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Association between untreated low back pain and injury proneness and confounding role of behavioral-health difficulties among younger adolescents: a population-based study

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Abstract

Purpose

Low back pain (LPB) is mostly left untreated (LBPuntreated) and may increase the injury risk due to associated behavioral-health difficulties (BHDs) among adolescents. This study assessed the association between LBPuntreated (vs. treated LBP (LBPtreated)) and injuries and the mediating role of BHDs among younger adolescents (10–16 years).

Methods

This population-based study compared 328 adolescents with LBPuntreated (mean age = 13.7 ± 1.3) with 291 with LBPtreated (mean age = 13.3 ± 1.2) from north-eastern France. They completed a questionnaire collecting, at school-year end, socioeconomic features, LBPtreated/LBPuntreated, BHDs (alcohol/tobacco use, excessive screen-time, poor social support, poor physical health, depressive symptoms, and pain limiting activities), and injuries during the current school-year. Data were analyzed using multinomial logistic regression models and Kaplan–Meier estimates.

Results

The proportion of subjects without alcohol/tobacco use or depressive symptoms decreased with time more quickly since age 10 among the adolescents with LBPuntreated than among those with LBPtreated. Hence, most LBP early started and the subjects with LBPuntreated had a higher risk of single injury (sex-age-class-level-socioeconomic-features-adjusted relative risk ratio RR = 1.63, p < 0.05, vs. LBPtreated) and a much higher risk of ≥ 2 injuries (RR = 2.60, p < 0.001). BHDs played a strong mediating role in the association between LBPuntreated and ≥ 2 injuries (contribution = 48%) but a modest mediating role in that between LBPuntreated and single injury (contribution = 10%) (pseudo R2 = 7.6%).

Conclusion

LBPuntreated is common and associated with injuries partly due to BHDs (which may alter physical/mental capabilities, risk perception/awareness, and vigilance) among younger adolescents. Our results may inform healthcare providers that they can detect/treat LBP and BHDs to prevent their aggravation and injuries.

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Acknowledgements

The authors would like to thank the staff of the schools for their valuable help in the study. This research involved French national institute with public funds and did not received specific funds.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of General Medicine, INSERM, Centre d’Investigations Cliniques Plurithématique 1433, UMR 1116, University of Lorraine, 20199, 9, avenue de la Forêt de Haye, 54500, Vandoeuvre-lès-Nancy, Meurthe-et-Moselle, France

    Kénora Chau

  2. Institut National de la Santé et de la recherche médicale (INSERM), unit 1178, CESP, Paris Sud University, Paris Descartes University, Maison de Solenn, 97, Boulevard de Port Royal, 75679, Paris Cedex 14, France

    Nearkasen Chau

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and data analysis were performed by KC. NC contributed to the data analysis. All authors contributed to the writing of the first draft, commented on previous versions of the manuscript, and read and approved the final manuscript.

Corresponding author

Correspondence to Nearkasen Chau.

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The authors declare that they have no conflict of interest, no financial interest, and no contractual constraints on publishing. There is no connection of any of the researchers with the tobacco, alcohol, pharmaceutical or gaming industries or anybody substantially funded by one of these organizations.

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Chau, K., Chau, N. Association between untreated low back pain and injury proneness and confounding role of behavioral-health difficulties among younger adolescents: a population-based study. Eur Spine J 32, 2069–2077 (2023). https://doi.org/10.1007/s00586-023-07679-4

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  • DOI: https://doi.org/10.1007/s00586-023-07679-4

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