Association between untreated low back pain and injury proneness and confounding role of behavioral-health difficulties among younger adolescents: a population-based study.

Abstract

Low back pain (LPB) is mostly left untreated (LBPuntreated) and may increase the injury risk due to associated behavioral-health difficulties (BHDs) among adolescents. This study assessed the association between LBPuntreated (vs. treated LBP (LBPtreated)) and injuries and the mediating role of BHDs among younger adolescents (10-16years). This population-based study compared 328 adolescents with LBPuntreated (mean age = 13.7 ± 1.3) with 291 with LBPtreated (mean age = 13.3 ± 1.2) from north-eastern France. They completed a questionnaire collecting, at school-year end, socioeconomic features, LBPtreated/LBPuntreated, BHDs (alcohol/tobacco use, excessive screen-time, poor social support, poor physical health, depressive symptoms, and pain limiting activities), and injuries during the current school-year. Data were analyzed using multinomial logistic regression models and Kaplan-Meier estimates. The proportion of subjects without alcohol/tobacco use or depressive symptoms decreased with time more quickly since age 10 among the adolescents with LBPuntreated than among those with LBPtreated. Hence, most LBP early started and the subjects with LBPuntreated had a higher risk of single injury (sex-age-class-level-socioeconomic-features-adjusted relative risk ratio RR = 1.63, p < 0.05, vs. LBPtreated) and a much higher risk of ≥ 2 injuries (RR = 2.60, p < 0.001). BHDs played a strong mediating role in the association between LBPuntreated and ≥ 2 injuries (contribution = 48%) but a modest mediating role in that between LBPuntreated and single injury (contribution = 10%) (pseudo R2 = 7.6%). LBPuntreated is common and associated with injuries partly due to BHDs (which may alter physical/mental capabilities, risk perception/awareness, and vigilance) among younger adolescents. Our results may inform healthcare providers that they can detect/treat LBP and BHDs to prevent their aggravation and injuries.