Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Forchstr. 340, Zurich, 8008, Switzerland.
Holbeinpraxis, Holbeinstrasse 65, Basel, 4051, Switzerland.
BMC Pediatr. 2024 Nov 21;24(1):757. doi: 10.1186/s12887-024-05194-z.
Distinguishing self-limiting ('trivial') from potentially consequential spinal pain in childhood and adolescence is crucial to prevent over- or under-medicalization. The aim of this study was to stratify participants for severity of spinal pain and to investigate associations of pain severity with potential consequences of pain and some psychophysical and clinical factors.
In 2020 and 2021, children and adolescents took part in a voluntary population-based spine screening event across Switzerland organized by the Swiss Chiropractors Association. The screening consisted of a questionnaire (14 questions) based on the Young Spine Questionnaire and a clinical examination by a chiropractor. Three subgroups of pain severity [no pain (including mild, occasional pain), one-sited moderate pain, one-sited severe or moderate/severe pain at multiple sites of the spine] were formed by combining the self-reported measures for pain intensity and pain frequency for two recall periods (lifetime, last week) according to literature. Multivariable logistic regression analyses were conducted to determine the associations between pain severity and potential pain consequences (impact of spinal pain on health and seeking medical advice because of spinal pain), as well as between pain severity and some psychophysical factors (head and/or belly pain, sleep problems, daytime tiredness) and clinical measures [trunk symmetry (rib hump), trunk muscle endurance (plank position)].
Of all participants (N = 457; 6-16 years; mean age = 10.9 ± 3.0 years; 220 boys), those with most severe spinal pain and with one-sited moderate pain in the last week had higher odds for reporting an impact of spinal pain on their health (OR = 13.5, 95%CI = 4.9-36.8; OR = 4.7, 95%CI = 1.5-14.4) and for searching medical advice because of spinal pain (OR = 11.6, 95%CI = 4.5-30.1; OR = 3.9, 95%CI = 1.6-9.2). Headache and/or belly pain (OR = 2.6, 95%CI = 1.2-5.5) and daytime tiredness (OR = 3.2, 95%CI = 1.3-7.9) increased the odds for having most severe pain compared to having no pain. The clinical measures were not associated with pain severity.
Stratification by pain severity, particularly when asked for pain in the last week, might help to minimize over- and under-medicalization of spinal pain in childhood and adolescence. Prospective studies are needed to clarify the relevance of the investigated clinical tests in the context of adolescent spinal pain.
区分儿童和青少年自限性（“轻微”）和潜在后果性的脊柱疼痛对于防止过度或不足的医学治疗至关重要。本研究的目的是对脊柱疼痛的严重程度进行分层，并探讨疼痛严重程度与疼痛的潜在后果以及一些心理物理学和临床因素之间的关联。
在 2020 年和 2021 年，瑞士脊椎按摩协会组织了一次瑞士全国范围的自愿脊柱筛查活动，儿童和青少年参加了该活动。筛查包括基于青少年脊柱问卷的问卷（14 个问题）和脊椎按摩师的临床检查。根据文献，通过结合自我报告的两个回忆期（终生、上周）的疼痛强度和疼痛频率测量值，将疼痛严重程度分为三个亚组[无疼痛（包括轻度、偶发性疼痛）、单侧中度疼痛、单侧严重或中度/严重疼痛多个脊柱部位]。多变量逻辑回归分析用于确定疼痛严重程度与潜在疼痛后果（脊柱疼痛对健康的影响以及因脊柱疼痛寻求医疗建议）之间的关联，以及疼痛严重程度与一些心理物理学因素（头部和/或腹部疼痛、睡眠问题、日间疲劳）和临床测量值[躯干对称性（肋骨隆起）、躯干肌肉耐力（平板支撑位置）]之间的关联。
在所有参与者（N=457；6-16 岁；平均年龄=10.9±3.0 岁；220 名男孩）中，那些脊柱疼痛最严重和上周单侧中度疼痛的人报告脊柱疼痛对其健康的影响（OR=13.5，95%CI=4.9-36.8；OR=4.7，95%CI=1.5-14.4）和因脊柱疼痛寻求医疗建议（OR=11.6，95%CI=4.5-30.1；OR=3.9，95%CI=1.6-9.2）的可能性更高。头痛和/或腹部疼痛（OR=2.6，95%CI=1.2-5.5）和日间疲劳（OR=3.2，95%CI=1.3-7.9）使出现最严重疼痛的可能性与无疼痛相比有所增加。临床测量值与疼痛严重程度无关。
通过疼痛严重程度进行分层，特别是当询问上周的疼痛时，可能有助于最大限度地减少儿童和青少年脊柱疼痛的过度和不足的医学治疗。需要前瞻性研究来澄清所研究的临床测试在青少年脊柱疼痛背景下的相关性。
