Etiology, Risk Factors, and Diagnosis of Back Pain in Children and Adolescents: Evidence- and Consensus-Based Interdisciplinary Recommendations.

Michael Frosch,Lea Höfel,Andreas Leutner,Stefan Bielack,Michael Dobe,Thekla Von Kalle,Frauke Mecher,Ralf Stücker,Bettina Hübner-Möhler,Uta Dirksen,Burkhard Lawrenz,Kiril Mladenov,Ralf Trauzeddel,Florian Geiger,Julia Wager,Boris Zernikow,Regina Trollmann,Heike Norda,Lorin Stahlschmidt,Susanne Blödt,R Häfner ,M Steinborn ,Maximilian David Mauritz

doi:10.3390/children9020192

Abstract

Using a structured approach and expert consensus, we developed an evidence-based guideline on the diagnosis of back pain and the treatment of non-specific back pain in children and adolescents. The first part comprises etiology, risk factors, and diagnosis. The second part, published in the same issue, includes treatment and prevention. A comprehensive and systematic literature search was conducted to identify relevant guidelines and studies. Based on the findings of this literature search, recommendations on risk factors and diagnosis were formulated and voted on by experts in a structured consensus-building process. Notable red flags for specific back pain and evidence-based risk factors for non-specific back pain in children and adolescents were identified. Only three evidence-based recommendations could be formulated for causes, red flags, and risk factors for back pain, while two recommendations are based on expert consensus. Regarding diagnostics, eight expert consensus recommendations and one evidence-based recommendation could be provided. Despite the importance of adequate diagnosis for the treatment of back pain in children and adolescents, results of this work confirm the deficit in research investment in this area.

Highlights

IntroductionBack pain can occur with an underlying disease (i.e., specific back pain) or without evident cause of the complaint (i.e., non-specific back pain)
Back pain is a relevant and increasing problem in children’s and adolescents’ health [1].Back pain can occur with an underlying disease or without evident cause of the complaint
This guideline aimed to provide evidence-based, age-specific recommendations for optimizing diagnosis that differentiates specific from non-specific back pain in children and adolescents

Summary

Introduction

Back pain can occur with an underlying disease (i.e., specific back pain) or without evident cause of the complaint (i.e., non-specific back pain). For specific back pain in childhood and adolescence, an extensive spectrum of differential diagnoses, including a wide variety of congenital and acquired underlying diseases, must be considered as potentially causative of the pain [1]. Non-specific back pain represents the largest group of back pain in adolescence [2] and is a predictor of chronic back pain in adults [3]. While it is relatively rare in childhood, the prevalence of non-specific back pain rapidly increases in adolescence [4].

Methods

Results

Conclusion