Background & Aims

Low back pain (LBP) is a highly disabling musculoskeletal complaint, present in all age groups, including young people. This complaint is among the 10 main causes of disability in the child and adolescent population, therefore it is necessary to give due attention to this population that complains of LBP early on. An approach according to the biopsychosocial model is encouraged to understand the complexity of LBP. Identifying associated variables in different dimensions contributes to understanding of LBP in the lives of children and adolescents and in which social context they are inserted. However, most of these studies explore the factors associated with the general prevalence of LBP, but the factors associated with disabling LBP, that is, pain that generates a negative impact in life, are still little explored. Thus, the objective of the study was to analyze the association between biophysical and psychosocial factors and the presence of disabling LBP in children and adolescents.

Methods

Cross-sectional study. Students aged 8 to 18 in public schools participated. Disabling LBP was assessed by the modified Presence and Impact of Pain in Kids (PIP-Kids) questionnaire. We also investigated sociodemographic characteristics, pain intensity (Numerical Rating Scale – NRS), number of painful sites (modified PIP-Kids), agreement between guardians and children about the presence of disabling LBP (PIP-Kids modified children version vs. parent version), psychosomatic symptoms (Psychosomatic Questionnaire for Children and Adolescents Brazilian-Portuguese version), sleep disorders (Pediatric sleep questionnaire – PSQ) perception of backpack weight, frequency of practicing sports and time of use of electronic devices. All instruments used were validated for the researched population. We built models by logistic regressions to analyze the dependent variable disabling LBP and the independent biophysical, psychological, social and lifestyle variables.

Results

777 children and adolescents were included, median age of 13 years (08-18), of which 59 (7.6%) had disabling LBP, 61% females. Median pain intensity was 6 out of 10 points. Bivariate logistic regression were: pain intensity (Odds ratio [OR] 1.23 [95%CI 1.09-1.37]), painful sites (OR 3.42 [95%CI 2.46-4.75]), psychosomatic symptoms (OR 1.16 [95%CI 1.08-1.24]), sleep disorders (OR 7.58 [95%CI 1.96-29.25]), agreement on reports of pain (OR 0.01[95%CI 0.008-0.03]), hours of cell phone use (OR 2.09 [95%CI 1.08-4.04]), spending more than 3 hours TV/games (OR 1.49 [95%CI 0.87-2.57]) and perception of backpack weight (OR 1.52 [95%CI 0.88-2.62]). The multivariate regression analysis revealed that those with disabling LBP were those with greater pain intensity (OR 1.32 [95%CI 1.14-1.53]) and a greater number of painful sites (OR 2.50 [95%CI 1.58-3.95]). Also, the presence of disabling LBP was lower when there was agreement on reports of the presence of pain between students and their guardians.

Conclusions

In our study, greater pain intensity and greater number of painful sites, agreement on pain reports were associated with the occurrence of disabling LBP in participating students. Family members, clinicians and teachers need to pay attention to children and adolescents’ reports about their painful complaints,especially considering that those with disagreement on reports of pain reported disabling pain. Considering the growing burden of LBP and that children and adolescents with pain may be adults with disabling and chronic LBP, we suggest that future studies focus on seeking prevention strategies for disabling LBP in this population; education about LBP for children and adolescents and also for parents, family members, educators and clinicians; and promote pain management by encouraging active maintenance in the daily lives of these children and adolescents.

References

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Presenting Author

Fabianna Jesus-Moraleida

Poster Authors

Tuyra Francisca Castro e Silva

MSc

Federal University of Ceará

Lead Author

Fabiana Moraleida

Universidade Federal do Ceara-Centro

Lead Author

Ana Carla Lima Nunes

Universidade Federal do Ceará

Lead Author

Tiê Parma Yamato

PhD

Universidade Cidade de São Paulo - UNICID

Lead Author

Topics

  • Pain in Special Populations: Adolescents