European Journal of Pediatrics

, Volume 176, Issue 6, pp 807–814 | Cite as

Spinal pain and co-occurrence with stress and general well-being among young adolescents: a study within the Danish National Birth Cohort

  • Sandra Elkjær StallknechtEmail author
  • Katrine Strandberg-Larsen
  • Lise Hestbæk
  • Anne-Marie Nybo Andersen
Original Article


This study aims to describe the patterns in low back, mid back, and neck pain complaints in young adolescents from the Danish National Birth Cohort (DNBC) and to investigate the co-occurrence of spinal pain and stress and general well-being, respectively. Cross-sectional data from the 11-year follow-up of DNBC were used. As part of a web-based survey, a total of 45,371 young adolescents between 10 and 14 years old completed the Young Spine Questionnaire, the Stress in Children Questionnaire, and a one-item question on general well-being. Associations between spinal pain and, respectively, stress and general well-being were estimated by means of multiple logistic regression models. Almost one fifth of boys and one quarter of girls reported spinal pain. Compared with adolescents who reported no stress, adolescents reporting medium and high values of stress had odds ratios (OR) of 2.19 (95% CI 2.08–2.30) and 4.73 (95% CI 4.28–5.23), respectively, of reporting spinal pain (adjusted for age, gender, and maternal education). Adolescents who reported poor general well-being had an OR of 2.50 (95% CI 2.31–2.72) for reporting spinal pain compared to adolescents with good general well-being.

Conclusion: Spinal pain is a common complaint among young adolescents and co-occurs with stress and poor general well-being. The mutual dependency between the factors remained to be explained.

What is Known:

The prevalence of spinal pain increases rapidly during childhood and adolescence, but different measurement instruments result in great variation in the estimates of spinal pain in children and adolescents.

Some studies have shown that different psychosocial measures are associated with spinal pain in children and adolescents.

What is New:

Spinal pain, as measured by the newly developed and validated Young Spine Questionnaire, is a common complaint in young adolescents aged 10–14 years.

Spinal pain in young adolescents co-occurs with stress and poor general well-being.


Back pain Lumbar pain Thoracic pain Neck pain School children 



Danish National Birth Cohort


Odds ratio


The revised version of the Faces Pain Scale


Standard deviation


Strengths and Difficulties Questionnaire


Stress in Children


Young Spine Questionnaire

95% CI

95% confidence intervals



The Danish National Research Foundation established the Danish Epidemiology Science Centre, where the Danish National Birth Cohort was initiated. The cohort is furthermore a result of a major grant from this foundation. Additional support for the DNBC is obtained from the Pharmacy Foundation, the Egmont Foundation, the March Dimes Birth Defects Foundation, the Augustinus Foundation, and the Health Foundation. The DNBC 11-year follow-up was supported by grants from the Danish Council for Independent Research (DFF) and the Lundbeck Foundation.

Authors’ contributions

Sandra Elkjær Stallknecht: Ms. Stallknecht analyzed the data and wrote the first draft of the manuscript.

Katrine Strandberg-Larsen: Ms. Strandberg-Larsen made substantial contributions to conception and design as well as analysis and interpretation of data, and reviewed and revised the manuscript.

Lise Hestbæk: Ms. Hestbæk developed the Young Spine Questionnaire, made substantial contributions to interpretation of results, and reviewed and revised the manuscript.

Anne-Marie Nybo Andersen: Ms. Andersen made substantial contributions to interpretation of results and reviewed and revised the manuscript.

All authors conceptualized and designed this study. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Compliance with ethical standards


This particular work was supported by the University of Copenhagen, the Danish Council for Independent Research (DFF), and the Lundbeck Foundation.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all mothers included in the study and children were invited to the study through an invitation to the mother.

Supplementary material

431_2017_2915_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14 kb)
431_2017_2915_MOESM2_ESM.docx (14 kb)
ESM 2 (DOCX 14 kb)
431_2017_2915_MOESM3_ESM.docx (4.8 mb)
ESM 3 (DOCX 4916 kb)


  1. 1.
    Aartun E, Hartvigsen J, Wedderkopp N, Hestbaek L (2014) Spinal pain in adolescents: prevalence, incidence, and course: a school-based two-year prospective cohort study in 1,300 Danes aged 11-13. BMC Musculoskelet Disord 15(1):187. doi: 10.1186/1471-2474-15-187 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Brattberg G (2004) Do pain problems in young school children persist into early adulthood? A 13-year follow-up. Eur J Pain 8(3):187–199. doi: 10.1016/j.ejpain.2003.08.001 CrossRefPubMedGoogle Scholar
  3. 3.
    Calvo-Munoz I, Gomez-Conesa A, Sanchez-Meca J (2013) Prevalence of low back pain in children and adolescents: a meta-analysis. BMC Pediatr 13:14. doi: 10.1186/1471-2431-13-14 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Cantril H (1965) The pattern of human concerns. Rutgers University Press, New BrunswickGoogle Scholar
  5. 5.
    Currie C, Zanotti C, Morgan A, Currie D, de Looze M, Roberts C, Samdal O, Smith O, Barnekow V (2012) Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from the 2009/2010 survey. WHO Regional Office for Europe (Health Policy for Children and Adolescents, No. 6), CopenhagenGoogle Scholar
  6. 6.
    Diepenmaat AC, van der Wal MF, de Vet HC, Hirasing RA (2006) Neck/shoulder, low back, and arm pain in relation to computer use, physical activity, stress, and depression among Dutch adolescents. Pediatrics 117(2):412–416CrossRefPubMedGoogle Scholar
  7. 7.
    Dunn KM, Hestbaek L, Cassidy JD (2013) Low back pain across the life course. Best Pract Res Clin Rheumatol 27(5):591–600. doi: 10.1016/j.berh.2013.09.007 CrossRefPubMedGoogle Scholar
  8. 8.
    Greene N, Greenland S, Olsen J, Nohr EA (2011) Estimating bias from loss to follow-up in the Danish National Birth Cohort. Epidemiology 22(6):815–822. doi: 10.1097/EDE.0b013e31822939fd PubMedGoogle Scholar
  9. 9.
    Gunzburg R, Balague F, Nordin M, Szpalski M, Duyck D, Bull D, Melot C (1999) Low back pain in a population of school children. Eur Spine J 8(6):439–443CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Hemingway H, Shipley MJ, Stansfeld S, Marmot M (1997) Sickness absence from back pain, psychosocial work characteristics and employment grade among office workers. Scand J Work Environ Health 23(2):121–129CrossRefPubMedGoogle Scholar
  11. 11.
    Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C (2006) The course of low back pain from adolescence to adulthood: eight-year follow-up of 9600 twins. Spine 31(4):468–472. doi: 10.1097/01.brs.0000199958.04073.d9 CrossRefPubMedGoogle Scholar
  12. 12.
    Hestbaek L, Korsholm L, Leboeuf-Yde C, Kyvik KO (2008) Does socioeconomic status in adolescence predict low back pain in adulthood? A repeated cross-sectional study of 4,771 Danish adolescents. Eur Spine J 17(12):1727–1734. doi: 10.1007/s00586-008-0796-5 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B (2001) The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement. Pain 93(2):173–183CrossRefPubMedGoogle Scholar
  14. 14.
    Jeffries LJ, Milanese SF, Grimmer-Somers KA (2007) Epidemiology of adolescent spinal pain: a systematic overview of the research literature. Spine 32(23):2630–2637. doi: 10.1097/BRS.0b013e318158d70b CrossRefPubMedGoogle Scholar
  15. 15.
    Lauridsen HH, Hestbaek L (2013) Development of the young spine questionnaire. BMC Musculoskelet Disord 14:185. doi: 10.1186/1471-2474-14-185 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Levin K, Currie C (2013) Reliability and validity of an adapted version of the Cantril Ladder for use with adolescent samples. Soc Indic ResGoogle Scholar
  17. 17.
    Linton SJ (2000) A review of psychological risk factors in back and neck pain. Spine 25(9):1148–1156CrossRefPubMedGoogle Scholar
  18. 18.
    Manchikanti L, Singh V, Datta S, Cohen SP, Hirsch JA (2009) Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Phys 12(4):E35–E70Google Scholar
  19. 19.
    Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, Sullivan SD (2008) Expenditures and health status among adults with back and neck problems. JAMA 299(6):656–664. doi: 10.1001/jama.299.6.656 CrossRefPubMedGoogle Scholar
  20. 20.
    Mohapatra S, Deo S, Satapathy A, Rath N (2014) Somatoform disorders in children and adolescents. German J Psychiatr 17(1):19–24Google Scholar
  21. 21.
    Murphy B, Buckle P, Stubbs D (2007) A cross-sectional study of self-reported back and neck pain among English schoolchildren and associated physical and psychological risk factors. Appl Ergon 38:797–804CrossRefPubMedGoogle Scholar
  22. 22.
    Mustard CA, Kalcevich C, Frank JW, Boyle M (2005) Childhood and early adult predictors of risk of incident back pain: Ontario Child Health Study 2001 follow-up. Am J Epidemiol 162(8):779–786. doi: 10.1093/aje/kwi271 CrossRefPubMedGoogle Scholar
  23. 23.
    Nohr EA, Frydenberg M, Henriksen TB, Olsen J (2006) Does low participation in cohort studies induce bias? Epidemiology 17(4):413–418. doi: 10.1097/01.ede.0000220549.14177.60 CrossRefPubMedGoogle Scholar
  24. 24.
    Olsen J, Melbye M, Olsen SF et al (2001) The Danish National Birth Cohort—its background, structure and aim. Scand J Public Health 29(4):300–307CrossRefPubMedGoogle Scholar
  25. 25.
    Osika W, Friberg P, Wahrborg P (2007) A new short self-rating questionnaire to assess stress in children. Int J Behav Med 14(2):108–117CrossRefPubMedGoogle Scholar
  26. 26.
    Pincus T, McCracken LM (2013) Psychological factors and treatment opportunities in low back pain. Best Pract Res Clin Rheumatol 27(5):625–635. doi: 10.1016/j.berh.2013.09.010 CrossRefPubMedGoogle Scholar
  27. 27.
    Szpalski M, Gunzburg R, Balague F, Nordin M, Melot C (2002) A 2-year prospective longitudinal study on low back pain in primary school children. Europ Spine J 11(5):459–464. doi: 10.1007/s00586-002-0385-y CrossRefGoogle Scholar
  28. 28.
    Torsheim T, Eriksson L, Schnohr CW, Hansen F, Bjarnason T, Valimaa R (2010) Screen-based activities and physical complaints among adolescents from the Nordic countries. BMC Public Health 10:324. doi: 10.1186/1471-2458-10-324 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Vos T, Flaxman AD, Naghavi M et al (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2163–2196CrossRefPubMedGoogle Scholar
  30. 30.
    Watson K, Papageorgiou A, Jones G, Taylor S, Symmons D, Silman A, Macfarlane G (2003) Low back pain in schoolchildren: the role of mechanical and psychosocial factors. Arch Dis Child 88(1):12–17CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Public Health, Section of Social MedicineUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of Sports Science and Clinical Biomechanics, Clinical BiomechanicsUniversity of Southern DenmarkOdenseDenmark

Personalised recommendations