Short summary

Children and adolescents with back pain, a vulnerable group, deserve equitable and effective treatment like adults, equal healthcare access, and future employment opportunities. Despite limited knowledge, this PhD project investigates their healthcare utilization, focusing on hospitals. Identifying treatment needs and related factors will inform guidelines to streamline care for these individuals, their families, and healthcare providers.

Rationale

Spinal pain in pediatric populations: Spinal pain (pain in the neck, mid and lower back) is more common among children and adolescents than one might have expected. A Danish population-based study found that 30% of school-age children experience spinal pain during a year, and the prevalence increases with age. Furthermore, the child/adolescent age group with spinal pain will more likely also experience spinal pain in adult life. As in adults, there is most often not a single cause for spinal pain, as it is multi-factorial in nature, and both biomechanical, psychological, and social factors can contribute to the pain intensity and frequency.

Impact on the multiple levels: Children, adolescents, and adults arguably perceive pain differently, and we cannot expect that a child/adolescent's course of pain or management is equal to that of adults. Whereas the experience of pain is common across age groups, and while we know a lot about the impact pain has on adults, we know little about how pain is being perceived, understood and how it impacts everyday life in child/adolescents. This is critical when discussing how to improve care for the child/adolescent with spinal pain. For instance, the prevalence of missed school days is apparently higher for those with spinal pain. They are also more limited with regards to sports and social activities compared to their peers without spinal pain.

For those affected with spinal pain the consequences will often extend beyond school attendance to include limited participation in sports and leisure activities as well as their social network, family, activities, etc. Highlighted by the low quality of life, psychological disorders, unstable mood, and school absenteeism, among others. However, and perhaps alarming, novel findings indicate that the psychological and social burden is extensive in child/adolescents presenting to general practice.

Status of knowledge: Within the last decade, there has been a rise in the scientific literature describing spinal conditions in the child/adolescent age group. It has become clear that spinal pain in child/adolescents is more common than previously assumed and that the prognosis of musculoskeletal-related pain generally is poor. However, the vast bulk of this research has been conducted on sampling from the general population, often from schools.

Healthcare utilization: We have very limited knowledge of the extent and patterns of child/adolescents' use of health care services for spinal pain. Whether spinal pain results in healthcare utilization at all, where and how often care-seeking occurs. For the Danish adult spinal pain population, succinct guidelines exist that describe how to make rational use of healthcare across sectors from primary (e.g., general practitioner) to secondary (e.g., hospitals) to tertiary care (e.g., municipal rehabilitation). This is implemented and regulated across the five regional authorities that manage the Danish healthcare system. However, no such guidelines exist for child/adolescents with spinal pain which potentially leads to mismanaged pain conditions, which in turn likely increases the risk of prolonged pain. Over a period of 12 months, almost 5% of all spine-related diagnostic codes recorded in the Danish hospital setting were given to patients under 18 (~3300 codes), but as delineated above, not as part of a guideline-informed management.

Social inequality: Another issue to consider is that for adults with spinal pain, there is vast social inequality in healthcare utilization, and this is even worse when considering self-paid services in primary care (e.g., physiotherapy). Thus, for children of parents with spinal pain, there is an increased risk of not receiving appropriate, guideline-informed treatment or perhaps treatment at all. To make matters worse, early pain debut significantly increased the risk of developing chronic spinal pain. Such an early disadvantage increases the risk of persistent spinal pain in adulthood, associated with future unemployment, comorbidity, continuous disability, and low psychological well-being.

Rationale: Spinal pain is the leading cause of years lived with disability, it is very costly to our society and experiencing pain early on in life is a potential risk for long-term spinal pain problems extending into adulthood. Thus, the knowledge gap concerning healthcare utilization of child/adolescents with spinal pain and how social inequality and comorbidity impact healthcare utilization is an important question. Therefore, we need a deeper insight into the background of the pediatric spinal pain population affected by spinal pain.

Description of the cohort

Children and adolescents with a spinal pain diagnosis, given in secondary health system.

Data and biological material

Diagnosis, sociodemographic, healthcare utilization

Collaborating researchers and departments

Medical Spinal Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark

• Casper Glissmann Nim
• Søren O'Neill

Macquarie University, Australia

• Michael Swain
• Amber Beynon