Best Pract Res Clin Rheumatol 2013 (Oct); 27 (5): 591–600 ~ FULL TEXT
Kate M Dunn • Lise Hestbaek • J David Cassidy
Arthritis Research UK Primary Care Centre,
Research Institute for Primary Care & Health Sciences,
Staffordshire ST5 5BG, UK.
Back pain episodes are traditionally regarded as individual events, but this model is currently being challenged in favour of treating back pain as a long-term or lifelong condition. Back pain can be present throughout life, from childhood to older age, and evidence is mounting that pain experience is maintained over long periods: for example, people with pain continue to have it on and off for years, and people without pain do not suddenly develop long-term pain. A number of factors predict back pain presence in epidemiological studies, and these are often present, and predictive, at different life stages. There are also factors present at particular life stages, such as childhood or adolescence, which predict back pain in adulthood. However, there are little published data on long-term pain patterns or predictors over the life course. Such studies could improve our understanding of the development and fluctuations in back pain, and therefore influence treatment approaches.
Keywords: Adolescence; Adults; Back pain; Children; Clinical course; Elderly; Natural history.
From the FULL TEXT Article:
Historically, the epidemiology of back pain was most commonly studied in adults, predominantly working age adults. Risk factors for back pain were also principally those factors present in adults at the time of onset, or shortly preceding the apparent onset of the condition. This focus was due at least in part to the prevailing belief that back pain was usually due to an injury, often occurring in the workplace. Research studies were often orientated around this model and focussed on the onset or persistence of episodes of pain, or studying risk factors present at a time point when an individual did not have pain and predicting the presence of pain at a later point. This model has been challenged over the last couple of
decades as a result of three factors: (1) developments in our understanding of the natural (or clinical) course of back pain, highlighting that individuals often experience repeated episodes, and that these episodes are not independent of each other; (2) increasing knowledge about the presence of back pain in children, young people and older age adults; and (3) the emergence of the biopsychosocial model of back pain , which indicated that psychological and social factors, as well as biomedical factors, might be related to the occurrence of back pain. One result of this is that studying single episodes of pain, or
presence of pain at one-off time points, is limiting our understanding of the condition.
Similar issues have been faced by researchers of other conditions and they have led to the development of life-course epidemiology. This can be defined as “the study of long-term biological, behavioural, and psychosocial processes that link adult health and disease risk to physical or social
exposures acting during gestation, childhood, adolescence, earlier in adult life, or across generations” (Ref. , pg 3). Application of methods and principles from life-course epidemiology to problems such
as cardiovascular disease and respiratory conditions has led to improved understanding of the widespread nature of their influence on health. Back pain researchers are beginning to take a longer-term or life-course perspective,  and this chapter aims to summarise some of the work that has been done and point to potential future directions.
Taking a lifetime perspective
The first challenge in moving on from our historical models of back pain is conceptual – thinking of back pain as a long-term or recurrent condition rather than a series of unrelated episodes. A simple ‘yes/no’ question on previous history of back pain has usually been the only information collected about prior pain experience. It is important to understand that people with no back pain at a point in time are not all the same: some may never have had back pain previously, whereas others may have
had one or more significant episodes of pain in the past. Ignoring this fact, and simply studying the onset of a new episode, can introduce biases such as incidence-prevalence bias  – people who have
had back pain before (from which they recovered) will be different from people who have never had back pain, as they might, for example, have certain illness perceptions or health behaviours as a result of their prior pain experience. In classical epidemiology, a risk factor is present in someone without the disease and is related to future onset of disease, but in someone with a prior history of back pain, is a
risk factor really a prognostic factor?
Although there is a general understanding that prior history of back pain is related to occurrence of future episodes (e.g., Ref. ), little is known about the specific influence of the timing, nature and
duration of those episodes – principles from life-course epidemiology relating to chains of risk and cumulative exposure might help elucidate these issues.
Our lack of understanding about back pain over the life course may be limiting treatment, as health care is usually focussed on discrete episodes of pain. There may be alternative approaches to the prevention and management of back pain that could be highlighted by taking a life-course approach.
Epidemiology of back pain over the life course
Prevalence of back pain over the life course
A recent systematic review has estimated the point prevalence of low back pain to be 12%, with a 1–month prevalence around 23%.  There is no strong evidence that these figures are different when children, adolescents or the elderly are considered separately. A recent meta-analysis also estimated the point prevalence of back pain among children/adolescents at 12%.  This paper and another
systematic review indicate that there is a clear rise in prevalence with age among children and adolescents, and adult prevalence levels appear to be reached by around the age of 18 years. [7, 8] At the
other end of the scale, among the elderly (>60 years), back pain again appears to have a similar prevalence as it does among people of middle age , although there is some evidence that severe forms of back pain may increase in prevalence with increasing age  and reduction of activities due
to back pain has been shown to increase with age. 
Although studies of prevalence give indications of the proportion of the population affected by back pain at any one time, it is not possible to tell from these studies whether it is the same people, or different people, who have the pain at different ages and time points. However, as the lifetime prevalence of back pain can be over 80% , it appears that it is not the same 12% of the population that has back pain all the time. This fits with studies showing that at least 40% of people seeking health care do recover within a year of an episode , many much quicker. 
Population-based studies with longer-term follow-up give further insights. One Swiss study with annual follow-ups over 5 years indicated that 14% of adults had back pain at all the follow-up
points and only 35% of the population were back-pain free at all times.  Similarly, a Dutch population study collecting data from adults at three time points over a 10–year period found that 30% of the population were back-pain free at all follow-up points but only 6% had back pain at all points.  A Danish study with 5–year follow-up (which had more stringent criteria for being pain free) found around 23% of people consistently reporting no pain days during the previous year at
each follow-up point, while around 10% reported >30 days of back pain at all points.  These studies, and others, indicate that while long-term persistent back pain is not common in the adult general population, the majority of people do experience back pain off and on over long periods of time.
There is evidence from general population samples that previous experience of back pain is a risk factor for a new episode among all adults [5, 17, 18] and the elderly.  However, among patient populations, systematic reviews show that a history of back pain is not a consistent predictor of
pain persistence , there is limited evidence of its value in predicting recovery  and therefore it is not considered to be useful.  While it seems intuitive that people who have had pain before are more likely to have persistent problems, the fact that a history of back pain is so common among this group (over 80% ) is perhaps one reason for the lack of predictive value. It may also
be difficult for patients to separate previous episodes from the current episode where they have long-term symptoms. It is therefore possible that using more information about the timing (e.g., whether episodes occur during critical periods), number and duration (e.g., to investigate risk accumulation) or nature and severity (e.g., fluctuating/mild or severe persistent trajectories – see the chapter in this issue on back pain trajectories) of previous episodes would add value to information about back pain history.
Back pain episodes
Episodes of back pain can be conceptualised as having sudden onset, sometimes due to trauma, or gradual (or insidious) onset. Most back pain episodes do appear to have sudden onset, with a
population-based study in the UK reporting 59% of back pain to be of sudden onset  and an Australian study in primary care reporting 80% of episodes to be of sudden onset.  Sudden onset of back pain has been linked with good early outcomes, but only among males.  However, how this
onset of pain episode relates to the initial or first onset of back pain, or to the long-term course, is unclear, as over 75% of people with new episodes of pain report having back pain previously. 
Furthermore, it is becoming increasingly clear that back pain is common in children and especially in adolescents.  Thus, the acute onset of back pain episodes commonly reported in general practice might be the result of problems beginning earlier in life.
Factors associated with back pain across the life course
In this section, we present information about factors associated with, predictive of or prognostic for back pain at different points in the life course.
Although genetic factors are present throughout life, they do not necessarily contribute equally to back pain at different life stages, because the relative contribution of various environmental factors varies with age. In a classical twin study, the total contribution of genetic factors to the overall probability of developing back pain decreases from around 70% at age 16 to 36% at age 40 , reflecting an increase in the relative environmental contribution over this age span.
Associations between childhood factors and adult back pain
There have been few studies specifically investigating links between factors identified in childhood or adolescence and the occurrence of back pain as adults. Two studies of Danish twins found associations between birth weight and back pain in young adults and some evidence of an association between social factors in adolescence and back pain later in life. [28, 29] Data from the 1958 British Birth Cohort Study demonstrated links between obesity and weight gain in early adulthood, and the later presence of back pain, but no links with body mass index (BMI) in childhood.  In the 1966 Northern Finland Birth Cohort, researchers found links between being overweight and smoking at the age of 14 years and hospitalisation for sciatica as adults. 
Other studies looking more broadly at chronic pain and functional limitations, or focussed on widespread pain or other pain sites, can provide further relevant information. For example, prospective studies report that childhood behaviour or adverse circumstances (such as road traffic accidents and maternal death), and the presence of symptoms such as abdominal pain and headaches, are associated with chronic widespread pain in adulthood. [32–34] Two studies using recalled information about childhood education, and childhood health and socioeconomic circumstances, showed that these were linked with adult functional limitation or chronic disabling pain, a proportion of which is likely to be caused by musculoskeletal pain. [35, 36] Another study found that components of prenatal, prepubertal and pubertal growth are predictive of grip strength
among adults , which is potentially associated with back pain. Further studies of this type would help us to understand whether, and how, childhood health and circumstances can influence back pain experience later in life. 
Maternal health, and thus pre-term birth or low birth weight, has an influence on the offspring’s susceptibility to disease [39, 40], although the effect size is modest for back pain.  Associations have been reported between parental (predominantly maternal) and child pain (including back pain) in population-based samples [42, 43]; but other studies have not found significant associations [44–46], with reasons for the inconsistent evidence unclear. However, there are indications of
a relationship between prevalence of back pain and parents’ socioeconomic status , and parental education.  Any associations might be partly mediated by lifestyle factors, such as overweight and smoking. Smoking is associated with back pain at all ages [48, 49]; but the association is stronger in adolescence than in adulthood. [50, 51] Another potential explanatory factor is learned health-care-seeking behaviour between parents and children, although a recent review
again reported conflicting evidence for the association between primary care consultations for back pain between parents and children.  The conceptual model suggested by Evans et al. presents a range of other potentially important factors in the links between parental and child pain, including socialisation, life events and family structure.  Good evidence for many of these links is, as yet, unavailable.
There are few prospective population-based studies of the risk of back pain among children and adolescents.  In the studies that have been published, conduct (behavioural) problems and high levels of hyperactivity were significant predictors of future back pain in a British sample  and psychological distress was a risk factor in a Canadian sample.  Other psychological factors such as depression  have also been associated with back pain in cross-sectional studies among adolescents. Among adults, factors such as stress, anxiety and depression are commonly reported risk factors for the development of back pain.  In addition, recent systematic reviews have found that depression, psychological distress, passive coping strategies and fear-avoidance beliefs are independently associated with the transition from acute to chronic back pain  and low levels of fear avoidance are associated with recovery from back pain.  In prospective studies among elderly people, depressive symptoms
scores have been linked with the onset of back pain. [19, 59] Further information about psychological factors in back pain is presented in another chapter within this issue (Pincus & McCracken).
Social determinants for back pain can be identified throughout life, although the nature probably changes during the life course. Problems with peer relationships in adolescents predict persistent back pain.  In working age, factors relating to the workplace have been more intensively studied and associations with factors such as low job satisfaction and perceived workload have been demonstrated [61–63]; and in old age, social support seems to have an impact on back pain , perhaps more so than among younger people.  Socioeconomic factors contribute to the course of back pain in different ways: parents’ socioeconomic status might play a role in back pain in adolescents , educational background is important throughout life  and possible litigation processes and compensation systems play a major role, mainly in the working population. [67–69]
Low back pain after motor vehicle collisions
The World Health Organization estimates that between 20 million and 50 million people are injured in road traffic collisions worldwide each year
(cited 28 August 2013). In the developed nations, the most common injuries occur to the soft tissues of the neck and lower back, and these account for about 80% or more of all motor vehicle injuries. [69, 70] Most patients with whiplash injury to the neck also complain of low back pain , and this is one of the reasons why the Quebec Government Task Force coined the term ‘whiplashassociated disorders’, to encompass the spectrum of soft-tissue injuries and symptoms after traffic injuries.  Overall, about 50% of those injured in traffic collisions complain of collision-related low back pain.  However, for the majority of those injured, it is unlikely that this would be the first time they had experienced low back pain, and it is likely, but yet unproven, that previous low back pain is a risk factor for low back pain after traffic collisions. There is evidence that whiplash injuries to the neck also increase the risk for future pain in the neck, thoracic spine and lower back.  Further, there is a poor correlation between the severity of the collision in terms of force generated and subsequent low back symptoms.  Results like these argue that we need to be acutely aware that neck and back complaints are closely related and share risk factors, even in the context of an obvious trauma. From a life-course perspective, back problems might be more prevalent after injury in those who are less resilient to traumatic events because of cumulative exposure. Further research is needed in this area.
Leisure time physical activity is usually considered to have an impact on back pain at all ages, but the evidence is conflicting. There are more consistent associations found between less back pain and more physical activity in the elderly than in younger populations. [76–79] Contrary to prior beliefs, and in support of the concept of ‘lifetime perspective’, occupational lifting does not seem to be an independent causative factor for the development of back pain.  Workload predicts back pain in adolescents [33, 81], whereas ergonomics does not play a role in relation to body comfort  and
school-bag weight does not predict back pain. 
A high correlation between back pain and pain in other parts of the musculoskeletal system, most commonly other areas of the spine, has been reported, with about one-third of back pain patients also complaining of neck pain. [83–85] This correlation seems to start at an early stage of the pain course, and pain in the three spinal regions behaves quite similarly with respect to occurrence and consequences, which may reflect the same, or similar, underlying aetiology.  This may in part be explained by genetic factors as heritability estimates for pain in the three regions are quite similar [86, 87] and genetic factors are twice as important for the occurrence of concurrent back and neck/shoulder pain as for each of them individually , indicating a common genetic basis for a high proportion of spinal pain. The high degree of co-occurrence is especially important because multisite pain may have more serious consequences than single-site pain.  The risk of poor prognosis increases when spinal pain is accompanied by pain elsewhere [23, 90], and functional problems have been shown to increase with increasing number of pain sites in both adolescence  and old age.  Finally, a higher number
of pain sites are also strongly associated with work disability. 
There are also strong links between back pain and other diseases and general health in adolescents and adults. [84, 94, 95] Similar associations are found for other types of musculoskeletal disorders. [96, 97] The earlier section on psychological factors also describes co-morbid mental health issues.
The mechanisms behind the relationships between back pain and general physical and mental health are poorly understood but they appear to be present throughout the life course. The associations described above are mainly based on cross-sectional studies. However, there are also longitudinal studies where somatisation has been associated with increased risk of back pain among adolescents  and risk of poor prognosis among adult populations [20, 98], indicating that somatisation is a risk factor for back pain. However, the reverse relationship has also been demonstrated where back pain leads to increased somatisation.  Thus, rather than one being a risk factor for the other, there might be some degree of common origin, which could be genetic, social, psychological, physical or a combination, and range across all ages.
It is evident that back pain is present from childhood to old age. Three key points draw us to the conclusion that factors present or developing in early life have a lifelong influence on the experiences of back pain: (i) Many of the factors associated with back pain among adults are also present (and associated with pain) among children; (ii) episodes of back pain are related to each other, even when preceded by a traumatic event; and (iii) evidence on the persistence of pain indicates that it may be the same groups of people who have pain either consistently, or on and off, throughout their life. What exactly
these early life factors are, and how they influence the pain experience is unclear. One possibility is that certain groups of individuals have a susceptibility or vulnerability, which might affect their likelihood of experiencing pain in the first place, but which, probably more importantly, might influence their ability to recover from an episode of pain (whatever the immediate ‘cause’ of the episode), thereby placing them
at increased risk of developing a long-term back pain problem. It seems likely, from the evidence, that this vulnerability results from a combination of genetic and environmental factors, such as socioeconomic situation, parental influences, psychological factors and presence of co-morbidities (pains and
other health problems). Evidence from long-term studies indicates that people with long-term problems can have pain episodes separated by periods that are pain free, continuous mild pain with low impact or severe pain with a large impact on their lives – whether these differences are due to different levels of vulnerability or a cumulative impact of the pain experience remains to be seen.
The epidemiology of back pain in children clearly shows an increase of pain prevalence and healthcare use with age, indicating that this is the age group in which any vulnerability develops or becomes apparent. It would therefore appear appropriate that studies of the incidence and development of back pain in childhood are important.
So where does this leave us in terms of the management of back pain? Management of individual episodes will continue to be important, and treating factors beyond the pain itself (i.e., comorbidity, psychological or work-related factors) is justified based on evidence throughout the life course. However, as highlighted in the chapter in this issue by Foster et al., current treatments have limited or inconsistent benefits for people with back pain. Taking a life-course perspective, and considering the strong correlation between back pain and general health, it seems appropriate to develop a more public
health-centred approach for prevention of long-term back pain in younger people. One example of such an approach is the Svendborg Project in Denmark, which is a public health initiative to treat firstonset back pain in children and to prevent it though activities and education.  Such an approach is important because limitations caused by musculoskeletal pain have a potential to influence all aspects of health and quality of life. Considering the potential consequences, it is apparent that we need to increase our knowledge about the epidemiology of musculoskeletal complaints in children and adolescents, including course, patterns of co-existence with other disorders, prognosis and risk factors.
Back pain research has had a traditional focus on studying episodes of pain, but evidence is mounting that the pain experience should be viewed as a long-term problem, with pain episodes closely linked with each other. Back pain is common throughout the life course, and similar factors are associated with the pain at different times. There is also strong evidence for the links between back pain, pain at other sites and other health problems. This evidence leads to the potential conclusion that vulnerability for long-term back pain develops at an early age, likely in childhood, and influences the occurrence of, and recovery from, episodes of back pain. However, strong evidence directly supporting this is currently lacking but could have important implications for the prevention and management of
KMD is supported by the Wellcome Trust (083572).
Biopsychosocial analysis of low back pain.
Baillière’s Clin Rheumatol 1992;6(3):523–57.
Kuh D, Ben-Shlomo Y.
A life course approach to chronic disease epidemiology.
Oxford: Oxford University Press; 2004.
Extending conceptual frameworks: life course epidemiology
for the study of back pain.
BMC Musculoskelet Disord 2010;11(1):23.
Delgado-Rodríguez M, Llorca J.
J Epidemiol Community Health 2004;58(8):635–41.
Papageorgiou AC, Croft PR, Thomas E, Ferry S, Jayson MI, Silman AJ.
Influence of previous pain experience on the episode incidence of
low back pain: results from the South Manchester Back Pain Study.
Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al.
A systematic review of the global prevalence of low back
Arthritis Rheum 2012;64(6):2028–37.
Calvo-Munoz I, Gomez-Conesa A, Sanchez-Meca J:
Prevalence of Low Back Pain in Children and Adolescents:
BMC Pediatr. 2013 (Jan 26); 13: 14
Jeffries, LJ, Milanese, SF, and Grimer-Somers, KA.
Epidemiology of Adolescent Spinal Pain:
A Systematic Overview of the Research Literature
Spine (Phila Pa 1976). 2007 (Nov 1); 32 (23): 2630–2637
Fejer R, Leboeuf-Yde C.
Does back and neck pain become more common as you get older?
A systematic literature review.
Chiropr Man Therap 2012;20(1):24.
Dionne CE, Dunn KM, Croft PR.
Does back pain prevalence really decrease with increasing age?
A systematic review.
Age Ageing 2006;35(3):229–34.
Leboeuf-Yde C, Fejer R, Nielsen J, Kyvik KO, Hartvigsen J.
Consequences of Spinal Pain: Do Age and Gender Matter?
A Danish Cross-sectional Population-based Study
of 34,902 Individuals 20-71 Years of Age
BMC Musculoskelet Disord. 2011 (Feb 8); 12: 39
The prevalence of low back pain:
a systematic review of the literature from 1966 to 1998.
J Spinal Disord
Hestbaek L, Leboeuf-Yde C, Manniche C.
Low Back Pain: What Is The Long-term Course?
A Review of Studies of General Patient Populations
European Spine Journal 2003 (Apr); 12 (2): 149–165
Pengel LHM, Herbert RD, Maher CG, Refshauge K.
Acute low back pain: systematic review of its prognosis.
BMJ 2003; 327:323–8.
Kolb E, Canjuga M, Bauer GF, Laubli T.
Course of back pain across 5 years:
a retrospective cohort study in the general population of Switzerland.
van Oostrom SH, Monique Verschuren WM, de Vet HC, Picavet HS.
Ten year course of low back pain in an adult population-based cohort –
the Doetinchem Cohort Study.
Eur J Pain 2011;15(9):993–8.
Hestbaek L, Leboeuf-Yde C, Engberg M, et al.
The Course of Low Back Pain in a General Population.
Results From a 5-year Prospective Study
J Manipulative Physiol Ther. 2003 (May); 26 (4): 213–219
Biering-Sørensen F, Thomsen CE, Hilden J.
Risk indicators for low back trouble.
Scand J Rehabil Med 1989;21(3):151–7.
Docking RE, Fleming J, Brayne C, Zhao J, Macfarlane GJ, Jones GT.
Epidemiology of back pain in older adults:
prevalence and risk factors for back pain onset.
Mallen CD, Peat G, Thomas E, Dunn KM, Croft PR.
Prognostic factors for musculoskeletal pain in primary care:
a systematic review.
Br J Gen Pract 2007;57(541):655–61.
Verkerk K, Luijsterburg PA, Miedema HS, Pool-Goudzwaard A, Koes BW.
Prognostic factors for recovery in chronic nonspecific low back pain:
a systematic review.
Phys Ther 2012;92(9):1093–108.
Chou R, Shekelle P.
Will this patient develop persistent disabling low back pain?
J Am Med Assoc 2010;303(13):1295–302.
Dunn KM, Jordan KP, Croft PR.
Contributions of prognostic factors for poor outcome
in primary care low back pain patients.
Eur J Pain 2011;15(3):313–9.
Macfarlane GJ, Thomas E, Croft PR, Papageorgiou AC, Jayson MI, Silman AJ.
Predictors of early improvement in low back pain amongst consulters
to general practice: the influence of pre-morbid and episode-related factors.
Pain 1999; 80(1–2):113–9.
Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, et al.
Prevalence of and screening for serious spinal pathology in patients
presenting to primary care settings with acute low back pain.
Arthritis Rheum 2009;60(10):3072–80.
Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, et al.
Characteristics of patients with acute low back pain
presenting to primary care in Australia.
Clin J Pain 2009;25(1):5–11.
Hestbaek L, Iachine IA, Leboeuf-Yde C, Kyvik KO, Manniche C.
Heredity of low back pain in a young population:
a classical twin study.
Twin Res 2004;7(1):16–26.
Hestbaek L, Leboeuf-Yde C, Kyvik K, Manniche C.
Is low back pain in youth associated with weight at birth?
A cohort study of 8000 Danish adolescents.
Dan Med Bull 2003;50(2):181–4.
Hestbaek L, Korsholm L, Leboeuf-Yde C, Kyvik KO.
Does socioeconomic status in adolescence predict low back pain in adulthood?
A repeated cross-sectional study of 4,771 Danish adolescents.
Eur Spine J 2008;17(12):1727–34.
Lake JK, Power C, Cole TJ.
Back pain and obesity in the 1958 British birth cohort.
Cause or effect?
J Clin Epidemiol 2000; 53(3):245–50.
Rivinoja AE, Paananen MV, Taimela SP, Solovieva S, Okuloff A, Zitting P, et al.
Sports, smoking, and overweight during adolescence as predictors of
sciatica in adulthood: a 28-year follow-up study of a birth cohort.
Am J Epidemiol 2011; 173(8):890–7.
Pang D, Jones GT, Power C, Macfarlane GJ.
Influence of childhood behaviour on the reporting of chronic widespread pain
in adulthood: results from the 1958 British Birth Cohort Study.
Jones GT, Power C, Macfarlane GJ.
Adverse events in childhood and chronic widespread pain in
adult life: results from the 1958 British Birth Cohort Study.
Jones GT, Silman AJ, Power C, Macfarlane GJ.
Are common symptoms in childhood associated with chronic widespread
body pain in adulthood? Results from the 1958 British Birth Cohort Study.
Arthritis Rheum 2007;56(5):1669–75.
Trajectories of functional health: the ‘long arm’ of
childhood health and socioeconomic factors.
Soc Sci Med 2008;66(4):849–61.
Lacey RJ, Belcher J, Croft PR.
Does life course socio-economic position influence chronic
disabling pain in older adults? A general population study.
Eur J Public Health 2013;23(4):534–40.
Kuh D, Hardy R, Butterworth S, Okell L, Wadsworth M, Cooper C, et al.
Developmental origins of midlife grip strength:
findings from a birth cohort study.
J Gerontol A Biol Sci Med Sci 2006;61(7):702–6.
Blyth FM, Jones GT, Macfarlane GJ.
Musculoskeletal health–how early does it start?
Rheumatology (Oxford) 2009; 48(10):1181–2.
Frankel S, Elwood P, Sweetnam P, Yarnell J, Smith GD.
Birthweight, body-mass index in middle age, and incident coronary heart disease.
Leon DA, Lithell HO, Vagero D, Koupilova I, Mohsen R, Berglund L, et al.
Reduced fetal growth rate and increased risk of death from
ischaemic heart disease: cohort study of 15 000
Swedish men and women born 1915-29.
BMJ 1998; 317(7153):241–5.
Littlejohn C, Pang D, Power C, Macfarlane GJ, Jones GT.
Is there an association between preterm birth or low birthweight and
chronic widespread pain? Results from the 1958 Birth Cohort Study.
Eur J Pain 2012;16(1):134–9.
Saunders K, Von Korff M, LeResche L, Mancl L.
Relationship of common pain conditions in mothers and children.
Clin J Pain 2007;23(3):204–13.
Hoftun GB, Romundstad PR, Rygg M.
Association of parental chronic pain with chronic pain in the adolescent
and young adult: family linkage data from the HUNT Study.
JAMA Pediatr 2013;167(1):61–9.
Jones GT, Silman AJ, Macfarlane GJ.
Parental pain is not associated with pain in the child:
a population based study.
Ann Rheum Dis 2004;63(9):1152–4.
Balague F, Skovron ML, Nordin M, Dutoit G, Pol LR, Waldburger M.
Low back pain in schoolchildren.
A study of familial and psychological factors.
Kovacs FM, Gestoso M, Gil Del Real MT, Lopez J, Mufraggi N, Mendez JI.
Risk factors for non-specific low back pain in schoolchildren
and their parents: a population based study.
Mustard CA, Kalcevich C, Frank JW, Boyle M.
Childhood and early adult predictors of risk of incident back pain:
Ontario Child Health Study 2001 follow-up.
Am J Epidemiol 2005;162(8):779–86.
Hestbaek L, Leboeuf-Yde C, Kyvik KO.
Are lifestyle-factors in adolescence predictors for adult low back pain?
A crosssectional and prospective study of young twins.
BMC Musculoskelet Disord 2006;7:27.
Smoking and low back pain. A systematic literature review of
41 journal articles reporting 47 epidemiologic studies.
Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E.
The association between smoking and low back pain: a meta-analysis.
Am J Med 2010;123(1):e7–35.
Alkherayf F, Wai EK, Tsai EC, Agbi C.
Daily smoking and lower back pain in adult Canadians:
the Canadian community health survey.
J Pain Res 2010;3:155–60.
Shraim M, Mallen CD, Dunn KM.
GP consultations for medically unexplained physical symptoms
in parents and their children: a systematic review.
Br J Gen Pract 2013;63(610):e318–25.
Evans S, Tsao JC, Lu Q, Myers C, Suresh J, Zeltzer LK.
Parent-child pain relationships from a psychosocial
perspective: a review of the literature.
J Pain Manag 2008;1(3):237–46.
Hill JJ, Keating JL.
Risk factors for the first episode of low back pain in children
are infrequently validated across samples and conditions:
a systematic review.
J Physiother 2010;56(4):237–44.
Jones GT, Watson KD, Silman AJ, Symmons DP, Macfarlane GJ.
Predictors of low back pain in British schoolchildren:
a population-based prospective cohort study.
Pediatrics 2003;111(4 Pt 1):822–8.
Korovessis P, Repantis T, Baikousis A.
Factors affecting low back pain in adolescents.
J Spinal Disord Tech 2010;23(8):513–20.
Hoy D, Brooks P, Blyth F, Buchbinder R.
The epidemiology of low back pain.
Best Pract Res Clin Rheumatol 2010;24(6):769–81.
Ramond A, Bouton C, Richard I, Roquelaure Y, Baufreton C, Legrand E, et al.
Psychosocial risk factors for chronic low back pain
in primary care – a systematic review.
Fam Pract 2011;28(1):12–21.
Hartvigsen J, Frederiksen H, Christensen K.
Physical and mental function and incident low back pain in seniors:
a population-based two-year prospective study of 1387
Danish twins aged 70 to 100 years.
Jones GT, Macfarlane GJ.
Predicting persistent low back pain in schoolchildren:
a prospective cohort study.
Arthritis Rheum 2009;61(10):1359–66.
Andersen JH, Haahr JP, Frost P.
Risk factors for more severe regional musculoskeletal symptoms:
a two-year prospective study of a general working population.
Arthritis Rheum 2007;56(4):1355–64.
Do psychological factors increase the risk for back pain in the general population
in both a cross-sectional and prospective analysis?
Eur J Pain 2005;9(4):355–61.
Oleske D, Lavender S, Andersson G, Hahn J, Zold-Kilbourn P, len-Toole C, et al.
Job exposures as correlates of recovery in population-based
rehabilitation intervention for work-related low back disorders.
Ann Epidemiol 2000;10(7):481.
Isacsson A, Hanson BS, Ranstam J, Rastam L, Isacsson SO.
Social network, social support and the prevalence of neck and low back pain
after retirement. A population study of men born in 1914 in Malmo, Sweden.
Scand J Soc Med 1995; 23(1):17–22.
Campbell P, Wynne-Jones G, Dunn KM.
The influence of informal social support on risk and
prognosis in spinal pain: a systematic review.
Eur J Pain 2011;15(5): 444.e1–e14.
Dionne CE, Von Korff M, Koepsell TD, Deyo RA, Barlow WE, Checkoway H.
Formal education and back pain: a review.
J Epidemiol Community Health 2001;55(7):455–68.
Rasmussen C, Leboeuf-Yde C, Hestbaek L, Manniche C.
Poor outcome in patients with spine-related leg or arm pain who are
involved in compensation claims: a prospective study of
patients in the secondary care sector.
Scand J Rheumatol 2008;37(6):462–8.
Hestbaek L, Rasmussen C, Leboeuf-Yde C.
Financial compensation and vocational recovery:
a prospective study of secondary care neck and back patients.
Scand J Rheumatol 2009;38(6):481–7.
Cassidy JD, Carroll L, Cote P, Berglund A, Nygren A.
Low back pain after traffic collisions: a population-based cohort study.
Cassidy JD, Carroll LJ, Cote P, Lemstra M, Berglund A, Nygren A.
Effect of eliminating compensation for pain and suffering
on the outcome of insurance claims for whiplash injury.
N Engl J Med 2000;342(16):1179–86.
Hincapié CA, Cassidy JD, Cote P, Carroll LJ, Guzman J.
Whiplash injury is more than neck pain:
a population-based study of pain localization after traffic injury.
J Occup Environ Med 2010;52(4):434–40.
Spitzer WO, Skovron ML, Salmi R, Cassidy JD.
Redefining whiplash and its management.
In: Cassidy JD, editor. Scientific monograph of the Quebec task force on whiplash-associated disorders. 20th ed.
Carroll LJ, Cassidy JD, Côté P.
Factors associated with the onset of an episode of
depressive symptoms in the general population.
J Clin Epidemiol 2003;56(7):651–8.
Berglund A, Alfredsson L, Jensen I, Cassidy JD, Nygren A.
The association between exposure to a rear-end collision
and future health complaints.
J Clin Epidemiol 2001;54(8):851–6.
Beattie N, Lovell ME.
Can patients with low energy whiplash associated disorder
develop low back pain?
Chen SM, Liu MF, Cook J, Bass S, Lo SK.
Sedentary lifestyle as a risk factor for low back pain:
a systematic review.
Int Arch Occup Environ Health 2009;82(7):797–806.
Sitthipornvorakul E, Janwantanakul P, Purepong N, Pensri P, van der Beek AJ.
The association between physical activity and neck
and low back pain: a systematic review.
Eur Spine J 2011;20(5):677–89.
Hildebrandt VH, Bongers PM, Dul J, van Dijk FJ, Kemper HC.
The relationship between leisure time, physical activities and
musculoskeletal symptoms and disability in worker populations.
Int Arch Occup Environ Health 2000;73(8):507–18.
Landmark T, Romundstad PR, Borchgrevink PC, Kaasa S, Dale O.
Longitudinal associations between exercise and pain in the general population –
the HUNT Pain Study.
PLoS One 2013;8(6):e65279.
Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S.
Causal assessment of occupational lifting and low back pain:
results of a systematic review.
Spine J 2010;10(6):554–66.
Mikkonen P, Viikari-Juntura E, Remes J, Pienimaki T, Solovieva S, Taimela S, et al.
Physical workload and risk of low back pain in adolescence.
Occup Environ Med 2012;69(4):284–90.
Brewer JM, Davis KG, Dunning KK, Succop PA.
Does ergonomic mismatch at school impact pain in school children?
Hartvigsen J, Davidsen M, Hestbaek L, Sogaard K, Roos EM.
Patterns of musculoskeletal pain in the population: a latent class analysis
using a nationally representative interviewer-based survey of 4817 Danes.
Eur J Pain 2013;17(3):452–60.
Bartholomeeusen S, Van ZJ, Truyers C, Buntinx F, Paulus D.
Higher incidence of common diagnoses in patients
with low back pain in primary care.
Pain Pract 2012;12(1):1–6.
Beales DJ, Smith AJ, O’Sullivan PB, Straker LM.
Low back pain and comorbidity clusters at 17 years of age: a crosssectional
examination of health-related quality of life and
specific low back pain impacts.
J Adolesc Health 2012; 50(5):509–16.
Hartvigsen J, Nielsen J, Kyvik KO, Fejer R, Vach W, Iachine I, et al.
Heritability of spinal pain and consequences of spinal pain: a comprehensive
genetic epidemiologic analysis using a population-based sample
of 15,328 twins ages 20-71 years.
Arthritis Rheum 2009 Oct 15;61(10):1343–51.
Leboeuf-Yde C, Fejer R, Nielsen J, Kyvik KO, Hartvigsen J.
Pain in the Three Spinal Regions: The Same Disorder?
Data From a Population-based Sample of 34,902 Danish Adults
Chiropractic & Manual Therapies 2012 (Apr 5); 20: 11
Nyman T, Mulder M, Iliadou A, Svartengren M, Wiktorin C.
High heritability for concurrent low back and neckshoulder pain:
a study of twins.
Spine (Phila Pa 1976) 2011;36(22):E1469–76.
Peat G, Thomas E, Wilkie R, Croft P.
Multiple joint pain and lower extremity disability in middle and old age.
Disabil Rehabil 2006;28(24):1543–9.
Thomas E, Silman AJ, Croft PR, Papageorgiou AC, Jayson MI, Macfarlane GJ.
Predicting who develops chronic low back pain in primary care:
a prospective study.
Kamaleri Y, Natvig B, Ihlebaek CM, Benth JS, Bruusgaard D.
Number of pain sites is associated with demographic, lifestyle,
and health-related factors in the general population.
Eur J Pain 2008;12(6):742–8.
Mottram S, Peat G, Thomas E, Wilkie R, Croft P.
Patterns of pain and mobility limitation in older people: cross-sectional
findings from a population survey of 18,497 adults
aged 50 years and over.
Qual Life Res 2008;17(4):529–39.
Kamaleri Y, Natvig B, Ihlebaek CM, Benth JS, Bruusgaard D.
Change in the number of musculoskeletal pain sites:
a 14-year prospective study.
Hestbaek L, Leboeuf-Yde C, Manniche C.
Is low back pain part of a general health pattern or is it a separate
and distinctive entity? A critical literature review
of comorbidity with low back pain.
J Manipulative Physiol Ther 2003; 26(4):243–52.
Hestbaek L, Leboeuf-Yde C, Kyvik KO, Vach W, Russell MB, Skadhauge L, et al.
Comorbidity with low back pain:
a crosssectional population-based survey of 12- to 22-year-olds.
Spine (Phila Pa 1976) 2004;29(13):1483–91.
Calhoun AH, Ford S, Millen C, Finkel AG, Truong Y, Nie Y.
The prevalence of neck pain in migraine.
Headache 2010; 50(8):1273–7.
Nolet PS, Cote P, Cassidy JD, Carroll LJ.
The association between self-reported cardiovascular disorders
and troublesome neck pain: a population-based cohort study.
J Manipulative Physiol Ther 2012;35(3):176–83.
Pincus T, Burton AK, Vogel S, Field AP.
A systematic review of psychological factors as predictors of
chronicity/disability in prospective cohorts of low back pain.
Jensen JC, Haahr JP, Frost P, Andersen JH.
The significance of health anxiety and somatization
in care-seeking for back and upper extremity pain.
Fam Pract 2012;29(1):86–95.
Wedderkopp N, Jespersen E, Franz C, Klakk H, Heidemann M, Christiansen C, et al.
Study protocol. The childhood health, activity, and motor
peformance school study Denmark (The CHAMPS-Study DK).
BMC Pediatr 2012;12:128.
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