Back Pain in Adolescents and Young Adults: A Retrospective Review of Psychosocial Factors and Treatment Strategies.
TL;DR
In pediatric back pain, structural pathology was not independently associated with symptom persistence, and Behavioral health factors demonstrated stronger associations with symptom burden and clinical outcomes, supporting a biopsychosocial model of care.
Abstract
Background
Nonspecific back pain is increasingly encountered in pediatric orthopaedic clinics. These visits are often complex and time-intensive, yet surgical intervention is rarely indicated. This study describes the characteristics of patients presenting with back pain at a single pediatric institution and examines associated biopsychosocial factors.
Methods
An IRB-approved retrospective review was conducted of patients aged 7 to 22 years presenting with back pain to pediatric orthopaedic and sports medicine clinics in 2021. Demographic, clinical, imaging, and behavioral health data were extracted from the electronic medical record. Patients were categorized based on the presence or absence of structural spine diagnoses. Comparative analyses were performed between groups. Multivariable logistic regression was used to identify independent predictors of persistent symptoms at follow-up.
Results
A total of 869 patients were included [mean age: 15.0±2.6 y; 537 (61.8%) female]. Chronic back pain was present in 631 patients (72.6%), and structural diagnoses were identified in 327 patients (37.6%), most commonly spondylolysis (14.6%) and scoliosis (14.3%). Behavioral health diagnoses were documented in 328 patients (37.7%). Pain severity did not differ significantly between patients with and without structural diagnoses (5.6±2.3 vs. 5.5±2.2; P=0.07). However, patients without structural diagnoses demonstrated significantly higher rates of behavioral health conditions (41.2% vs. 32.1%; P<0.001), including depression, ADHD, behavioral concerns, and suicidal ideation. On multivariable analysis, behavioral health diagnoses were independently associated with persistent symptoms (adjusted OR: 1.78, 95% CI: 1.32-2.41; P<0.001), whereas structural diagnosis was not (adjusted OR: 0.89, 95% CI: 0.65-1.23; P=0.48). Higher pain severity was also associated with symptom persistence (adjusted OR: 1.12 per point increase, 95% CI: 1.05-1.20; P=0.001).
Conclusions
In pediatric back pain, structural pathology was not independently associated with symptom persistence. Behavioral health factors demonstrated stronger associations with symptom burden and clinical outcomes, supporting a biopsychosocial model of care. Routine integration of behavioral health assessment may improve management and reduce persistent symptoms in this population. LEVELS OF EVIDENCE Level III-retrospective cohort study.