Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Feb 2;9(2):192.
doi: 10.3390/children9020192.

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

Michael Frosch  1   2 , Maximilian D Mauritz  1   2 , Stefan Bielack  3 , Susanne Blödt  4 , Uta Dirksen  5 , Michael Dobe  1   2 , Florian Geiger  6 , Renate Häfner  7 , Lea Höfel  7 , Bettina Hübner-Möhler  1   2 , Thekla von Kalle  8 , Burkhard Lawrenz  9 , Andreas Leutner  10 , Frauke Mecher  11 , Kiril Mladenov  12 , Heike Norda  13 , Lorin Stahlschmidt  1   2 , Marc Steinborn  14 , Ralf Stücker  12 , Ralf Trauzeddel  15 , Regina Trollmann  16 , Julia Wager  1   2 , Boris Zernikow  1   2
Affiliations
Review

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

Michael Frosch et al. Children (Basel). .

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.

Keywords: adolescents; back pain; children; diagnosis; etiology; evidence-based; guideline; risk factors.

PubMed Disclaimer

Conflict of interest statement

The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart. LoE = Level of evidence. 1 n = 206 articles did not contain sufficient information regarding underlying disease or concomitant symptoms for further analysis. 2 Eight articles were included for specific and non-specific back pain.
Figure 2
Figure 2
Diagnostic algorithm for back pain in children and adolescents. Green box = treatment; blue box = diagnostic measures; red box = diagnostic decision. 1 Red flags for specific back pain (Chapter 3.1.1, Table 1), 2 Risk factors for non-specific back pain (Chapter 3.1.2, Table 2), 3 Low life satisfaction, anxiety, depression, low self-esteem (see Table 2).
See this image and copyright information in PMC

References

    1. MacDonald J., Stuart E., Rodenberg R. Musculoskeletal Low Back Pain in School-aged Children: A Review. JAMA Pediatr. 2017;171:280–287. doi: 10.1001/jamapediatrics.2016.3334. - DOI - PubMed
    1. Yang S., Werner B.C., Singla A., Abel M.F. Low Back Pain in Adolescents: A 1-Year Analysis of Eventual Diagnoses. J. Pediatr. Orthop. 2017;37:344–347. doi: 10.1097/BPO.0000000000000653. - DOI - PubMed
    1. Hestbaek L., Leboeuf-Yde C., Kyvik K.O. Is comorbidity in adolescence a predictor for adult low back pain? A prospective study of a young population. BMC Musculoskelet. Disord. 2006;7:29. doi: 10.1186/1471-2474-7-29. - DOI - PMC - PubMed
    1. Kamper S.J., Yamato T.P., Williams C.M. The prevalence, risk factors, prognosis and treatment for back pain in children and adolescents: An overview of systematic reviews. Best Pract. Res. Clin. Rheumatol. 2016;30:1021–1036. doi: 10.1016/j.berh.2017.04.003. - DOI - PubMed
    1. Feldman D.S., Straight J.J., Badra M.I., Mohaideen A., Madan S.S. Evaluation of an Algorithmic Approach to Pediatric Back Pain. J. Pediatr. Orthop. 2006;26:353–357. doi: 10.1097/01.bpo.0000214928.25809.f9. - DOI - PubMed

LinkOut - more resources