Etiology, Risk Factors, and Diagnosis of Back Pain in Children and Adolescents: Evidence- and Consensus-Based Interdisciplinary Recommendations

Abstract

Using a structured approach and expert consensus, we developed an evidence-based guideline on the diagnosis of back pain and the treatment of non-specific back pain in children and adolescents. The first part comprises etiology, risk factors, and diagnosis. The second part, published in the same issue, includes treatment and prevention. A comprehensive and systematic literature search was conducted to identify relevant guidelines and studies. Based on the findings of this literature search, recommendations on risk factors and diagnosis were formulated and voted on by experts in a structured consensus-building process. Notable red flags for specific back pain and evidence-based risk factors for non-specific back pain in children and adolescents were identified. Only three evidence-based recommendations could be formulated for causes, red flags, and risk factors for back pain, while two recommendations are based on expert consensus. Regarding diagnostics, eight expert consensus recommendations and one evidence-based recommendation could be provided. Despite the importance of adequate diagnosis for the treatment of back pain in children and adolescents, results of this work confirm the deficit in research investment in this area.

Back Pain without Disease or Substantial Injury in Children and Adolescents: A Twin Family Study Investigating Genetic Influence and Associations

“…As expected [1], the prevalence for both back pain categories increased with age, but the prevalence was not greater in females.…”

“…Back pain in children and adolescents without substantial trauma or disease is prevalent and is the largest category of back pain in this age group [1,2]. The reported lifetime prevalence of low back pain (LBP) in adolescents ranges from 10% to 70% in previous studies [3][4][5], and prevalence rates increase with age across adolescence for both males and females [3][4][5][6].…”

“…The ICD-11 diagnostic classification is somewhat controversial [9][10][11] and has not yet been widely applied. It has only recently been mentioned in pediatric chronic pain [12][13][14] and was not mentioned in the comprehensive review by Frosch et al [1], in which the term non-specific back pain was applied. Chronic primary pain is defined [8] as pain in one or more anatomical regions that (1) persists or recurs for longer than three months; (2) is associated with significant emotional distress (e.g., anxiety, anger, frustration, or depressed mood) and/or significant functional disability (interference in activities of daily life and participation in social roles); and (3) the symptoms are not better accounted for by another diagnosis.…”

Describing the nonsurgical, nonpharmacological interventions offered to adolescents with persistent back pain in randomized trials: A scoping review

“…Prospective research on adolescents suggests that the risk factors for chronic pain, including chronic back pain, include psychological, social and lifestyle factors such as poor sleep, anxiety, depression, low life satisfaction and low self‐esteem (Beynon et al, 2020; Frosch, Mauritz, et al, 2022; Wager et al, 2020). In early 2022, an expert consensus group published the first evidence‐based interdisciplinary guidelines for treating children and adolescents with nonspecific back pain (Frosch, Leinwather, et al, 2022).…”

Zusammenfassung der S3 Leitlinie „Rückenschmerz bei Kindern und Jugendlichen“

“…Für den Interessierten wurde dies noch ergänzt durch einen Evidenzbericht, in dem alle zitierten Artikel systematisch beschrieben und ausgewertet wurden, so dass jede einzelne Empfehlung gut nachvollziehbar ist. Da sehr viele internationale Studien ausgewertet wurden und die Erkenntnisse auch auf andere Länder übertragbar sind, wurden die Kernaussagen zur Ätiologie und Diagnostik einerseits und Therapie andererseits in zwei englischsprachigen Artikeln in "Children" publiziert [2,3].…”