Rate, Intensity, Disability, and Characteristics of Back Pain in Children 0 to 18 Years Old Referred to Pediatric Orthopedics for Spinal Concerns

Abstract

Importance: The rate of back pain in children is unclear.

Objective: This study evaluated the rate, intensity, disability, and characteristics of back pain across the pediatric age span in children referred with spinal concerns.

Design: This study used a retrospective design.

Setting: This was completed at a tertiary pediatric orthopedic institution in the United States.

Participants: Seventeen thousand nine hundred eleven children (6621 male and 11,280 female) ages 0 to 18.9 with any spinal condition from July 2018 to April 2022 were evaluated.

Main outcomes: All children/caregivers were asked yes/no, "Is back pain a significant concern at today's visit or the past 6 months?" Beginning in February 2020, children who reported back pain were assigned the 9-item Oswestry Disability Index (ODI-9). Beginning in April 2021, all children ages 5 and above were assigned 3 patient-reported outcomes measurement information system (PROMIS) pediatric measures: pain interference, mobility, and anxiety.

Results: Forty-two percent (7580/17,911) of all children with spinal concerns reported back pain which increased from about 20% at age 2 to about 30% by age 7 to 40% by age 13 to at least 55% by age 16. Back pain intensity averaged 2.0 out of 5. ODI-9 scores averaged minimal disability (18%). Female sex (odds ratio [OR] = 1.36), public insurance type (OR = 1.33), increased age (OR = 1.16), higher PROMIS pain interference scores (OR = 1.13), increased body mass index (BMI) percentile (OR = 1.01), and lower PROMIS mobility scores (OR = 0.98) were associated with the presence of back pain.

Conclusions: Four in 10 children referred with spinal concerns report back pain, which increases with female sex, public insurance type, age, BMI percentile, and worse PROMIS pain interference and mobility scores. Quantifying the functional, mental health, and socioeconomic burden of back pain can help prioritize multidisciplinary interventions.

Relevance: Clinicians need to pay attention to the likelihood of back pain in a younger demographic than traditionally thought.

Keywords: Back Pain; Children; Odds Ratio; Pain; Patient-centered Care; Patient-reported Outcomes Measurement Information System; Pediatric; United States.