Background & Aims
The rising prevalence of low back pain necessitates a nuanced exploration of pain recall accuracy, particularly among youth [1,2,3]. Reliable self-reports are crucial for comprehensive clinical and epidemiological research, encompassing the assessment of prevalence, natural history, and long-term impacts [4]. This study aimed to quantify the 5-year recall of back pain in adolescents from a Portuguese birth cohort and explore how sensitivity and pain history predict recall agreement.
Methods
We analyzed data of 1,089 participants from the Generation XXI population-based birth cohort (2005/6), based in Porto, Portugal, focusing on adolescents who completed the Lübeck Pain-Screening Questionnaire (LPQ) at age 13 and an explicit pain memory questionnaire at age 18 [5, 6]. We compared back pain reported at 13 to recalled back pain at 18, investigating instances of forgetting/under-recalling, over-recalling, correctly recalling presence /absence of back pain. We further merged both concordant recalls into a single group and under-recalling and over-recalling of any back pain as discordant recall instances. Parameters such as current pain, family history of pain, health-related quality of life (Kiddo-KINDL), environmental sensitivity (Highly Sensitive Child Scale), and self-perceived pain sensitivity (“In general, pain doesn’t bother me as much as it does others”) were analyzed [7-9].
Results
At age 18, 3% of participants correctly recalled experiencing back pain at age 13, whereas over three-quarters accurately recalled its absence. About 12% under-recalled, and 8% over-recalled past back pain. Discordant recall was more common among current pain sufferers than those without pain (78.3% vs 21.7%; p<0.001). Family history of chronic pain was associated with decreased recall accuracy (adjusted OR 0.63; 95% CI 0.47 – 0.85). Males had significantly higher odds of correct recall of prior back pain than females (OR 1.62; 95% CI 1.20 – 2.19). Current back pain was linked to 60% lower odds of correct recall (adjusted OR 0.40; 95% CI 0.26 – 0.63), whereas higher environmental sensitivity increased the odds of correct recall (adjusted OR 1.74; 95% CI 1.07 – 2.85). Diagnosis of any disease was associated with 30% lower odds of correct recall (adjusted OR 0.70; 95% CI 0.49 – 0.99).
Conclusions
Only a small percentage of adolescents remembered having back pain after 5 years, while almost 12% under-recalled it. Males and adolescents with higher environmental sensitivity demonstrated higher accuracy in recalling prior back pain status, whereas concurrent pain, a diagnosis of any disease, and a family history of pain were linked to reduced accuracy in recalling past back pain experiences. These findings highlight the importance of considering individual and familial factors in assessments of adolescent pain and underscore the need for tailored approaches in evaluating patient-reported pain histories. It is important to recognize that recalling past pain is not merely a cognitive task but involves a reassessment influenced by current experiences and perspectives.
Investigating adolescents’ ability to recall back pain experiences from five years prior has implications for patient care, influencing clinical practice, diagnostic approaches, treatment strategies, and overall patient well-being. The low percentage of accurately recalling pain at age 13 highlights challenges in relying on memory for clinical assessments. Understanding factors influencing recall, such as family history of and the impact of ongoing pain on memory accuracy, can guide healthcare professionals in interpreting patients’ reported pain histories.
References
1.Ferreira, M. L., de Luca, K., Haile, L. M., Steinmetz, J. D., Culbreth, G. T., Cross, M., & Mahmoodpoor, A. (2023). Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology, 5(6), e316-e329.
2.Calvo-Muñoz, I., Gómez-Conesa, A., & Sánchez-Meca, J. (2013). Prevalence of low back pain in children and adolescents: a meta-analysis. BMC pediatrics, 13(1), 1-12.
3.Hestbaek, L., Leboeuf-Yde, C., & Kyvik, K. O. (2006). Is comorbidity in adolescence a predictor for adult low back pain? A prospective study of a young population. BMC musculoskeletal disorders, 7, 1-7.
4.Noel, M., Palermo, T. M., Chambers, C. T., Taddio, A., & Hermann, C. (2015). Remembering the pain of childhood: applying a developmental perspective to the study of pain memories. Pain, 156(1), 31-34.
5.Alves, E., Correia, S., Barros, H., & Azevedo, A. (2012). Prevalence of self-reported cardiovascular risk factors in Portuguese women: a survey after delivery. International journal of public health, 57, 837-847.
6. Roth-Isigkeit, A., Thyen, U., Stöven, H., Schwarzenberger, J., & Schmucker, P. (2005). Pain among children and adolescents: restrictions in daily living and triggering factors. Pediatrics, 115(2), e152-e162.
7. Teixeira, I. P., Novais, I. D. P., Pinto, R. D. M. C., & Cheik, N. C. (2012). Cultural adaptation and validation of the KINDL questionnaire in Brazil for adolescents between 12 and 16 years of age. Revista Brasileira de Epidemiologia, 15, 845-857.
8. Bullinger, M., Brütt, A. L., Erhart, M., Ravens-Sieberer, U., & BELLA Study Group. (2008). Psychometric properties of the KINDL-R questionnaire: results of the BELLA study. European child & adolescent psychiatry, 17, 125-132.
9. Pluess, M., Assary, E., Lionetti, F., Lester, K. J., Krapohl, E., Aron, E. N., & Aron, A. (2018). Environmental sensitivity in children: Development of the Highly Sensitive Child Scale and identification of sensitivity groups. Developmental psychology, 54(1), 51
Presenting Author
Nare Navasardyan
Poster Authors
Nare Navasardyan
MSc
EPIUnit, Institute of Public Health of the University of Porto, Portugal
Lead Author
Ana Henriques
EPIUnit, Institute of Public Health of the University of Porto, Portugal
Lead Author
S. Bernardes
Iscte - Lisbon University Institute/Centro de Investigação e Intervenção Social (CIS), Department of Social and Organizational Psychology
Lead Author
M. Talih
EPIUnit, Institute of Public Health of the University of Porto, Portugal
Lead Author
Raquel Lucas
EPIUnit, Institute of Public Health of the University of Porto, Portugal
Lead Author
Topics
- Epidemiology