Neck and Back Pain in Children:
Prevalence and Progression Over Time
SOURCE: BMC Musculoskelet Disord. 2011 (May 16); 12: 98 ~ FULL TEXT
Per Kjaer, Niels Wedderkopp, Lars Korsholm, and Charlotte Leboeuf-Yde
Institute of Sports Science and Clinical Biomechanics, Part of Clinical Locomotion Network, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark. email@example.com
The following article appears to be the first study to track and review the progression of back pain in the same group of children, over a prolonged period, to see how (or if) it is a contributor to those same complains in adulthood.
Of particular interest is Table 2, because it breaks down and tracks complaints of either neck, mid back, or low back pain in the same group of children at 3 different time periods: ages 9, 13 and 15 years old.
Table 2: Prevalence rates of different types of back pain in a cohort of Danish children/ adolescents surveyed at three time points
|Age Group||Age 9||Age 13||Age 15|
The Abstract and Full Text Article:
BACKGROUND: It is generally acknowledged that back pain (BP) is a common condition already in childhood. However, the development until early adulthood is not well understood and, in particular, not the individual tracking pattern. The objectives of this paper are to show the prevalence estimates of BP, low back pain (LBP), mid back pain (MBP), neck pain (NP), and care-seeking because of BP at three different ages (9, 13 and 15 years) and how the BP reporting tracks over these age groups over three consecutive surveys.
METHODS: A longitudinal cohort study was carried out from the years of 1997 till 2005, collecting interview data from children who were sampled to be representative of Danish schoolchildren. BP was defined overall and specifically in the three spinal regions as having reported pain within the past month. The prevalence estimates and the various patterns of BP reporting over time are presented as percentages.
RESULTS: Of the 771 children sampled, 62%, 57%, and 58% participated in the three back surveys and 34% participated in all three. The prevalence estimates for children at the ages of 9, 13, and 15, respectively, were for BP 33%, 28%, and 48%; for LBP 4%, 22%, and 36%; for MBP 20%, 13%, and 35%; and for NP 10%, 7%, and 15%. Seeking care for BP increased from 6% and 8% at the two youngest ages to 34% at the oldest. Only 7% of the children who participated in all three surveys reported BP each time and 30% of these always reported no pain. The patterns of development differed for the three spinal regions and between genders. Status at the previous survey predicted status at the next survey, so that those who had pain before were more likely to report pain again and vice versa. This was most pronounced for care-seeking.
CONCLUSION: It was confirmed that BP starts early in life, but the patterns of onset and development over time vary for different parts of the spine and between genders. Because of these differences, it is recommended to report on BP in youngsters separately for the three spinal regions, and to differentiate in the analyses between the genders and age groups. Although only a small minority reported BP at two or all three surveys, tracking of BP (particularly NP) and care seeking was noted from one survey to the other. On the positive side, individuals without BP at a previous survey were likely to remain pain free at the subsequent survey.
From the FULL TEXT Article
It is well known that back pain (BP) is a common and costly problem in the general population. Previously, BP in children was considered rare and a sign of a potentially serious disorder [1,2]. Today, according to a recent systematic review, the general opinion would be that BP, including low back pain (LBP), mid back pain (MBP) and neck pain (NP), starts already early in life to accelerate during the early teens up till early adulthood  and that its presence in young age is a precursor for BP also in adulthood . In order to approach the issues of prevention and treatment it is helpful to understand the extent and course of a disease, particularly around the time of its onset and that picture is, presently, far from clear. Methodological and definition issues can partly explain this . However, this is also a question of the study objectives and design. It is therefore not surprising that the estimates from various studies vary and that often they make no sense. Also, there appears to be no credible data on the true incidence for each spinal region in young people.
In addition, it is not clear to what extent BP in youngsters results in consequences such as those seen in adults, namely reduced activities, sick leave (i.e. absence from school), and consultations with health care practitioners. We found only few studies on children and adolescents dealing with this topic but their conclusions differed. Auvinen et al  reported that the seeking of health care increased with age for both LBP and NP, whereas others found no such increase [6,7]. In another study, no associations with age were found for reduced activities and taking time off from school . Others who reported on this issue did not take age into account. It is therefore not known if these consequences are proportional to the prevalence of pain at the various ages or if the consequences have an age-related profile of their own.
Theoretically, the prevalence rates in cohorts born at different times could be affected by dissimilar living conditions rather than by being a product of age. Therefore, in order to study the development over time in individuals, it would be more correct to follow a cohort over time rather than comparing prevalence estimates for children of different age groups, who were all surveyed at the same time. Although population-based studies have been published on the trajectories of back pain in general over time in young people [9,10], we found no study in which all three spinal regions had been investigated prospectively. Because the onset of pain in the three different spinal regions previously was shown to arise at different ages  and because of the obviously different anatomical and biomechanical properties of the lumbar, thoracic and cervical regions, we considered it relevant to study these spinal regions independently.
In order to obtain more information in this area we collated data obtained in three previous studies on back pain in children, who were considered representative of the general Danish population. The two main objectives of our study were:
To describe the prevalence of BP (including LBP, MB and NP) and care seeking in these children when they were aged 9, 13 and 15 years.
To study to which extent BP and care seeking track over time in these children at these three points in time.
In addition, we reported data for boys and girls separately, and took into account the tracking pattern also for those who failed to participate in the previous survey.
Flow of participants in a longitudinal study of Danish children/adolescents at three time points (T1, T2 and T3).
Summary of findings
This is to our knowledge the first study to report BP (back pain ), LBP (low back pain ), MBP (mid back pain) and NP (neck pain) at three different points in time over a 6-year period in one cohort of children/adolescents. Overall, absence of pain was the most common finding. When considering those with pain, it was noted that in the youngest group (9 yrs), MBP was the most common complaint, whereas LBP was most commonly reported at the next two surveys. At the youngest age, boys reported most LBP, MBP, and seeking care for BP but were overtaken by the girls already at 13. Care seeking was very uncommon in the youngest group and much less common than BP (6% vs. 33%). At the age of 15, this gap had decreased (34% vs. 48%), indicating either that the symptoms are now more bothersome or that the pain was not taken seriously by the parents until the child is older.
A rapid increase in LBP reporting was seen from the age of nine to 13 and it was, in particular, those who previously had pain who were more likely to report it again. For the last survey this was noted to be very pronounced in some variables (previous care seeking and previous NP). It was somewhat less marked for MBP and BP in general, whereas this finding was almost absent for LBP. The findings in the second survey were less evident. Of the 261 children who participated in all three surveys, only 7% reported BP all three times and 30% reported no pain all three times, showing that frequent or constant pain in this age group is not yet common.
Comparisons with other studies are not easily done, as we could not find any that included the same age groups and studied all spinal areas. There is, of course, no obvious reason to doubt that BP starts early and since it is more common in young adults than in children, it has to increase in adolescence. This has been shown, for example, by Stanford et al in a recent population-based study on “weekly or more recurrent BP” . That BP at this age is fairly uncommon was convincingly shown also in a study by Dunn et al . About 3/4 of their 11-14 yr olds belonged to the “no pain problem” groups, when BP was defined as “pain in the past three months that lasted a whole day or more, or that had occurred several times in a year” and when the trajectory pattern was measured as often as three times per year over three years. The stability of this pattern (tracking) was apparent also from their results.
Strength and weaknesses of the study
A strength of this study is that the study sample was taken from the general population and can be considered relatively representative of the general Danish population. Nevertheless, because the majority of children failed to participate at all three surveys, it was important to study the pain pattern in the “sometimes” participants. One could expect that the more disadvantaged children would be those who more likely to abstain from participation, and that they might be more likely to have BP. However, the non-participants who appeared either in the second or third survey were seen to be more likely to have no BP or, at least, not to feel concerned about BP. The reason for this is perhaps that some of the “previous” non-participants were rather uninterested in the study, precisely because they had no BP. On the other hand, those who had BP might have been more interested in participating, as participation in the study meant access to a free MRI of the lumbar spine. An over representation of participants with BP would obviously increase the prevalence estimates and affect the tracking results, but the overall picture that emerges from this study appears clear, despite this.
Retrospective self-reported BP estimates in both adults and children are probably rather approximative. It is therefore important that the child who participates in a study clearly understands what is meant by “BP”. In these surveys we used a method previously shown to give credible results  and the interview was performed by one person in the first and the last survey whereas two radiographers took turns at the second survey. This is likely to provide credible results. Also, the length of the recall period was such as to optimize the validity of this variable. Intuitively, a one-month recall period would be acceptable, particularly as several questions were asked in relation to BP: “today”, “last week” and “in the past month”, increasing the children’s possibility to recall past events.
It was confirmed that BP starts early in life, but the patterns of onset and development over time vary for different parts of the spine and between genders. Because of these differences, it is recommended to report on BP in youngsters separately for the three spinal regions, and to differentiate in the analyses between the genders and age groups. Although only a small minority reported BP at two or all three surveys, tracking of BP (particularly NP) and care seeking was noted from one survey to the other. On the positive side, individuals without BP at a previous survey were likely to remain pain free at the subsequent survey.
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