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Spinal pain in childhood: prevalence, trajectories, and diagnoses in children 6 to 17 years of age

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Abstract

This study aimed to investigate the trajectories of spinal pain frequency from 6 to 17 years of age and describe the prevalence and frequency of spinal pain and related diagnoses in children following different pain trajectories. First through fifth-grade students from 13 primary schools were followed for 5.5 years. Occurrences of spinal pain were reported weekly via text messages. Children reporting spinal pain were physically evaluated and classified using International Classification of Disease criteria. Trajectories of spinal pain frequency were modeled from age 6 to 17 years with latent class growth analysis. We included data from 1556 children (52.4% female, mean (SD) baseline age = 9.1 (1.9) years) and identified 10,554 weeks of spinal pain in 329,756 weeks of observation. Sixty-three percent of children reported one or more occurrences of spinal pain. We identified five trajectories of spinal pain frequency. Half the children (49.8%) were classified as members of a “no pain” trajectory. The remaining children followed “rare” (27.9%), “rare, increasing” (14.5%), “moderate, increasing” (6.5%), or “early-onset, decreasing” (1.3%) spinal pain trajectories. The most common diagnoses in all trajectory groups were non-specific (e.g., “back pain”). Tissue-specific diagnoses (e.g., muscle strain) were less common and pathologies (e.g., fracture) were rare.

  Conclusion: From childhood through adolescence, spinal pain was common and followed heterogeneous courses comprising stable, increasing, and early-onset trajectories. These findings accord with recommendations from adult back pain guidelines that most children with spinal pain can be reassured that they do not have a serious disease and encouraged to stay active.

What is Known:

• Spinal pain imposes a large burden on individuals and society.

• Although many people first experience the condition in childhood, little is known about the developmental trajectories of spinal pain from childhood to adolescence.

What is New:

• Data from 1556 children and 329,756 participant weeks showed five unique spinal pain trajectories from 6 to 17 years: most children rarely reported spinal pain, while one in five followed increasing or early-onset trajectories.

• Most pain occurrences were non-specific; pathological diagnoses were rare.

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Availability of data and material

Data are available from the CHAMPS Study Steering Committee upon reasonable request. Legal and ethical restrictions apply. Interested parties may contact Dr. Niels Christian Møller (nmoller@health.sdu.dk), and the following information will be required at the time of application: a description of how the data will be used, securely managed, and permanently deleted.

Code availability

The code used in the analysis is available upon reasonable request.

Abbreviations

CHAMPS study-DK:

Childhood health, activity, and motor performance school study Denmark

ICD:

International Classification of Diseases

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Funding

The CHAMPS Study-DK was originally supported by grants from The TRYG Foundation, University College Lillebaelt, University of Southern Denmark, The Nordea Foundation, The IMK foundation, e.g., The Egmont Foundation, The A.J. Andersen Foundation, The Danish Rheumatism Association, Østifternes Foundation, Brd. Hartmann’s Foundation, TEAM Denmark, The Danish Chiropractor Foundation, and The Nordic Institute of Chiropractic and Clinical Biomechanics. No funding was secured for the current study. The funders had no role in the design or conduct of the study.

Author information

Authors and Affiliations

  1. Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada

    Jeffrey J. Hébert

  2. College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia

    Jeffrey J. Hébert & Amber M. Beynon

  3. Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia

    Amber M. Beynon & Michael S. Swain

  4. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Bobby L. Jones

  5. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada

    Chinchin Wang

  6. Centre for Clinical Epidemiology, Lady Davis Institute, McGill University, Montreal, QC, Canada

    Chinchin Wang & Ian Shrier

  7. Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    Jan Hartvigsen, Lise Hestbæk & Tina Junge

  8. Chiropractic Knowledge Hub, Odense, Denmark

    Jan Hartvigsen & Lise Hestbæk

  9. Department of Regional Health Research, University of Southern Denmark, Odense, Denmark

    Charlotte Leboeuf-Yde

  10. Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark

    Tina Junge

  11. Private Practice, Haderslev, Denmark

    Claudia Franz

  12. Department of Regional Health Research, Center of Research in Childhood Health, University of Southern Denmark, Odense, Denmark

    Niels Wedderkopp

Authors
  1. Jeffrey J. Hébert
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  2. Amber M. Beynon
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  3. Bobby L. Jones
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  4. Chinchin Wang
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  5. Ian Shrier
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  7. Charlotte Leboeuf-Yde
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  8. Lise Hestbæk
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  9. Michael S. Swain
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  10. Tina Junge
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  11. Claudia Franz
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  12. Niels Wedderkopp
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Contributions

Prof Hébert analyzed and interpreted the data, drafted the initial manuscript, and critically reviewed the manuscript for important intellectual content. Dr Beynon, Ms Wang, Dr Shrier, and Dr Swain carried out initial analyses and interpreted the data, and critically reviewed the manuscript for important intellectual content. Dr Jones analyzed and interpreted the data and critically reviewed the manuscript for important intellectual content. Prof Leboeuf-Yde, Prof Hartvigsen, and Prof Hestbæk conceptualized and designed the study, and critically reviewed the manuscript for important intellectual content. Dr Junge and Dr Franz acquired data and critically reviewed the manuscript for important intellectual content. Prof Wedderkopp conceptualized and designed the study, coordinated and supervised data collection, interpreted the data, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Jeffrey J. Hébert.

Ethics declarations

Ethics approval

The study protocol was approved by the Regional Scientific Ethical Committee of Southern Denmark (ID S-20080047) and registered with the Danish Data Protection Agency (J.nr. 2008–41-2240).

Consent to participate

All participating children gave verbal assent and parents provided written informed consent prior to enrollment.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests. Prof Hébert receives salary and research support from the Canadian Chiropractic Research Foundation and the New Brunswick Health Research Foundation.

Additional information

Communicated by Gregorio Paolo Milani

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Hébert, J.J., Beynon, A.M., Jones, B.L. et al. Spinal pain in childhood: prevalence, trajectories, and diagnoses in children 6 to 17 years of age. Eur J Pediatr 181, 1727–1736 (2022). https://doi.org/10.1007/s00431-021-04369-5

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  • DOI: https://doi.org/10.1007/s00431-021-04369-5

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