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First Study in 15 Years to Assess Back Pain in Children, Adolescents

by Elizabeth Hofheinz, M.Ed., M.P.H.

When we think of back discomfort, our minds tend to turn toward adult aches and pains. But don’t forget the children, says new research from Hospital for Special Surgery (HSS) in New York. Their study, “The Epidemiology of Back Pain in American Children and Adolescents,” appears in the August 15, 2020 edition of Spine.

Noting that the prevalence of back pain has increased in recent years, the authors cited prior work indicating that such pain increases with age—and that the initial episodes of back pain are associated with high risk of chronic back pain including pain in adulthood.

Co-first author Peter Fabricant, M.D., M.P.H., an orthopedic surgeon at HSS, told OSN, “My co-first author, Dr. Widmann sees lots of patients with general ‘back pain’ and wanted to study more about its national prevalence/incidence and how it is treated in a way that represents a balanced cohort of American children and adolescents. This is not something that has been rigorously studied before.”

The researchers undertook a cross-sectional survey on 4,002 children and adolescents from 10 to 18 years old. Participants were equally split by age and sex and represented census-weighted distributions of state of residence, race/ethnicity, and health insurance status. A total of 3,669 participants were included in the final analysis.

The investigators also sought to look for any significant associations between demographic variables and back pain, as well as determine the impact of back pain on daily activities and quality of life in individuals who sought treatment.

The Pain Domain of the Scoliosis Research Society-22r was used as it has even been validated in children without scoliosis. The Patient Reported Outcome Measurement Information System Pain Interference scale was used to assess the degree to which pain interfered with daily activities within the last week.

Any child reporting pain within the last year was asked to give details on: the duration of the pain, the location of their back pain based on a labeled figure, what time of day the pain occurred, if they ever received medical care for the pain (and type of medical treatment if they did receive care).

Dr. Fabricant commented to OSN: “We found that back pain in one form or another is very common in children and adolescents (33.7%). The incidence also increases linearly with age. However, back pain is usually not severe and infrequently results in any procedural treatments such as injections or surgery (1.6%).”

The authors wrote, “Prevalence of back pain increased with age and was significantly more common in females. 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.”

“Participants with back pain on average had significantly BMIs [higher body mass indexes], heights, weights…” Of those reporting back pain, most indicated that it lasted less than one month and primarily occurred in the evenings.

“Based on a linear trend line, the percentage of children that experienced back pain increased approximately 4.1% with each year of age and the percentage of children that sought treatment increased approximately 2.1% with each year of age.”

Dr. Fabricant told OSN, “Because back pain is often recurrent and becomes more common with age, clinicians should counsel patients about the possibility of future episodes of back pain and the importance of preventative treatments.”

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Elizabeth Hofheinz

Two time winner of the MORE award Ms. Hofheinz was the first writer employed by Orthopedics This Week. The MORE award is granted annually by the American Academy of Orthopaedic Surgeons to recognize excellence in journalism. Ms. Hofheinz is currently the Director of Communications for Ortho Spine Partners (OSP).

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