Managing Back Pain in Pediatric Patients

Child having chiropractic back adjustment

It is well known that back pain is very common in adults, but children and adolescents also experience this problem. A prior systematic review reported the annual incidence of low back pain in those 18 years of age and under to be 33.6%. Other evidence regarding thoracic pain reveals a lifetime prevalence of 9.5-72% in children and adolescents.

Most episodes of back pain in younger patients are brief, but approximately one third experience recurrence within a year and one quarter have three or more episodes, with about 13% experiencing episodes lasting five or more weeks. So, in some younger patients, back pain is more than a temporary, minor nuisance. We also know that back pain incidence increases as children age into adulthood.

Management of back pain in children and adolescents has generally been studied less than in adults, but many of the concepts and approaches are similar. Two prior systematic reviews have explored the evidence pertaining to manual therapy for younger back pain patients, but a judgement of effectiveness was precluded due to the limited and low-quality evidence. Exercise is also a reasonable option and is promising for improving pain intensity in children compared to no treatment (5), but prior evidence summaries have included mixed location pain (ex. neck, shoulder and back pain) in their analyses.

These authors conducted an integrative systematic review of quantitative, qualitative and economic evidence relating to the rehabilitative management of thoracic and low back pain in children and adolescents aged 19 years or younger.

From the authors of the paper: “The findings in our review have important implications for clinical practice. First, as evident in the included qualitative study, the patient-doctor relationship should be highlighted, providing a foundation for a positive interaction that may facilitate increased compliance with treatment towards the goal of recovery (i.e., subcategories 2 and 3: coaching from care providers, compliance with treatment) [42]. Second, information provided via education/advice should be considered as part of care program [44]. Third, spinal manipulation and group-based exercise may be considered through shared decision-making to reduce pain intensity in adolescents with LBP based on low to moderate certainty evidence [33–36].” (NOTE: References in the quote contained in the original paper, not this review).

RESEARCH REVIEW: Rehabilitation of Back Pain in Pediatric Patients

This paper was published in Chiropractic & Manual Therapies (2024)

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