Sydney School of Health Science, University of Sydney, Sydney, Australia.
Nepean Blue Mountains Local Health District, Penrith, Australia.
Eur J Pain. 2022 Feb;26(2):522-530. doi: 10.1002/ejp.1878. Epub 2021 Nov 5.
Spinal pain (SP), including neck and back pain, is common and often associated with poor mental health and reduced quality of life of adolescents. Contemporary understanding of SP favours a biopsychosocial approach, and emerging evidence suggests the stronger influence of psychological rather than other factors.
We aimed to investigate if experiencing psychological distress in early childhood increases the risk of spinal pain with impact during adolescence.
1175 adolescents from a prospective cohort study (Raine Study Gen2) were included. Psychological distress was assessed at ages 2, 5, 8 and 10 using Child Behaviour Check List (CBCL). CBCL total and subscale scores (internalizing and externalizing symptoms) were converted to age-standardized scores and dichotomized according to t-scores (>60=high distress). Life-time spinal pain, including low back, mid back, or neck/shoulder, was measured at age 17. We were interested in adolescent SP with impact (care seeking, medication use, school absenteeism, daily activity interference, leisure activity interference) and defined cases as SP with impact (one or more) or greater impact (two or more) impacts. We investigated the longitudinal associations between childhood psychological distress and adolescent SP using univariate and multivariable logistic regression models.
Psychological distress in childhood increased the odds of adolescent SP with impact by 33% (OR 1.33; 95% CI 1.01-1.76), but not spinal pain with greater impact (OR 1.22; 95% 0.83-1.80). Internalizing symptoms were associated with SP with greater impact and externalizing symptoms with SP with impact after adjusting for a range of potential child and family confounders.
Psychological distress in childhood increases the risk of SP with impact in adolescence and may be a promising prevention target.
Our findings provide evidence that psychological distress early in life is an independent risk factor for spinal pain with impact during adolescence. As psychological distress during childhood is potentially modifiable, it may be a promising target for research on the prevention of consequential spinal pain in adolescence. Identifying and addressing psychological distress in children may be an important component of best practice to reduce consequential spinal pain in adolescents.
脊柱疼痛（SP），包括颈部和背部疼痛，在青少年中很常见，通常与心理健康状况不佳和生活质量下降有关。目前对 SP 的理解倾向于采用生物心理社会方法，新出现的证据表明心理因素的影响比其他因素更大。
我们旨在研究儿童早期经历心理困扰是否会增加青少年时期脊柱疼痛的风险，这种疼痛会对他们的生活产生影响。
研究纳入了前瞻性队列研究（Raine 研究 Gen2）中的 1175 名青少年。在 2、5、8 和 10 岁时使用儿童行为检查表（CBCL）评估心理困扰。将 CBCL 总分和子量表得分（内化和外化症状）转换为年龄标准化得分，并根据 t 分数（>60=高困扰）分为二分变量。在 17 岁时测量终生脊柱疼痛，包括下背部、中背部或颈部/肩部。我们关注的是对青少年生活有影响的 SP（寻求医疗、药物使用、缺课、日常活动干扰、休闲活动干扰），并将病例定义为有影响（一种或多种）或更大影响（两种或多种）的 SP。我们使用单变量和多变量逻辑回归模型研究了儿童期心理困扰与青少年 SP 之间的纵向关联。
儿童时期的心理困扰使青少年时期 SP 的发生风险增加了 33%（OR 1.33；95%CI 1.01-1.76），但与更大影响的 SP 无关（OR 1.22；95%CI 0.83-1.80）。在调整了一系列潜在的儿童和家庭混杂因素后，内化症状与更大影响的 SP 相关，外化症状与有影响的 SP 相关。
儿童时期的心理困扰增加了青少年时期 SP 发生的风险，可能是一个有前途的预防目标。
我们的研究结果表明，生命早期的心理困扰是青少年时期脊柱疼痛的独立危险因素。由于儿童时期的心理困扰具有潜在的可改变性，因此它可能是预防青少年时期严重脊柱疼痛的研究中一个很有前途的目标。识别和解决儿童的心理困扰可能是减少青少年严重脊柱疼痛的最佳实践的重要组成部分。
