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The association between psychological and social factors and spinal pain in adolescents

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Spinal pain, back pain, and/or neck pain begins early in life and is strongly associated with spinal pain in adulthood. Understanding the relationship between psychological and social factors and adolescent spinal pain may be important in both the prevention and treatment of spinal pain in this age group. We aimed to determine if psychological and social factors were associated with spinal pain in a cross-sectional study of a school-based cohort of 1279 Danish adolescents aged 11–13, who were categorized into “any” and “substantial” spinal pain. “Substantial spinal pain” was defined as a lifetime frequency of “sometimes” or “often” and a pain intensity of at least two on the revised Faces Pain Scale. Logistic regression analyses, stratified by sex, were conducted for single and all variables together. Eighty-six percent of participants reported “any spinal pain” and 28% reported “substantial spinal pain”. Frequency of psychological and social factors was significantly higher in those with spinal pain compared to those without. As the frequency of psychological and social factors increased, the odds of both “any spinal pain” and “substantial spinal pain” also increased.

Conclusion: Psychological and social factors may be important determinants in adolescent spinal pain.

What is Known:

Spinal pain begins early in life to reach adult levels by age 18. Spinal pain in adolescence is strongly associated with spinal pain in adulthood.

In adults, psychological and social factors and spinal pain are strongly related; however, this relationship in adolescence is poorly understood.

What is New:

Adolescents with spinal pain reported a significantly higher frequency of psychological factors and loneliness and lower levels of pupil acceptance.

Adolescents reporting higher levels of loneliness, lower levels of pupil acceptance, and increased frequency of psychological factors had increased odds of reportingsubstantial spinal pain”.

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Confidence interval


Health Behaviour in School-Aged Children


odds ratio


Revised Faces Pain Scale


spinal pain


Young Spine Questionnaire


Socioeconomic status


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The SPACE study was provided by the Centre for Intervention Research and funded by TrygFonden.

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Authors and Affiliations



SB: analyzed the data and drafted the manuscript. EA and JH: contributed to the interpretation of results. PS: reviewed and revised the manuscript. EB: aided in the analysis and interpretation of the data. LH: contributed substantially to the interpretation of results.

All authors contributed to the conception and study design and reviewed, revised, and approved the manuscript.

Corresponding author

Correspondence to Sarah Batley.

Ethics declarations


For the SPACE study, a letter was sent to parents informing them of the study and that they could withdraw their child’s participation at any time. For more details, see the SPACE protocol [29]. The Regional Ethics Committee for Southern Denmark was advised about the study and data collection. Under Danish law, no ethics approval was needed because the study did not include any invasive tests or interventions. Approval was obtained from the Danish Data Protection Agency (#2010-41-5147).

For the current study, Research Ethics Board approval was obtained from Canadian Memorial Chiropractic College (#172011).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Approval was obtained from the Danish Data Protection Agency (#2010-41-5147). Research Ethics Board approval was obtained from Canadian Memorial Chiropractic College (#172011).

Informed consent

For the SPACE study, a letter was sent to parents informing them of the study and that they could withdraw their child’s participation at any time.

Additional information

Communicated by Mario Bianchetti

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Batley, S., Aartun, E., Boyle, E. et al. The association between psychological and social factors and spinal pain in adolescents. Eur J Pediatr 178, 275–286 (2019).

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