Back Pain Affects One-third of American Youth

Michael Vlessides

March 14, 2019

LAS VEGAS — Back pain is ubiquitous in the United States and is not limited to adults; one in three young people have experienced back pain in the previous year, according to one of the first studies of its kind.

Peter Fabricant

"Back pain is very common in children and adolescents, and it increases linearly with age," said researcher Peter Fabricant, MD, from the Hospital for Special Surgery in New York City. "Only about 40% seek any kind treatment, and the vast majority of those don't require anything more than massage or physical therapy; very few require injections or surgery."

The epidemiologic study also revealed a series of factors to be significantly associated with back pain, such as body mass index (BMI), backpack use, sex, and level of athletic competition.

Back pain is very common in children and adolescents, and it increases linearly with age.

Few, if any, previous studies have delved into the epidemiology of back pain in American children and adolescents, Fabricant said here at the American Academy of Orthopaedic Surgeons 2019 Annual Meeting.

"After an extensive literature search, we found only two large primary studies that have taken place in the United States in the past 20 years," he reported. One of those trials examined only girls (Arch Pediatr Adolesc Med. 2004;158:797-803) and the other was limited to Michigan residents in grades three through eight (J Back Musculoskelet Rehabil. 2006;19:25-33).

To help bridge this gap, Fabricant and his colleagues analyzed data from an epidemiologic sample of 3669 children and adolescents with a mean age of 14 years and a mean BMI of 21.6 kg/m². There was an equal distribution of cohort members by age and sex, and census-weighted distributions of race and ethnicity, health insurance status, and state of residence were represented in the study population.

In their cross-sectional, survey-based investigation, the researchers calculated the overall prevalence and incidence of back pain.

One in Three Affected

Back pain in the previous year was reported by 1236 respondents (33.7%), and 177 of these (4.8%) reported current back pain.

There was a significant association between the incidence of back pain and age (P < .001). And for each increasing year of age, the percentage of children and adolescents who reported back pain in the previous year increased about 4%.

Mean weight was higher in children and adolescents who reported back pain than in those who did not (132.3 vs 119.8 lbs; P < .001), as was mean BMI (22.2 vs 21.2 kg/m²; P < .001).

However, "it's unlikely this difference in BMI is very clinically relevant," Fabricant acknowledged. "Frankly, I think the study was a little overpowered to detect this."

Back pain in the previous year was reported by significantly more girls than boys (38.3% vs 29.0%; P < .001).

Of the 1236 respondents who experienced back pain, lumbar pain was the most common type reported (68.9%).

Reports of back pain in the evening were more common than in the morning (48.9% vs 40.8%), and 15.1% of respondents reported that back pain woke them up during the night.

Only 505 (40.9%) of the children and adolescents who reported back pain sought treatment: 44.0% tried physical therapy, 34.1% underwent chiropractic treatment, and 33.9% used massage therapy.

One of the study's secondary findings offers a bit of good news with respect to American youth: 2910 (79.3%) of the respondents said they participated in a sport or physical activity. However, there was a significant association between back pain and the level of competition (P < .001), with participants performing at the highest levels reporting the most pain.

Children and adolescents who used backpacks with two straps were less likely to experience back pain than those who used rolling backpacks (30.6% vs 54.5%), a finding that Fabricant called "counterintuitive".

"We think that this might be an effect rather than a cause," he explained. "We suspect children with back pain were using rolling backpacks because of their pain."

No associations were found between back pain and the health insurance status or the race or ethnicity of the children.

I think many of the activities that our kids participate in can lead to back pain.

This research offers a ground-level view of back pain in a population that is often overlooked in the literature, said Matthew Schmitz, MD, from the San Antonio Military Medical Center.

"This has been reported in the adult literature, but we know that you can't necessarily extrapolate adult results to a pediatric population," he told Medscape Medical News. "To have a baseline on something like back pain that we can use for educational purposes is a tremendous addition to the field."

The rate of back pain in children and adolescents is hardly surprising, given its prevalence among American adults. "If you look at adult studies, almost every American adult experiences back pain in their life. And I think many of the activities that our kids participate in can lead to back pain," said Schmitz.

"The deconditioned state of many of our kids can also contribute to back pain after participation in sports," he added. "I think it'll be interesting to see, as they continue to study this, if back pain is more common in the athletes or the deconditioned people."

Fabricant and Schmitz have disclosed no relevant financial relationships.

American Academy of Orthopaedic Surgeons (AAOS) 2019 Annual Meeting: Paper 342. Presented March 13, 2019.

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