The investigation and management of back pain in children

ABSTRACT

Back pain in children and adolescents is probably much less common than in adults, but its true incidence is unknown. Although back pain has traditionally been considered a rare and often sinister presentation in the paediatric age group, recent literature now suggests that a relatively high number of children do experience back pain, but only a small proportion seek medical attention. For the majority of children with back pain no underlying cause is identified, but some require investigation to exclude serious underlying pathology. Laboratory and imaging investigations should be targeted towards those with “red flag” symptoms and signs. Imaging studies, particularly MRI, have an important role in diagnosis of underlying pathology such as infection or malignancy.

INTRODUCTION

Back pain in children and adolescents is probably much less common than in adults, but its true incidence is unknown. One of the problems in determining the incidence and prevalence of back pain is the way in which it is defined. The majority of studies look at low back pain (LBP), often without defining the term, rather than any back pain. LBP may be variously defined as low back pain with no apparent clinical cause, non-specific pain or non-organic pain. It is also used as a general descriptive term for any type of back pain. The term mechanical back pain is also confusing as this may refer to pain without a pathological underlying cause, but conversely is also used to describe conditions arising from overuse or trauma such as muscle strain, intervertebral disc prolapse or even spondylolysis.

Although back pain has traditionally been considered a rare and often sinister presentation in the paediatric age group, recent literature now suggests that a relatively high number of children do experience back pain, but only a small proportion seek medical attention.1 However, of those that do …