelerometers at age 9, 13, and 16; quantified patterns of lumbar multifidus intramuscular adipose tissue (IMAT) change from 13 to 16 years using magnetic resonance imaging; and recorded LBP and its impact with standardised questionnaires and interviews. Associations were examined with crude and adjusted logistic or multinomial models and reported with odds ratios (OR) or relative risk ratios (RRR). We included data from 364 children (mean[SD] age = 9.7[.4] years). PA behaviour was not associated with LBP. Having persistently high IMAT levels at age 13 and 16 was associated with greater odds of LBP (OR[95% CI] = 2.98[1.17 to 7.58]). Increased time in moderate and vigorous intensity PA was associated with a lower risk of higher IMAT patterns (RRR[95% CI] = .67[.46 to .96] to .74[.55 to 1.00]). All associations became non-significant after adjusting for sex and body mass index (BMI). Future studies investigating the relationships between PA behaviour, lumbar multifidus IMAT, and impactful LBP should account for potential confounding by sex and BMI.

Chronic backpain among adolescents in Denmark: trends 1991-2018 and association with socioeconomic status

Chronic backpain among adolescents is important because the prevalence is high, above 10%, and more than 10% of all adolescents experience impacts on important day-to-day activities. Chronic backpain tracks into adulthood and is associated with several health problems. The objective was to study trends in the prevalence of chronic backpain among adolescents 1991-2018, to examine the association with socioeconomic status (SES), and whether this association changed over time. The study used data from eight comparable cross-sectional school surveys of nationally representative samples of 11-15-year-olds in 1991, 1994, 1998, 2002, 2006, 2010, 2014, and 2018, which constitute the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study. The participation rate was 74.6% of the eligible study population, n = 29,952. Chronic backpain was defined as self-reported backpain daily or several days a week during the last 6 months. The prevalence of chronic backpain was 11.1%, significantly increasing from 8.9% in 1991 to 11.7% in 2018. The OR for chronic backpain was 1.20 (95% CI: 1.10-1.31) in middle, and 1.56 (95% CI: 1.41-1.73) in low compared to high SES. Sensitivity analyses with two other cut-points for backpain frequency showed similar associations.Conclusion: Chronic backpain is common among adolescents and the prevalence increased from 1991 to 2018. The prevalence was highest in lower SES families. We recommend increased efforts to prevent chronic backpain. What is Known: • Chronic backpain among adolescents is common, has a high burden of disability, is associated with several health problems, and tracks into adulthood. What is New: • The prevalence of chronic backpain among adolescents in Denmark increased from 8.9% in 1991 to 11.7% in 2018. • The prevalence was highest among adolescents from lower SES families.

Prevalence and Characteristics of Back Pain in Children and Adolescents from the Region of Murcia (Spain): ISQUIOS Programme

Puberty is a vulnerable period for musculoskeletal disorders due to the existence of a wide inter-individual variation in growth and development. The main objective of the present study was to describe the prevalence of back pain (BP) in the past year and month in school-aged children according to sex, age, maturity status, body mass index (BMI) and pain characteristics. This study involved 513 students aged between 9 and 16 years. Anthropometric measures were recorded to calculate the maturity stage of the students using a regression equation comprising measures for age, body mass, body height, sitting height and leg length. An ad hoc questionnaire composed of eight questions was used to describe BP prevalence in school-aged children. The results showed that the prevalence of BP in school-aged children was observed in 35.1% over the last year (45% boys and 55% girls), and 17.3% (40.4% boys and 59.6% girls, with an association found between female sex and BP) in the last month. The prevalence of back pain in the past year and month was higher the older the students were, or the more pubertal development they had experienced. The prevalence of BP in the last year was also higher in those with overweight or obesity. After adjustment for sex, there was an association between BP and older age and higher BMI in boys and an association between BP and higher pubertal development in girls. In summary, the present study showed that the prevalence of BP was related to the maturity stage and weight of the participants, with different prevalence patterns found according to sex.

Reducing the Weight of Spinal Pain in Children and Adolescents

Spinal pain in adults is a significant burden, from an individual and societal perspective. According to epidemiologic data, spinal pain is commonly found in children and adolescents, where evidence emerging over the past decade has demonstrated that spinal pain in adults can, in many cases, be traced back to childhood or adolescence. Nevertheless, very little focus has been on how to best manage spinal pain in younger age groups. The purpose of this article is to put the focus on spinal pain in children and adolescents and highlight how and where these problems emerge and how they are commonly dealt with. We will draw on findings from the relevant literature from adults to highlight potential common pathways that can be used in the management of spinal pain in children and adolescents. The overall focus is on how healthcare professionals can best support children and adolescents and their caregivers in making sense of spinal pain (when present) and support them in the self-management of the condition.

Translation and validation of the German version of the Young Spine Questionnaire

Background

Back pain in childhood and adolescence increases the risk for back pain in adulthood, but validated assessment tools are scarce. The aim of this study was to validate the Young Spine Questionnaire (YSQ) in a German version (G-YSQ) in children and adolescents.

Methods

Children and adolescents between 10 and 16 years (N = 240, 166 females, mean age = 13.05 ± 1.70 years), recruited in chiropractic practices and schools, completed the G-YSQ (translated according to scientific guidelines) and the KIDSCREEN-10 (assessing health-related quality of life) at three time points. Test-retest reliability was determined calculating intraclass correlation coefficients [ICC_(3,1)] using start and two week-data. Construct validity was investigated testing a priori hypotheses. To assess responsiveness, the patients additionally filled in the Patient Global Impression of Change (PGIC) after three months and the area under the curve (AUC) of receiver operating curves was calculated.

Results

The ICC_(3,1) was 0.88 for pain intensity and pain frequency, indicating good reliability, 0.68 for week prevalence and 0.60 for point prevalence, indicating moderate reliability. Pain intensity, frequency and prevalence differed between patients and controls (p < 0.001) and, except point prevalence, between older (> 12 years) and younger control participants (p < 0.01). Health-related quality of life of participants with severe pain (in one or several spinal regions) was lower (KIDSCREEN-10, total score: F(4,230) = 7.26, p < 0.001; KIDSCREEN-10, self-rated general health: H(4) = 51.94, p < 0.001) than that of participants without pain or with moderate pain in one spinal region. Thus, altogether these findings indicate construct validity of the G-YSQ. The AUC was 0.69 (95 % CI = 0.57–0.82) and 0.67 (95 % CI = 0.54–0.80) for week and point prevalence, respectively, indicating insufficient responsiveness of the G-YSQ.

Conclusions

Apart from the question on point prevalence, construct validity and sufficient test-retest reliability was shown for the G-YSQ. However, its responsiveness needs to be improved, possibly by asking for pain frequency during the last week instead of (dichotomous) week prevalence.

Trial registration

ClinicalTrials.gov, NCT02955342, registered 07/09/2016, https://clinicaltrials.gov/ct2/results?cond=&term=NCT02955342&cntry=CH&state=&city=Zurich&dist=.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02804-y.

Daily activity limitations and physical activity encouragement influence adolescents seeking health care for neck and low back pain

BACKGROUND

Understanding the factors associated with care-seeking behaviour in adolescents with spinal pain will inform health care professionals and guide a better decision-making.

OBJECTIVE

To identify factors, including parents' habits and behaviour, related to care-seeking in adolescents with neck pain or low back pain (LBP).

STUDY DESIGN

A cross-sectional study.

METHODS

Adolescents between 10 and 17 years were randomly recruited from public schools. The proportion of adolescents with neck or LBP and those who had sought care for neck and LBP were assessed with the Nordic Musculoskeletal questionnaire. Daily activity limitation and the frequency of parents' habits and behaviour were collected using self-reported questions. Logistic regression analyses were performed to investigate if the following factors were associated with adolescents' care-seeking behaviour due to neck or LBP: daily activity limitations, physical activity (PA) domains, items of the social support scale.

RESULTS

The prevalence of adolescents reporting neck or LBP was 31.4% (318 out of 1011). Of these, 35.8% (n = 114) sought care for neck or low back pain. Activity limitations related to neck or LBP (OR: 5.83, 95% CI: 3.46 to 9.84), higher PA levels at school (OR: 1.67, 95% CI: 1.02 to 2.75), and PA encouragement (OR: 2.73, 95% CI: 1.27 to 5.85) were associated with care-seeking in adolescents with neck or LBP.

CONCLUSION

Adolescents with activity limitations due to neck or LBP, higher PA levels at school and encouraged by parents or friends to practice PA were more likely to seek care for their neck or LBP.

Musculoskeletal consultations from childhood to adulthood: a longitudinal study

BACKGROUND

The Global Burden of Disease reports indicate that musculoskeletal conditions are important causes of disability worldwide. Such conditions may originate in childhood, but studies investigating changes longitudinally and from childhood to adulthood are infrequent.

METHODS

Nine birth cohorts of children (starting at ages 7-15 years) were followed. Participants were identified from Consultations in Primary Care Archive, an electronic health record database of 11 English general practices. Musculoskeletal consultation prevalence figures were calculated, and reasons for consultation evaluated.

RESULTS

Annual musculoskeletal consultation prevalence was similar across cohorts for each age. Prevalence increased from 6 to 16% between ages 7 and 22 and was higher in males until age 15, after which prevalence was higher in females. Pain was the most common reason for consultation. Back pain consultations increased from 1 consultation/1000 7 year olds to 84 consultations/1000 22 year olds. Lower limb pain consultations increased from 21 consultations/1000 7 year olds to 56 consultations/1000 22 year olds.

CONCLUSIONS

This study shows that from childhood, individuals are more likely to seek healthcare for musculoskeletal consultations as they age, but rates are not increasing over time. Changes in consultation rates by age, gender and pain region may inform studies on the development of chronic musculoskeletal pain over the life-course.

School-based interventions to improve spinal health of children and adolescents: a systematic review

Background: The prevalence of spinal pain is high in children and adolescents attending school. There are no evidence-based guidelines to promote spinal health (spinal pain and spinal well-being) in schoolsPurpose: This study aimed to 1) determine the usefulness of school-based interventions in promoting spinal health in children and adolescents and 2) synthesize the evidence in a user-friendly infographic.Methods: A search was performed across eight databases from the inception of the databases to August 2019 for full-text English-language articles which assessed the effect of school-based interventions on spinal health. Spinal health outcomes included pain limited to the spinal area including lower back, upper back, neck, and neck-shoulder pain, and impacts of spinal pain (e.g., absenteeism from school). Studies were appraised for methodological quality (PEDro scale and Johanna Briggs Institute checklist). The usefulness of interventions was based on meta-analyses; calculated effect size; the number of spinal health outcomes; and the direction of the (summary) effect of the intervention.Results: Twenty-two studies were included. Four interventions were identified: 1) exercise; 2) education; 3) the combination of exercise and education; and 4) furniture.Conclusion: School-based exercise is most useful to promote spinal health in the short term, followed by a combination of exercise and education, and education-only interventions.

National Estimates of Chronic Musculoskeletal Pain and Its Treatment in Children, Adolescents, and Young Adults in the United States: Data From the 2007-2015 National Ambulatory Medical Care Survey

OBJECTIVES

To portray physician office visits by young Americans with chronic musculoskeletal pain; to describe clinical management in this group; and to explore factors associated with prescribed treatments.

STUDY DESIGN

Using nationally representative data of ambulatory physician office visits (2007-2015 United States National Ambulatory Medical Care Survey), we identified and cross-sectionally analyzed visits by persons <25 years of age diagnosed with a chronic musculoskeletal pain condition.

RESULTS

There were 28.6 million visits over the 9-year period for chronic musculoskeletal pain for persons <25 years of age, (average 3.2 million visits/year). There were more visits among older age groups, female persons, non-Hispanic White ethnicity/race, and those with more medical visits in the past year. Nonopioid medications were the most frequent treatments in all age groups (range 38.5%-48.8%). Opioids were rarely prescribed for children and adolescents but were prescribed in 23% of visits among young adults (18-24 years of age). Health education and counseling were consistently prescribed at 20% of visits and physical therapy (range 9.5%-23.7%) and other treatments were less frequently prescribed. Age, sex, payment source, and physician specialty were associated with various treatments.

CONCLUSION

There were over 3 million annual visits for chronic musculoskeletal pain in young Americans; these increased with age. Pharmacologic treatment is used more than nonpharmacologic approaches, and opioid prescribing in the 18- to 24-year-old age group approaches estimates in adults with musculoskeletal pain.

Sagittal standing spinal alignment and back pain in 8 to 12-year-old children from the Region of Murcia, Spain: The ISQUIOS Program

BACKGROUND

The child's spine shows changes in posture and balance of its curvatures during growth and musculoskeletal spinal conditions are likely to develop, such as back pain (BP).

OBJECTIVE

The purposes of this study were (a) to describe the sagittal spinal alignment in a relaxed standing position and (b) to analyze its association with BP among 8 to 12-year-old children.

METHODS

This was a cross-sectional study. A total of 731 elementary schoolchildren (379 girls and 352 boys), from 16 Spanish schools, participated. An unilevel inclinometer was used to quantify the sagittal spinal curvatures (thoracic and lumbar) in a relaxed standing position. Sagittal spinal morphotype was analyzed by sex, age, weight, height, and BMI. Children's parents or legal guardians filled in a questionnaire according to the children's responses about the BP suffered in the previous week and the preceding year.

RESULTS

The mean angular value of thoracic kyphosis was 36.08 ± 8.99∘ and significantly higher in males than in females (p= 0.036). In contrast, the mean value of lumbar lordosis was 32.11 ± 7.46∘, being higher in females than in men (p< 0.01). The thoracic curve tends to increase by age (p= 0.003). Children who had low back pain (LBP) in the previous week had a significantly greater lumbar curve (35.88 ± 8.20∘) than those who did not have LBP in the preceding week (32.24 ± 7.30∘). The angle for lumbar curvature was a small predictor of LBP occurrence in the assessed children (OR = 1.082 [small]; 95% CI = 1.009-1.160, p= 0.028).

CONCLUSIONS

To conclude, almost 3/4 of the students were classified with normal thoracic kyphosis; however, 27.36% of the students had thoracic hyperkyphosis. Lumbar hyperlordosis was identified in 9.05% of the students, and was 2.5 times more frequent in girls. The lumbar curvature was a small predictor of LBP occurrence in the assessed children and the angle of lumbar curvature that most accurately identified individuals at risk of developing LBP was determined to be 33∘. The results of this study indicate the need to assess sagittal spinal curvatures at school during development ages.

Mother-reported pain experience between ages 7 and 10: A prospective study in a population-based birth cohort

BACKGROUND

Trajectory studies suggest considerable stability of persistent or recurrent pain in adolescence. This points to the first decade of life as an important aetiologic window for shaping future pain, where the potential for prevention may be optimised.

OBJECTIVES

We aimed to quantify changes in mother-reported pain experience in children between ages 7 and 10 and describe clusters of different pain experiences defined by complementary pain features.

METHODS

We conducted a prospective study using data from 4036 Generation XXI birth cohort participants recruited in 2005-06. Pain history was reported by mothers at ages 7 and 10 using the Luebeck pain screening questionnaire. We tracked changes in six pain features over time using relative risks (RRs) and their 95% confidence intervals (95% CIs). Clusters were obtained using the k-medoids algorithm.

RESULTS

The risk of severe pain at age 10 increased with increasing severity at age 7, with RRs ranging from 2.18 (95% CI 1.90, 2.50) for multisite to 4.43 (95% CI 3.19, 6.15) for high frequency pain at age 7. A majority of children (59.4%) had transient or no pain but two clusters included children with stable recurrent pain (n = 404, 10.2% of the sample). One of those (n = 177) was characterised by higher probabilities of multisite pain (74.6% and 66.7% at ages 7 and 10, respectively), with psychosocial triggers/contexts (59.3% and 61.0%) and daily-living restrictions (72.2% and 84.6%). Most children in that cluster (58.3%) also self-reported recent pain at age 10 and had more frequent family history of chronic pain (60.5%).

CONCLUSIONS

All pain features assessed tracked with a positive gradient between ages 7 and 10, arguing for the significance of the first decade of life in the escalation of the pain experience. Multisite pain and psychosocial attributions appeared to be early markers of more adverse pain experiences.

The Epidemiology of Back Pain in American Children and Adolescents

STUDY DESIGN

Cross-sectional survey.

OBJECTIVE

To determine the prevalence of back pain in American children and adolescents, with a focus on anatomic region, duration, severity, and treatment patterns, and to investigate for any predictive variables.

SUMMARY OF BACKGROUND DATA

No study has examined the prevalence of back pain in American children and adolescents in the last 15 years. Because the prevalence of back pain varies greatly by country and year of investigation, previous studies are not generalizable.

METHODS

A United States epidemiologic cross-sectional survey-based investigation was performed in children and adolescents ages 10 and 18 years old, equally split by age and sex, and representing census-weighted distributions of state of residence, race/ethnicity, and health insurance status. Prevalence of back pain was evaluated and described.

RESULTS

In total, 1236 (33.7%) participants reported experiencing back pain within the last year and 325 (8.9%) reported severe back pain within the last year. Prevalence of back pain increased with age and was significantly more common in females, P < 0.001 for both. Treatment for back pain was sought by 505 (40.9%) of the participants with pain, of which physical therapy was the most common. Invasive procedural treatment (e.g., injections, surgery) were rare and comprised only 61 (1.6%) of study participants. In addition, government insurance and lack of insurance coverage was associated with low treatment seeking behavior compared to private insurance users (P = 0.010 and P = 0.006, respectively).

CONCLUSION

Despite how commonly it presents, the majority of young patients with back pain do not report procedural treatment such as injections or surgery. However, because many American children and adolescents seek treatment, future research on the etiology, treatment, and prevention of back pain in children and adolescents is essential to reducing a common and financially demanding problem.

LEVEL OF EVIDENCE

4.

Relationship between frontal knee position and the degree of thoracic kyphosis and lumbar lordosis among 10-12-year-old children with normal body weight

INTRODUCTION

Incorrect positioning of the body in space increases the tension of the myofascial tissue and overloads the skeleton. It is important to look for factors that affect the deterioration of body posture that could be eliminated. Understanding the interrelationship between the positioning of individual body segments should be the key knowledge for those involved in the prevention and correction of faulty body posture. The study aimed to determine the relationship between the degree of physiological curvatures of the spine and the incidence of incorrect knee position.

MATERIALS AND METHODS

The study involved 685 children aged 10-12. Body height, weight and BMI were measured and calculated. The degree of thoracic kyphosis and lumbar lordosis was assessed using the Zebris Pointer ultrasound system. Valgus and varus knees were diagnosed in an upright position based on the intermalleolar distance with knees together, and intercondylar distance with the feet placed together. The statistical analysis uses descriptive statistics, the Mann-Whitney U test (comparison of girls and boys), the Kruskal-Wallis test, the Tukey's post hoc test (comparison of variables in participants with correct, varus and valgus knees) and Spearman's rank correlation coefficient (the relationship between the position of the spine and knees).

RESULTS

The examined girls were heavier than the boys and had higher BMI. Spine deformities and incorrect knee position are common among 10-12-year-old children. The girls and boys differed significantly in the spine shape in the sagittal plane and the intermalleolar distance. Round lumbar lordosis is more characteristic for girls, and for boys, round thoracic kyphosis. For both genders, valgus knees occur more often than varus knees and coexist with decreased thoracic kyphosis. The rounder the thoracic kyphosis, the greater distance between the knees and the smaller distance between ankles.

CONCLUSIONS

The frontal knee position significantly correlated with the depth of thoracic kyphosis.

Factors associated with non-specific low back pain in children aged 10-12 from Bucaramanga, Colombia: A cross-sectional study

BACKGROUND

There are no Colombian studies published that assess non-specific low back pain (NSLBP) risk factors in children.

OBJECTIVE

To determine the factors associated with NSLBP in 73 children (19.2% girls) aged 10-12 years in one military school in Bucaramanga, Colombia.

METHODS

A questionnaire was used to obtain information of risk factors. Subsequently, children's weight and height were measured. The backpack was weighed at the beginning of each day from Monday to Friday. Crude and adjusted prevalence ratios were calculated, with their respective 95% confidence interval (CI).

RESULTS

The one-month prevalence of NSLBP was 39.7% (95% CI 28.4-51.9). In the multivariate analysis, carrying backpacks wearing between 12% and 20% of body weight, having a perception that the backpack is very heavy, and being a passive smoker increase the likelihood of NSLBP, while being 11-year-old compared to 10-year-old decreases the likelihood of having NSLBP, adjusted for gender, body mass index, and history of LBP in parents.

CONCLUSIONS

High prevalence of low back pain was found in children between 10 and 12 years old. The study of the decisive factors of low back pain is important to identify children at risk, as well as to develop efficient primary prevention programs.

Potential risk factors and triggers for back pain in children and young adults. A scoping review, part I: incident and episodic back pain

Background

The one-month prevalence of back pain in children and adolescents has been reported at 33, 28 and 48% at ages 9, 13 and 15 respectively. There are many suspected risk factors and triggers of back pain in young people.

Objective

The purpose of this scoping review was to identify potential risk factors and potential triggers for back pain in young people. The purpose of part I was to identify potential risk factors for incident and episodic back pain in young people. Part II included all eligible studies with unclear or mixed types of back pain.

Methods

Due to the vast number of studies on "risk factors" for back pain, a two-part scoping review of the literature was chosen as the best way to summarise the evidence. We adhered to the PRISMA-ScR guideline for scoping reviews. General potential risk factors and triggers for back pain in children and young adults (≤ 24 years) were included, incorporating physical, environmental, and/or physiological factors. A search was conducted using PubMed and Cochrane databases from inception to September 2018, limited to the English language. Within part I, and because of their importance, only the results of the studies that investigated risk factors of incident back pain and back pain episodes are presented.

Results

The search identified 7356 articles, of which 91 articles were eligible for this scoping review. The majority of the eligible articles had an unclear definition of back pain (results presented in scoping review part II). There were 7 inception cohort studies included and 1 cohort study that met the criteria for part I. The most consistent risk factors for incident and episodic back pain are female sex and older age.

Conclusion

Due to inconsistent ways of reporting on the type of back pain, no definitive risk factor for back pain has been identified. In general, females often report more symptoms, also for other diseases, and older age is not a useful risk factor as it merely indicates that the onset may not be in childhood. Clearly, the time has come to study the causes of back pain from different angles.

Potential risk factors and triggers for back pain in children and young adults. A scoping review, part II: unclear or mixed types of back pain

Background

Back pain is a global problem in terms of disability and financially, with a large burden both to the individual and to society. Back pain was previously believed to be uncommon in children. However, there is a growing body of evidence that this is not the case.

Objective

Part I of this scoping review studied risk factors of incident and episodic back pain. In this part II we aimed to identify all risk factors and triggers with unclear or mixed type back pain in young people and to identify any gaps in the literature.

Methods

A scoping review design was selected to summarise the evidence, as there are many studies on "risk factors" for back pain. The scoping review followed the PRISMSA-ScR guidelines. We considered all studies that tested potential risk factors and triggers for thoracic and/or lumbar spine pain, in children, adolescents, and young adults (≤ 24 years). PubMed and Cochrane databases were searched from inception to September 2018, to identify relevant English language articles. The results regarding potential risk factors were separated into temporal precursors and bidirectional risk factors and the studies were classified by study design.

Results

Our comprehensive search strategy identified 7356 articles, of which 83 articles were considered eligible for this review (part II). There were 53 cross-sectional studies and 30 cohort studies. Potential risk factors for back pain were: female sex, older age, later pubertal status, positive family history of back pain, increased growth, and a history of back pain, most of which are temporal precursor variables. There was limited research for the illness factors, spinal posture, and muscle endurance in the development of back pain.

Conclusion

Many of the included studies approached risk factors in similar ways and found factors that were associated with back pain but were not obvious risk factors as causality was uncertain. Future research should be more rigorous and innovative in the way that risk factors are considered. This could be through statistical approaches including cumulative exposures, or longitudinal approaches including multi-trajectory methods. Additionally, data on proposed risk factors should be collected before the onset of back pain.

Back Pain and Knowledge of Back Care Related to Physical Activity in 12 to 17 Year Old Adolescents from the Region of Murcia (Spain)

Knowledge on back care is important to prevent back problems. The purpose of this study was to a) describe back pain and knowledge on back care related to physical activity in adolescents and b) determine the association between these two factors. This was a cross-sectional study. A total of 276 students (aged from 12 to 17 years old), from three Spanish public secondary schools, had to complete a survey about back pain and another one about their knowledge on back care related to physical activity. The results showed a mean score of 2.54 ± 1.85 (out of 10), and 90.58% of students failed the knowledge test. Those who suffered from back pain in the week before scored higher (2.91 ± 1.66) than non-sufferers (2.42 ± 1.90), with statistically significant differences (Z = −2.109; p = 0.035; r = 0.127), although with no academically relevant differences. Finally, despite the relationship between a higher mean score in the knowledge test and back pain within the previous week, it has been found that there was not a significant association because most of the students got very low scores in the knowledge test. It also shows an important lack of knowledge about physical activity for back care in adolescents.

Cortical dynamics of sensorimotor information processing associated with balance control in adolescents with and without idiopathic scoliosis

OBJECTIVE

This study aims at examining the cortical dynamics of sensorimotor information processing related to balance control in participants with adolescent idiopathic scoliosis (AIS) and in age-matched controls (CTL).

METHODS

Cortical dynamics during standing balance control were assessed in 13 girls with AIS and 13 age-matched controls using electroencephalography. Time-frequency analysis were used to determine frequency power during ankle proprioception alteration (ankle tendons co-vibration interval) or reintegration of ankle proprioception (post-vibration interval) with or without vision.

RESULTS

Balance control did not differ between groups. In the co-vibration interval, a significant suppression in alpha (8-12 Hz) and beta (13-30 Hz) band power and a significant increase in theta (4-7 Hz) band power were found respectively in the vision and non-vision condition in the AIS group compared to the CTL group. In the post-vibration interval, significant suppressions in beta (13-30 Hz) and gamma (30-50 Hz) band power were observed in the AIS group in the non-vision condition.

CONCLUSION

Participants with AIS showed brain oscillations differences compared to CTL in the sensorimotor cortex while controlling their balance in various sensory conditions.

SIGNIFICANCE

Future study using evaluation of cortical dynamics could serve documenting whether rehabilitation programs have an effect on sensorimotor function in AIS.

Pubertal development and growth are prospectively associated with spinal pain in young people (CHAMPS study-DK)

PURPOSE

To examine the prospective associations of pubertal development and linear growth with spinal pain frequency and duration in children.

METHODS

We recruited students from 10 public primary schools. Over 42 months, pubertal development was assessed four times and categorized according to Tanner stages 1-5, and height was measured on seven occasions. Occurrences of spinal pain were reported weekly via text messaging. We constructed variables for spinal pain duration (total weeks with pain) and frequency (number of episodes). Potential associations between pubertal development and growth were examined with generalized estimating equations and reported with incident rate ratios (IRRs). All models were adjusted for potential confounders.

RESULTS

Data from 1021 children (53% female; mean [SD] age = 9.4 [1.4] years), with median participation duration of 39 months, were included. Advancing pubertal development was associated with increased spinal pain duration (IRR [95% CI] = 1.90 [1.45, 2.49] to 5.78 [4.03, 8.29]) and frequency of pain episodes (IRR [95% CI] = 1.32 [1.07, 1.65] to 2.99 [2.24, 3.98]). Similar associations were observed for each 1-cm change in height in 6 months with spinal pain duration (IRR [95% CI] = 1.19 [1.15, 1.23]) and frequency (IRR [95% CI] = 1.14 [1.11, 1.17]). The relations between pubertal development and spinal pain, as well as growth and spinal pain, were largely independent.

CONCLUSIONS

In young people, pubertal development and linear growth are likely to be independent risk factors for the development of spinal pain. Pubertal development demonstrates evidence of dose-response in its relationship with spinal pain. This knowledge may assist healthcare providers with clinical decision-making when caring for pediatric patients. These slides can be retrieved under Electronic Supplementary Material.

Trunk muscle strength and lumbo-pelvic kinematics in adolescent athletes: Effects of age and sex

Considering their potential relevance for low-back pain, we investigated trunk muscle strength, sagittal lumbo-pelvic alignment while standing and lumbo-pelvic ratio during trunk flexion in adolescent athletes with regard to the effects of age and sex. Twenty-two early adolescent (EA: 13-15 years, 10 females) and 28 late adolescent (LA: 16-19 years, 14 females) high-level athletes (training duration more than 12 hours per week) participated in the study. We measured trunk extension and trunk flexion moments during maximum voluntary isometric contractions using a dynamometer. Further, we examined lumbo-pelvic kinematics in the upright standing position and during forward trunk bending using two 3-dimensional accelerometers. Using a lineal regression model in which the flexion moment from each participant was used as predictor for the corresponding extension moment, we found higher residuals (P < 0.001) in the EA compared to LA, indicating greater imbalances in the trunk muscle strength in EA. We found a higher lordosis in the upright position, greater pelvic rotation, and greater lordotic posture during the forward bending in females (P < 0.01). These age-related imbalances and sex-related characteristics in lumbo-pelvic kinematics might affect the neuromuscular control of trunk stability and the magnitude of spine loading. We recommend the implementation of specific coordination and stabilization programs for muscle groups that contribute to lumbo-pelvic kinematics and training routines that support a balanced strength development within the trunk muscles in adolescent athletes.

Outcomes research in non-specific low back pain : Knowledge transfer in clinical practice

Objective

The aims of this article are to provide an overview and discuss current concepts and future trends in outcomes research in non-specific low back pain, specifically considering the perspective of patients, patient-reported outcomes and outcome measures as well as to facilitate knowledge transfer into clinical practice.

Review strategy

The breadth of this work and the required brevity of this article were not amenable to a formal approach, such as a systematic literature review or a formal scoping review. Literature sources were identified through medical databases but different sources of information and of various methodologies were also included. Furthermore, outcomes meaningful for patients and examples of outcome measures that are applicable in clinical practice were extracted. Areas for future research were identified and discussed.

Results

Patient-reported outcomes and outcome measures are essential in patient-centered care. The assessment of the patients’ perspective is important to ensure motivation, active involvement, self-management and adherence, especially in non-pharmacological interventions for low back pain. To facilitate the use of outcome measurements for low back pain in clinical practice, future studies should focus on a clinically feasible index, which includes patient-reported as well as clinician-reported or performance-based variables. Relationships between different types of outcomes and outcome measures as well as resource and outcome-based healthcare constitute important topics for future research. New digital technologies can support continuous outcome measurement and might enable new patient-driven models of care.

Conclusion

Active patient involvement is an essential part of non-pharmacological treatment in low back pain and needs to be considered in terms of outcomes and outcome measurement.

Spinal pain is prospectively associated with cardiovascular risk factors in girls but not boys (CHAMPS study-DK)

PURPOSE

To examine the prospective associations between spinal pain exposures and risk factors for cardiovascular disease in children and explore the mediating role of health-related physical activity.

METHODS

Students were recruited from ten public primary schools. Each week from November 2008 to October 2010, parents reported spinal pain occurrences in their children via text messaging. Clustered cardiovascular risk was estimated with a composite score comprising fasting serum triglycerides, homeostasis assessment model-estimated insulin resistance (HOMA-IR), total to high-density lipoprotein cholesterol ratio, and systolic blood pressure. Additional outcomes were fasting serum insulin and glucose concentrations and body mass index categories. Associations were explored with multilevel mixed regression models and reported with beta coefficients (β) and percent difference scores. All models were adjusted for potential confounders.

RESULTS

Data from 1022 children (53% female) with mean ± SD age of 8.4 ± 1.4 years were included. Girls with spinal pain had greater clustered cardiovascular risk (β [95% CI]; percent difference [95% CI] = .41 [.02-.80]; 3.3% [.2-6.4%]) than those without spinal pain. Similar outcomes were observed for log insulin (percent difference [95% CI] = 3.4% [.6-6.2%]) and log HOMA-IR = (percent difference [95% CI] = 3.8% [.4-7.3%]). Remaining associations between spinal pain and cardiovascular risk in girls were nonsignificant. There were no associations between spinal pain and cardiovascular risk in boys. Moderate-to-vigorous-intensity physical activity did not appear to mediate this relationship.

CONCLUSION

These findings suggest a potentially important link between spinal pain and cardiovascular risk in girls that may be independent of health-related physical activity. These slides can be retrieved under Electronic Supplementary Material.

The natural course of low back pain from childhood to young adulthood - a systematic review

Background

Taking the natural course of recurrent and fluctuating low back pain (LBP) seen in longitudinal studies of adults into consideration, the aetiology and development of LBP in children and adolescents also needs to be reflected in a long-term course. Therefore, a systematic critical literature review was undertaken to assess the natural course of LBP in the general population from childhood through adolescence to young adulthood.

Methods

A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL and PsycINFO with synonyms of search terms for 1) low back pain; 2) natural course; 3) cohort study and 4) children. Records in English, German, French, Danish, Swedish, and Norwegian were included. To assess the methodological quality of the studies, the NIH quality assessment checklist for cohort studies was adapted and risk of bias was assessed on a study level. Two authors independently reviewed selected studies, assessed quality, and extracted data. A synthesis of results in relation to the natural course of LBP was created.

Results

Totally, 3373 records were identified, eight articles were included for quality assessment, and finally, four studies of good to fair quality were included for synthesis of results. Indication of three common patterns of LBP were identified across studies and labelled as 1) ´children and adolescents with no LBP or low probability of LBP´ (49 to 53%), 2) ´children and adolescents with fluctuation of LBP´ (16 to 37%) and 3) ´children and adolescents with repeated reporting of LBP´ (< 1 to 10%).

Conclusion

Although methodological heterogeneity, mainly due to different age ranges, an indication of a natural course of LBP was seen across studies. The majority of children and adolescents repeatedly reporting no or low probability of LBP. With recall periods between one week to three months and sampling rates ranging from one to four years, a very low rate repeatedly reported LBP, and approximately one-fifth to one-third of children and adolescents had fluctuating reports of LBP. A need of future research of LBP trajectories with short reporting period lengths and narrower sampling windows in a long-term perspective is emphasized in order to study childhood influences on the development of LBP throughout life.

The association between psychological and social factors and spinal pain in adolescents

Spinal pain, back pain, and/or neck pain begins early in life and is strongly associated with spinal pain in adulthood. Understanding the relationship between psychological and social factors and adolescent spinal pain may be important in both the prevention and treatment of spinal pain in this age group. We aimed to determine if psychological and social factors were associated with spinal pain in a cross-sectional study of a school-based cohort of 1279 Danish adolescents aged 11-13, who were categorized into "any" and "substantial" spinal pain. "Substantial spinal pain" was defined as a lifetime frequency of "sometimes" or "often" and a pain intensity of at least two on the revised Faces Pain Scale. Logistic regression analyses, stratified by sex, were conducted for single and all variables together. Eighty-six percent of participants reported "any spinal pain" and 28% reported "substantial spinal pain". Frequency of psychological and social factors was significantly higher in those with spinal pain compared to those without. As the frequency of psychological and social factors increased, the odds of both "any spinal pain" and "substantial spinal pain" also increased.Conclusion: Psychological and social factors may be important determinants in adolescent spinal pain. What is Known: • Spinal pain begins early in life to reach adult levels by age 18. Spinal pain in adolescence is strongly associated with spinal pain in adulthood. • In adults, psychological and social factors and spinal pain are strongly related; however, this relationship in adolescence is poorly understood. What is New: • Adolescents with spinal pain reported a significantly higher frequency of psychological factors and loneliness and lower levels of pupil acceptance. • Adolescents reporting higher levels of loneliness, lower levels of pupil acceptance, and increased frequency of psychological factors had increased odds of reporting "substantial spinal pain".

Physical risk factors for adolescent neck and mid back pain: a systematic review

Background

Besides low back pain (LBP), also neck pain (NP) and mid back pain (MBP) are common health issues in adolescence. Psychological factors are regarded as main risk factors for spinal pain in adolescence, but recent studies suggest that the importance of physical factors might be underestimated. The purpose of this study was to summarize the results of studies on physical risk factors for adolescent NP and MBP.

Methods

Cross-sectional and prospective English studies on NP and MBP in adolescents aged 10 to 18 were searched by a professional librarian in Medline (OvidSP), Premedline (PubMed), EMBASE, Cochrane, CINAHL, PEDro and PsycINFO up to October 2016. Studies that were restricted to self-report via questionnaires were excluded.

Results

Eight cross-sectional studies could be included in this review. Some aspects of sagittal alignment in sitting (increased lumbar lordosis) and standing (anteroposition of the head, sway-back posture) were associated with NP. Study comparability was impeded by inconsistent definitions of NP and MBP and a wide variety of outcome measures.

Conclusions

This systematic review indicates that prospective studies using a consistent definition of NP and MBP are needed. Such studies might further investigate sagittal alignment in sitting and standing as possible risk factors for NP and MBP in adolescence using a consistent terminology for the outcomes and longitudinal research designs.

Electronic supplementary material

The online version of this article (10.1186/s12998-018-0206-y) contains supplementary material, which is available to authorized users.

Evaluating Short-Term Musculoskeletal Pain Changes in Desk-Based Workers Receiving a Workplace Sitting-Reduction Intervention

This paper explores changes in musculoskeletal pain among desk-based workers over three months of a workplace-delivered, sitting-reduction intervention. Participants (n = 153, 46% female; mean ± SD aged 38.9 ± 8.0 years) were cluster-randomized (n = 18 work teams) to receive an organizational change intervention, with or without an activity tracker. A modified Nordic Musculoskeletal Questionnaire assessed pain intensity (0–9; none–worst possible) in the neck, upper and lower back, upper and lower extremities, and in total. The activPAL3 (7 days, 24 h/day protocol) measured sitting and prolonged sitting in ≥30 min bouts at work. Mixed models adjusting for cluster and intervention arm examined changes in pain (n = 104), and their associations with reductions in sitting and prolonged sitting (h/10 h at work) (n = 90). Changes in pain were nonsignificant (p ≥ 0.05) and small for total pain (−0.06 [95% CI: −0.27, 0.16]) and for each body area (−0.26 [−0.66, 0.15] for upper back to 0.09 [−0.39, 0.56] for lower back). Sitting reduction was associated with reduced lower back pain (−0.84 [−1.44, −0.25] per hour, p = 0.005); other effects were small and non-significant. No substantial average changes in pain were seen; some improvement in lower back pain might be expected with larger sitting reductions. Larger samples and diverse interventions are required for more definitive evidence.

Is Health-related Quality of Life Decreased in Adolescents With Back Pain?

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To evaluate the association between back pain and health-related quality of life (HRQoL) among adolescents.

SUMMARY OF BACKGROUND DATA

The prevalence of back pain has been increasing not only in the adult population but also among children and adolescents. The better knowledge about the association between back pain and health-related quality of life could facilitate the implementation of new intervention strategies on prevention and treatment of back pain.

METHODS

A sample of 350 students from the fifth to ninth grades of one public school in Niterói, Rio de Janeiro, Brazil. Anthropometric measures and information regarding sociodemographic, lifestyle, frequency and intensity of neck (NP), thoracic (TP), and low back pain in the previous month were collected using a personal digital assistant. HRQoL was assessed by KIDSCREEN-27. Multiple linear regression analyses were performed to investigate the association between back pain and HRQoL by sex.

RESULTS

The mean age of participants was 12.7 (±1.6) years. Frequency of NP, TP, and low back pain was 34.3, 27.1, and 13.1%, respectively. The mean intensity of pain was 2.3 (±0.2) for neck, 2.0 (±0.2) for thoracic, and 1.3 (±0.1) for low back pain. The presence of two/three painful sites was reported by 21.7% of the adolescents. The frequency and severity of neck pain were inversely associated with global HRQoL in both the sexes. There is a strong inverse association between the number of painful sites and global HRQoL and domains.

CONCLUSION

The presence and intensity of cervical pain and the number of painful regions were associated with lower HRQoL in adolescents, which is worrying due to the important relationship between back pain in the adolescence and in the adulthood.

LEVEL OF EVIDENCE

3.

Child and adolescent musculoskeletal pain (CAM-Pain) feasibility study: testing a method of identifying, recruiting and collecting data from children and adolescents who consult about a musculoskeletal condition in UK general practice

OBJECTIVES

Test a method of identifying, recruiting and collecting data from children and adolescents who consult their general practitioner about a musculoskeletal condition.

DESIGN

Prospective cohort feasibility study.

SETTING

13 general practices in West Midlands of England.

PARTICIPANTS

Patients aged 8-19 years who consult their general practice about a musculoskeletal condition. Patients were identified via a relevant musculoskeletal Read code entered at the point of consultation.

OUTCOME MEASURES

Feasibility was assessed in terms of study processes (recruitment rates), data collection procedures (duration, response variability), resource utilisation (mail-outs) and ethical considerations (acceptability).

RESULTS

From October 2016 to February 2017, an eligible musculoskeletal Read code was entered on 343 occasions, 202 patients were excluded (declined, n=153; screened not suitable, n=49) at the point of consultation. The remaining 141 patients were mailed an invitation to participate (41.1%); 46 patients responded to the invitation (response rate: 32.6%), of which 27 patients consented (consent rate: 19.1%). Participants mean age was 13.7 years (SD 2.7) and current pain intensity was 2.8 (SD 2.7). All participants completed the 6-week follow-up questionnaire. All participants found the interview questions to be acceptable and would consider participating in a similar study in the future. The majority of general practitioners/nurse practitioners, and all of the research nurses reported to be adequately informed about the study and found the study processes acceptable.

CONCLUSION

The expected number of participants were identified and invited, but consent rate was low (<20%) indicating that this method is not feasible (eg, for use in a large prospective study). Recruiting children and adolescents with musculoskeletal conditions in a primary care setting currently presents a challenge for researchers. Further work is needed to identify alternative ways to conduct studies in this population in order to address the current knowledge gap in this field.

Risk factors of non-specific spinal pain in childhood

PURPOSE

Non-specific spinal pain can occur at all ages and current evidence suggests that pediatric non-specific spinal pain is predictive for adult spinal conditions. A 5-year long, prospective cohort study was conducted to identify the lifestyle and environmental factors leading to non-specific spinal pain in childhood.

MATERIALS AND METHODS

Data were collected from school children aged 7-16 years, who were randomly selected from three different geographic regions in Hungary. The risk factors were measured with a newly developed patient-reported questionnaire (PRQ). The quality of the instrument was assessed by the reliability with the test-retest method. Test (N = 952) and validity (N = 897) datasets were randomly formed. Risk factors were identified with uni- and multivariate logistic regression models and the predictive performance of the final model was evaluated using the receiver operating characteristic (ROC) method.

RESULTS

The final model was built up by seven risk factors for spinal pain for days; age > 12 years, learning or watching TV for more than 2 h/day, uncomfortable school-desk, sleeping problems, general discomfort and positive familiar medical history (χ² = 101.07; df = 8; p < 0.001). The probabilistic performance was confirmed with ROC analysis on the test and validation cohorts (AUC = 0.76; 0.71). A simplified risk scoring system showed increasing possibility for non-specific spinal pain depending on the number of the identified risk factors (χ² = 65.0; df = 4; p < 0.001).

CONCLUSION

Seven significant risk factors of non-specific spinal pain in childhood were identified using the new, easy to use and reliable PRQ which makes it possible to stratify the children according to their individual risk. These slides can be retrieved under Electronic Supplementary Material.

A systematic review on quantifiable physical risk factors for non-specific adolescent low back pain

PURPOSE

The aim of this systematic review was to analyze the results of studies on quantifiable physical risk factors (beyond questionnaires) for adolescent low back pain (LBP).

METHODS

A systematic search was conducted in Medline (OvidSP), Premedline (PubMed), EMBASE, Cochrane, CINAHL, PEDro and PsycINFO. Cross-sectional, prospective and retrospective English language studies on LBP in adolescents aged 10 to 18 years were included.

RESULTS

Twenty-two mostly cross-sectional studies were included. Trunk muscle endurance in particular seemed to be associated with adolescent LBP, while a possible association of trunk muscle strength and spinal flexibility was less clear.

CONCLUSION

There is a need for prospective studies on quantifiable physical risk factors for adolescent LBP. Such studies should focus on back and abdominal muscle endurance, possibly in combination with sagittal spinal mobility, sagittal postural alignment and neurodynamics as possible modifiable risk factors for LBP.

Does lower extremity pain precede spinal pain? A longitudinal study

The main objective was to investigate whether children aged 9-15 years at baseline were more likely to experience an incident event of spinal pain after experiencing lower extremity pain. Children's musculoskeletal pain was monitored by weekly mobile phone text message responses from parents, indicating whether the child had spinal pain, lower extremity pain, or upper extremity pain the preceding week. Data were analyzed using mixed effect logistic regression models and cox regression models. The association between an incident event of spinal pain and LE pain the preceding weeks increased with increasing observation period and was statistically significant for 12 and 20 weeks (OR = 1.34 (95% CI 1.05 to 1.70) and OR = 1.39 (95% CI 1.11 to 1.75), respectively). We found that the likelihood increased in children with more frequent or longer duration of lower extremity pain. The reversed relationship was investigated as well, and we also found a positive association between spinal pain and a subsequent incidence event of lower extremity pain, but less pronounced.Conclusion: Children were more likely to experience an incident event of spinal pain after experiencing lower extremity pain. The likelihood increased in children with more frequent or longer duration of lower extremity pain. What is Known: • Both spinal pain and lower extremity pain often start early in life and is common already in adolescence. What is New: • Children were more likely to experience an incident event of spinal pain after experiencing LE pain. • The likelihood increased in children with more frequent or longer duration of LE pain.

Prevalence and incidence of musculoskeletal extremity complaints in children and adolescents. A systematic review

BACKGROUND

It is difficult to gain an overview of musculoskeletal extremity complaints in childhood although this is essential to develop evidence-based prevention and treatment strategies. The objectives of this systematic review were therefore to describe the prevalence and incidence of musculoskeletal extremity complaints in children and adolescents in both general and clinical populations in relation to age, anatomical site and mode of onset.

METHODS

MEDLINE and EMBASE were electronically searched; risk of bias was assessed; and data extraction was individually performed by two authors.

RESULTS

In total, 19 general population studies and three clinical population studies were included with children aged 0-19 years. For most of the analyses, a division between younger children aged 0-12 years, and older children aged 10-19 years was used. Lower extremity complaints were more common than upper extremity complaints regardless of age and type of population, with the most frequent pain site changing from ankle/foot in the youngest to knee in the oldest. There were about twice as many non-traumatic as traumatic complaints in the lower extremities, whereas the opposite relationship was found for the upper extremities in the general population studies. There were relatively more lower extremity complaints in the general population studies than in the clinical population studies. The review showed no pattern of differences in reporting between studies of high and low risk of bias.

CONCLUSIONS

This review shows that musculoskeletal complaints are more frequent in the lower extremities than in the upper extremities in childhood, and there are indications of a large amount of non-traumatic low intensity complaints in the population that do not reach threshold for consultation. A meta-analysis, or even a simple overall description of prevalence and incidence of musculoskeletal extremity complaints in children and adolescents was not feasible, due to a large variety in the studies, primarily related to outcome measurements.

Low Back Pain With Impact at 17 Years of Age Is Predicted by Early Adolescent Risk Factors From Multiple Domains: Analysis of the Western Australian Pregnancy Cohort (Raine) Study

Study Design Prospective cohort study of the Western Australian Pregnancy Cohort (Raine) Study. Background Low back pain (LBP) commonly develops in adolescence and is a significant risk factor for adult LBP. A broad range of factors have been associated with the development of adolescent LBP, but prior literature has limitations related to characterization of LBP and the scope of risk factors considered. Objective This study aimed to identify potential factors contributing to the development of LBP, with and without impact, at 17 years of age, utilizing a broad range of exposures at 14 years of age. Methods Data from 1088 participants (52.1% female) with "no LBP," "LBP with minimal impact," and "LBP with impact" at 17 years of age and a range of measures from multiple domains, including spinal pain, physical, psychological, social, and lifestyle, at 14 years of age were collected for the study. Multivariable multinomial logistic regression was used to estimate the association of potential mechanistic factors at 14 years of age with LBP at 17 years of age. Results Female sex and back pain at 14 years of age were strongly associated with LBP at 17 years of age. Potential mechanistic factors for LBP outcomes at 17 years of age included exposures from the pain (neck/shoulder pain) and physical domains (standing posture subgroup membership, back muscle endurance, throwing distance), psychological domain (somatic complaints, aggressive behavior), social domain (socioeconomic area), and lifestyle domain (exercise out of school). Conclusion The findings support the multidimensional nature of adolescent LBP and highlight the challenge this presents for epidemiological research, clinical practice, and prevention initiatives in the general population. Level of Evidence Prognosis, level 1b. J Orthop Sports Phys Ther 2017;47(10):752-762. doi:10.2519/jospt.2017.7464.

Musculoskeletal pain in children and adolescents

Introduction

Musculoskeletal (MSK) pain in children and adolescents is responsible for substantial personal impacts and societal costs, but it has not been intensively or systematically researched. This means our understanding of these conditions is limited, and healthcare professionals have little empirical evidence to underpin their clinical practice. In this article we summarise the state of the evidence concerning MSK pain in children and adolescents, and offer suggestions for future research.

Results

Rates of self-reported MSK pain in adolescents are similar to those in adult populations and they are typically higher in teenage girls than boys. Epidemiological research has identified conditions such as back and neck pain as major causes of disability in adolescents, and in up to a quarter of cases there are impacts on school or physical activities. A range of physical, psychological and social factors have been shown to be associated with MSK pain report, but the strength and direction of these relationships are unclear. There are few validated instruments available to quantify the nature and severity of MSK pain in children, but some show promise. Several national surveys have shown that adolescents with MSK pain commonly seek care and use medications for their condition. Some studies have revealed a link between MSK pain in adolescents and chronic pain in adults.

Conclusion

Musculoskeletal pain conditions are often recurrent in nature, occurring throughout the life-course. Attempts to understand these conditions at a time close to their initial onset may offer a better chance of developing effective prevention and treatment strategies.

Spinal pain in Danish school children - how often and how long? The CHAMPS Study-DK

Background

Spinal pain in children and adolescents is a common condition, usually transitory, but the picture of spinal pain still needs elucidation, mainly due to variation in measurement methods. The aim of this study was to describe the occurrence of spinal pain in 8–15 year-old Danish school children, over a 3-year period. Specifically determining the characteristics of spinal pain in terms of frequency and duration.

Methods

The study was a 3-year prospective longitudinal cohort study including 1400 school children. The outcomes were based on weekly text messages (SMS) to the parents inquiring about the child’s musculoskeletal pain, and on clinical data from examinations of the children.

Results

The 3-year prevalence was 55%. The prevalence was 29%, 33% and 31% for each of the three study years respectively, and increased statistically significantly with age, especially for lumbopelvic pain. Most children had few and short-lasting episodes with spinal pain, but more than one out of five children had three or more episodes during a study year and 17% of all episodes lasted for more than 4 weeks.

Conclusion

This study demonstrates that spinal pain is a substantial problem. Most episodes are brief, but there are a vast number of children with frequent and long-lasting episodes of spinal pain indicating a need for action regarding evidence-based prevention and management.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-017-1424-5) contains supplementary material, which is available to authorized users.

Content validity and test-retest reliability of a low back pain questionnaire in Zimbabwean adolescents

BACKGROUND

In Zimbabwe, a recent increase in the volume of research on recurrent non-specific low back pain (NSLBP) has revealed that adolescents are commonly affected. This is alarming to health professionals and parents and calls for serious primary preventative strategies to be developed and implemented forthwith. Early identification initiatives should be prioritised in order to curtail the condition and its progression. In an attempt to be proactive in minimising the prevalence of recurrent NSLBP, this study was conducted to evaluate the content validity and test-retest reliability of a survey questionnaire with the aim of proffering a valid and reliable questionnaire which can be used in non-clinical settings to identify adolescents with recurrent NSLBP in Harare, Zimbabwe and determine the possible factors associated with the condition.

METHODS

The study was conducted in two parts. The first part assessed content validity of the questionnaire using four experts derived from academia and clinical practice. The second part evaluated the reliability of the questionnaire among 125 high school-children aged between 13 and 19 years in a test-retest study.

RESULTS

Twenty-six (26) out of thirty questions in the questionnaire had an Item Content Validity index of 1.00, demonstrating complete agreement among content experts. Overall, the Scale Content Validity Index for the questionnaire was 0.97. Item completion for the reliability study was satisfactory. The questionnaire items had kappa values ranging from 0.17 (slight agreement) to 1 (perfect agreement). High levels of reliability were found for the questions on school bag use (k=0.94), sports participation (k=0.97), and lifetime prevalence (k=0.89).

CONCLUSION

Excellent content validity and slight to perfect test-retest reliability was found for the Low Back Pain (LBP) questionnaire. These results are comparable to findings of other studies evaluating the psychometric properties of LBP questionnaires. Cognisant of the limitations of the study, the results of this study suggest that the LBP questionnaire could be used in local studies investigating LBP among adolescents although questions enquiring on functional limitations and sciatica may need further consideration.

[Factors associated with back pain in adolescents from public schools in one city from South Brazil]

OBJECTIVE

To investigate the prevalence of back pain and associated factors in children attending public schools from South Brazil.

METHODS

A cross-sectional study, conducted between May-July 2014, where a random sample of 619 adolescents, aged 10-17 years of age, was evaluated. The prevalence of back pain was assessed using the Nordic Musculoskeletal Questionnaire, and the independent variables (demographic and biological information, the way of transporting school supplies, and pain during and after the walk) were obtained through a standardized questionnaire. The Poisson regression model was used to estimate unadjusted and adjusted prevalence of back pain in association with the factors investigated.

RESULTS

The prevalence of back pain was 45.2 %, out of which 64.6 % reported pain in one region, 27.1 % in two and 8.3 % in the three regions investigated. After an individual assessment of regions, it was found that the highest prevalence of pain relates to the dorsal region (26.2 %). The most relevant associated factors include female gender (OR=1.43, 95 %CI 1.19-1.74; p<0.01), age between 14 and 17 (OR=1.22; 95 %CI = 1.03-1.45; p=0.02), and dark skin (OR=1.20, 95 %CI 1.01-1.43; p=0.04).

CONCLUSION

The results highlight the need for greater attention to adolescents complaining of back pain, in order to prevent the presence of this chronical disorder in adolescence and later in adulthood. Therefore, it is necessary to educate adolescents and their guardians for the stimulation and consequent adoption of healthy practices for musculoskeletal integrity.

Multivariable modeling of factors associated with spinal pain in young adolescence

PURPOSE

To investigate the factors related to the 1-month period prevalence of low back pain (LBP), neck pain (NP) and thoracic spine pain (TSP) in young adolescents, thereby considering potential correlates from the physical, sociodemographic, lifestyle, psychosocial and comorbid pain domains.

METHODS

In this cross-sectional baseline study, 69 factors potentially associated with spinal pain were assessed among 842 healthy adolescents before pubertal peak growth. With consideration for possible sex differences in associations, multivariable analysis was used to simultaneously evaluate contributions of all variables collected in the five domains.

RESULTS

A significantly higher odds of LBP was shown for having high levels of psychosomatic complaints (odds ratio: 4.4; 95 % confidence interval: 1.6-11.9), a high lumbar lordotic apex, retroversed pelvis, introverted personality, and high levels of negative over positive affect. Associations with a higher prevalence and odds of NP were found for psychosomatic complaints (7.8; 2.5-23.9), TSP in the last month (4.9; 2.2-10.8), backward trunk lean, high levels of negative over positive affect and depressed mood. Having experienced LBP (2.7; 1.3-5.7) or NP (5.5; 2.6-11.8) in the preceding month was associated with a higher odds of TSP, as were low self-esteem, excessive physical activity, sedentarism and not achieving the Fit-norm.

CONCLUSIONS

Psychosomatic symptoms and pain comorbidities had the strongest association with 1-month period prevalence of spinal pain in young adolescents, followed by factors from the physical and psychosocial domains. The role that "physical factors" play in non-adult spinal pain may have been underestimated by previous studies.