Etiology, Risk Factors, and Diagnosis of Back Pain in Children and Adolescents: Evidence- and Consensus-Based Interdisciplinary Recommendations
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Causes, Red Flags and Risk Factors
3.1.1. Causes and Red Flags for Specific back Pain in Childhood and Adolescence
3.1.2. Risk Factors for Non-Specific Back Pain in Childhood and Adolescence
3.1.3. Risk Factors for Chronicity of Non-Specific Back Pain (“Yellow Flags”) in Children and Adolescents
3.1.4. Prognosis of Non-Specific Back Pain in Childhood and Adolescence
3.2. Diagnostics
3.2.1. Medical History
3.2.2. Physical Examination
3.2.3. Diagnostic Imaging
3.2.4. Laboratory Tests
3.2.5. Screening of Psychological and Social Risk Factors
3.2.6. Multidisciplinary Assessment
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
- MacDonald, J.; Stuart, E.; Rodenberg, R. Musculoskeletal Low Back Pain in School-aged Children: A Review. JAMA Pediatr. 2017, 171, 280–287. [Google Scholar] [CrossRef] [PubMed]
- Yang, S.; Werner, B.C.; Singla, A.; Abel, M.F. Low Back Pain in Adolescents: A 1-Year Analysis of Eventual Diagnoses. J. Pediatr. Orthop. 2017, 37, 344–347. [Google Scholar] [CrossRef] [PubMed]
- Hestbaek, L.; Leboeuf-Yde, C.; Kyvik, K.O. Is comorbidity in adolescence a predictor for adult low back pain? A prospective study of a young population. BMC Musculoskelet. Disord. 2006, 7, 29. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kamper, S.J.; Yamato, T.P.; Williams, C.M. The prevalence, risk factors, prognosis and treatment for back pain in children and adolescents: An overview of systematic reviews. Best Pract. Res. Clin. Rheumatol. 2016, 30, 1021–1036. [Google Scholar] [CrossRef]
- Feldman, D.S.; Straight, J.J.; Badra, M.I.; Mohaideen, A.; Madan, S.S. Evaluation of an Algorithmic Approach to Pediatric Back Pain. J. Pediatr. Orthop. 2006, 26, 353–357. [Google Scholar] [CrossRef] [Green Version]
- Kordi, R.; Rostami, M. Low Back Pain in Children and Adolescents: An Algorithmic Clinical Approach. Iran. J. Pediatr. 2011, 21, 259–270. [Google Scholar]
- Rodriguez, D.P.; Poussaint, T.Y. Imaging of back pain in children. Am. J. Neuroradiol. 2010, 31, 787–802. [Google Scholar] [CrossRef] [Green Version]
- Cruikshank, M.; Ramanan, A.V. Fifteen-minute consultation: A structured approach to the management of a child or adolescent with back pain. Arch. Dis. Child.-Educ. Pract. 2014, 99, 202–207. [Google Scholar] [CrossRef]
- Davis, P.J.C.; Williams, H.J. The investigation and management of back pain in children. Arch. Dis. Child.-Educ. Pract. 2008, 93, 73–83. [Google Scholar] [CrossRef]
- Bernstein, R.M.; Cozen, H. Evaluation of back pain in children and adolescents. Am. Fam. Physician 2007, 76, 1669–1676. [Google Scholar]
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Ständige Kommission Leitlinien. AWMF-Regelw. Leitlin. 2012, 1, 409–412. [Google Scholar]
- OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence; Oxford Centre for Evidence-Based Medicine: Oxford, UK, 2011. [Google Scholar]
- Calvo-Muñoz, I.; Kovacs, F.M.; Roqué, M.; Gago Fernández, I.; Seco Calvo, J. Risk Factors for Low Back Pain in Childhood and Adolescence: A Systematic Review. Clin. J. Pain 2018, 34, 468–484. [Google Scholar] [CrossRef]
- Jones, G.T.; Watson, K.D.; Silman, A.J.; Symmons, D.P.; Macfarlane, G.J. Predictors of Low Back Pain in British Schoolchildren: A Population-Based Prospective Cohort Study. Pediatrics 2003, 111, 822–828. [Google Scholar] [CrossRef] [PubMed]
- Barke, A.; Gaßmann, J.; Kröner-Herwig, B. Cognitive processing styles of children and adolescents with headache and back pain: A longitudinal epidemiological study. J. Pain Res. 2014, 7, 405–414. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Salminen, J.J.; Erkintalo, M.; Laine, M.; Pentti, J. Low back pain in the young—A prospective three-year follow-up study of subjects with and without low back pain. Spine 1995, 20, 2101–2108. [Google Scholar] [CrossRef]
- Smith, A.; Beales, D.; O’Sullivan, P.; Bear, N.; Straker, L. 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. J. Orthop. Sports Phys. Ther. 2017, 47, 752–762. [Google Scholar] [CrossRef]
- Dunn, K.M.; Jordan, K.P.; Mancl, L.; Drangsholt, M.T.; Le Resche, L. Trajectories of pain in adolescents: A prospective cohort study. Pain 2011, 152, 66–73. [Google Scholar] [CrossRef] [Green Version]
- Yamato, T.P.; Maher, C.G.; Traeger, A.C.; Wiliams, C.M.; Kamper, S.J. Do schoolbags cause back pain in children and adolescents? A systematic review. Br. J. Sports Med. 2018, 52, 1241–1245. [Google Scholar] [CrossRef] [Green Version]
- Clark, E.M.; Tobias, J.H.; Fairbank, J. The Impact of Small Spinal Curves in Adolescents Who Have Not Presented to Secondary Care: A Population-Based Cohort Study. Spine 2016, 41, E611–E617. [Google Scholar] [CrossRef] [Green Version]
- Eckhoff, C.; Kvernmo, S. Musculoskeletal pain in Arctic indigenous and non-indigenous adolescents, prevalence and associations with psychosocial factors: A population-based study. BMC Public Health 2014, 14, 617. [Google Scholar] [CrossRef] [Green Version]
- Picavet, H.S.J.; Berentzen, N.; Scheuer, N.; Ostelo, R.W.J.G.; Brunekreef, B.; Smit, H.A.; Wijga, A. Musculoskeletal complaints while growing up from age 11 to age 14: The PIAMA birth cohort study. Pain 2016, 157, 2826–2833. [Google Scholar] [CrossRef] [PubMed]
- Gill, D.K.; Davis, M.C.; Smith, A.J.; Straker, L.M. Bidirectional relationships between cigarette use and spinal pain in adolescents accounting for psychosocial functioning. Br. J. Health Psychol. 2014, 19, 113–131. [Google Scholar] [CrossRef] [PubMed]
- Sjolie, A.N. Persistence and change in nonspecific low back pain among adolescents: A 3-year prospective study. Spine 2004, 29, 2452–2457. [Google Scholar] [CrossRef] [PubMed]
- Stanford, E.A.; Chambers, C.T.; Biesanz, J.C.; Chen, E. The frequency, trajectories and predictors of adolescent recurrent pain: A population-based approach. Pain 2008, 138, 11–21. [Google Scholar] [CrossRef]
- Härmä, A.-M.; Kaltiala-Heino, R.; Rimpelä, M.; Rantanen, P. Are adolescents with frequent pain symptoms more depressed? Scand. J. Prim. Health Care 2002, 20, 92–96. [Google Scholar] [CrossRef]
- Auvinen, J.P.; Tammelin, T.H.; Taimela, S.P.; Zitting, P.J.; Mutanen, P.O.A.; Karppinen, J.I. Musculoskeletal pains in relation to different sport and exercise activities in youth. Med. Sci. Sports Exerc. 2008, 40, 1890–1900. [Google Scholar] [CrossRef]
- Guddal, M.H.; Stensland, S.Ø.; Småstuen, M.C.; Johnsen, M.B.; Zwart, J.-A.; Storheim, K. Physical Activity Level and Sport Participation in Relation to Musculoskeletal Pain in a Population-Based Study of Adolescents: The Young-HUNT Study. Orthop. J. Sports Med. 2017, 5, 2325967116685543. [Google Scholar] [CrossRef]
- Mikkonen, P.; Viikari-Juntura, E.; Remes, J.; Pienimäki, T.; Solovieva, S.; Taimela, S.; Zitting, P.; Koiranen, M.; Leino-Arjas, P.; Karppinen, J. Physical workload and risk of low back pain in adolescence. Occup. Environ. Med. 2012, 69, 284–290. [Google Scholar] [CrossRef]
- Mikkonen, P.; Leino-Arjas, P.; Remes, J.; Zitting, P.; Taimela, S.; Karppinen, J. Is smoking a risk factor for low back pain in adolescents? A prospective cohort study. Spine 2008, 33, 527–532. [Google Scholar] [CrossRef]
- Auvinen, J.P.; Tammelin, T.H.; Taimela, S.P.; Zitting, P.J.; Järvelin, M.-R.; Taanila, A.M.; Karppinen, J.I. Is insufficient quantity and quality of sleep a risk factor for neck, shoulder and low back pain? A longitudinal study among adolescents. Eur. Spine J. 2010, 19, 641–649. [Google Scholar] [CrossRef] [Green Version]
- Coenen, P.; Smith, A.; Paananen, M.; O’Sullivan, P.; Beales, D.; Straker, L. Trajectories of Low Back Pain From Adolescence to Young Adulthood. Arthritis Care Res. 2017, 69, 403–412. [Google Scholar] [CrossRef] [PubMed]
- Johansson, M.S.; Jensen Stochkendahl, M.; Hartvigsen, J.; Boyle, E.; Cassidy, J.D. Incidence and prognosis of mid-back pain in the general population: A systematic review. Eur. J. Pain 2017, 21, 20–28. [Google Scholar] [CrossRef] [PubMed]
- Van Gessel, H.; Gassmann, J.; Kröner-Herwig, B. Children in pain: Recurrent back pain, abdominal pain, and headache in children and adolescents in a four-year-period. J. Pediatr. 2011, 158, 977–983. [Google Scholar] [CrossRef] [PubMed]
- Kröner-Herwig, B.; Gorbunova, A.; Maas, J. Predicting the occurrence of headache and back pain in young adults by biopsychological characteristics assessed at childhood or adolescence. Adolesc. Health Med. Ther. 2017, 8, 31–39. [Google Scholar] [CrossRef] [Green Version]
- Wilne, S.; Collier, J.; Kennedy, C.; Koller, K.; Grundy, R.; Walker, D. Presentation of childhood CNS tumours: A systematic review and meta-analysis. Lancet Oncol. 2007, 8, 685–695. [Google Scholar] [CrossRef]
- Aartun, E.; Hartvigsen, J.; Hestbaek, L. Validity of Commonly Used Clinical Tests to Diagnose and Screen for Spinal Pain in Adolescents: A School-Based Cohort Study in 1300 Danes Aged 11–15 Years. J. Manip. Physiol. Ther. 2016, 39, 76–87. [Google Scholar] [CrossRef]
- Salminen, J.J.; Erkintalo-Tertti, M.O.; Paajanen, H.E. Magnetic resonance imaging findings of lumbar spine in the young: Correlation with leisure time physical activity, spine mobility, and trunk muscle strength in 15-year-old pupils with or without low-back pain. J. Spinal Disord. 1993, 6, 386–391. [Google Scholar] [CrossRef]
- Tofte, J.N.; CarlLee, T.L.; Holte, A.J.; Sitton, S.E.; Weinstein, S.L. Imaging Pediatric Spondylolysis: A Systematic Review. Spine 2017, 42, 777–782. [Google Scholar] [CrossRef]
- Grossman, D.C.; Curry, S.J.; Owens, D.K.; Barry, M.J.; Davidson, K.W.; Doubeni, C.A.; Epling, J.W.; Kemper, A.R.; Krist, A.H.; Kurth, A.E.; et al. Screening for Adolescent Idiopathic Scoliosis: US Preventive Services Task Force Recommendation Statement. JAMA 2018, 319, 165–172. [Google Scholar] [CrossRef] [Green Version]
- Ramirez, N.; Flynn, J.M.; Hill, B.W.; Serrano, J.A.; Calvo, C.E.; Bredy, R.; Macchiavelli, R.E. Evaluation of a systematic approach to pediatric back pain: The utility of magnetic resonance imaging. J. Pediatr. Orthop. 2015, 35, 28–32. [Google Scholar] [CrossRef]
- Chorpita, B.F.; Yim, L.; Moffitt, C.; Umemoto, L.A.; Francis, S.E. Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behav. Res. Ther. 2000, 38, 835–855. [Google Scholar] [CrossRef]
- Stahlschmidt, L.; Chorpita, B.F.; Wager, J. Validating the German version of the Revised Children’s Anxiety and Depression Scale in a sample of pediatric chronic pain patients. J. Psychosom. Res. 2019, 124, 109786. [Google Scholar] [CrossRef] [PubMed]
- Théroux, J.; Stomski, N.; Hodgetts, C.J.; Ballard, A.; Khadra, C.; Le May, S.; Labelle, H. Prevalence of low back pain in adolescents with idiopathic scoliosis: A systematic review. Chiropr. Man. Therap. 2017, 25, 10. [Google Scholar] [CrossRef]
- Grødahl, L.H.J.; Fawcett, L.; Nazareth, M.; Smith, R.; Spencer, S.; Heneghan, N.; Rushton, A. Diagnostic utility of patient history and physical examination data to detect spondylolysis and spondylolisthesis in athletes with low back pain: A systematic review. Man. Ther. 2016, 24, 7–17. [Google Scholar] [CrossRef] [PubMed]
- Hasler, C.C. Back pain during growth. Swiss Med. Wkly. 2013, 143, w13714. [Google Scholar] [CrossRef] [PubMed]
Category | Red Flag |
---|---|
Demographic data | Age < 10 years |
Medical history | Trauma, respiratory arrest after trauma |
Onset of back pain associated with exercise | |
Previous or current glucocorticoid therapy | |
Pre-existing and concomitant medical conditions | |
Neurological symptoms | Motor or sensory disturbances of the extremities |
Radicular pain | |
Bladder or bowel dysfunction | |
Other clinical signs | Fever |
Local swelling | |
Lymph node enlargement | |
Externally apparent structural changes of the spine | |
Palpable step deformity | |
Joint hypermobility | |
Inflammatory signs of disease (arthritis, enthesitis, cutaneous vasculitis) | |
Arterial hypertension | |
Pain characteristics/other pain locations | Compression pain or localized pressure pain |
Pain in the head, thorax, abdomen, flanks, extremities, glutes, or pelvis | |
Arthralgia or myalgia |
Category | Risk Factor | References |
---|---|---|
Evidence-based risk factors | ||
Demographic data | Increasing age in adolescence | [13,14,15] |
Female gender | [4,13,15,17,18,23] | |
Medical history | Competitive sports | [4,13,14] |
Previous pain episodes | [4,17,24] | |
Psychosocial factors | Low life satisfaction | [18] |
Anxiety | [15,25] | |
Depression | [17,18,23,25,26] | |
Low self-esteem | [25] | |
Potential risk factors | ||
Medical history | High levels of sports activity and technical sports | [14,27,28] |
Family history of back pain | [4,13] | |
Workplace factors | e.g., sitting, lifting and carrying, posture | [24,29] |
Health behavior | Smoking 1 | [4,13,23,30] |
Short sleep duration, inadequate sleep quality | [31] |
Category | Risk Factor | References |
---|---|---|
Demographic data | Female gender | [25] |
Psychosocial factors | Low life satisfaction | [18,25] |
Anxiety | [25] | |
Depression | [25] | |
Low self-esteem | [25] | |
Health behavior | Regular smoking 1 | [30]. |
Category | Prognostic Factor | References |
---|---|---|
Demographic data | Female gender | [18,32] |
Psychosocial factors | Low life satisfaction | [18] |
Depression | ||
Somatization disorder | ||
Co-occurring diseases | Asthma 1 | [3] |
Headache | [3,32] |
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Frosch, M.; Mauritz, M.D.; Bielack, S.; Blödt, S.; Dirksen, U.; Dobe, M.; Geiger, F.; Häfner, R.; Höfel, L.; Hübner-Möhler, B.; et al. Etiology, Risk Factors, and Diagnosis of Back Pain in Children and Adolescents: Evidence- and Consensus-Based Interdisciplinary Recommendations. Children 2022, 9, 192. https://doi.org/10.3390/children9020192
Frosch M, Mauritz MD, Bielack S, Blödt S, Dirksen U, Dobe M, Geiger F, Häfner R, Höfel L, Hübner-Möhler B, et al. Etiology, Risk Factors, and Diagnosis of Back Pain in Children and Adolescents: Evidence- and Consensus-Based Interdisciplinary Recommendations. Children. 2022; 9(2):192. https://doi.org/10.3390/children9020192
Chicago/Turabian StyleFrosch, Michael, Maximilian D. Mauritz, Stefan Bielack, Susanne Blödt, Uta Dirksen, Michael Dobe, Florian Geiger, Renate Häfner, Lea Höfel, Bettina Hübner-Möhler, and et al. 2022. "Etiology, Risk Factors, and Diagnosis of Back Pain in Children and Adolescents: Evidence- and Consensus-Based Interdisciplinary Recommendations" Children 9, no. 2: 192. https://doi.org/10.3390/children9020192