Association between untreated low back pain and injury proneness and confounding role of behavioral-health difficulties among younger adolescents: a population-based study.

PURPOSE

Low back pain (LPB) is mostly left untreated (LBP) and may increase the injury risk due to associated behavioral-health difficulties (BHDs) among adolescents. This study assessed the association between LBP (vs. treated LBP (LBP)) and injuries and the mediating role of BHDs among younger adolescents (10-16 years).

METHODS

This population-based study compared 328 adolescents with LBP (mean age = 13.7 ± 1.3) with 291 with LBP (mean age = 13.3 ± 1.2) from north-eastern France. They completed a questionnaire collecting, at school-year end, socioeconomic features, LBP/LBP, BHDs (alcohol/tobacco use, excessive screen-time, poor social support, poor physical health, depressive symptoms, and pain limiting activities), and injuries during the current school-year. Data were analyzed using multinomial logistic regression models and Kaplan-Meier estimates.

RESULTS

The proportion of subjects without alcohol/tobacco use or depressive symptoms decreased with time more quickly since age 10 among the adolescents with LBP than among those with LBP. Hence, most LBP early started and the subjects with LBP had a higher risk of single injury (sex-age-class-level-socioeconomic-features-adjusted relative risk ratio RR = 1.63, p < 0.05, vs. LBP) and a much higher risk of ≥ 2 injuries (RR = 2.60, p < 0.001). BHDs played a strong mediating role in the association between LBP and ≥ 2 injuries (contribution = 48%) but a modest mediating role in that between LBP and single injury (contribution = 10%) (pseudo R = 7.6%).

CONCLUSION

LBP is common and associated with injuries partly due to BHDs (which may alter physical/mental capabilities, risk perception/awareness, and vigilance) among younger adolescents. Our results may inform healthcare providers that they can detect/treat LBP and BHDs to prevent their aggravation and injuries.