The Prevalence and Progression of Neck and Back Pain in Children Over Time
SOURCE: Musculoskelet Disord. 2011 (May 16); 12: 98
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
|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
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.
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.
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