Clinical Course of Spinal Pain in Adolescents: A Feasibility Study in a Chiropractic Setting

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SOURCE:   BMJ Open 2025 (Jan 30); 15 (1): e088834
Laura RC Montgomery • Steven J Kamper • Anika Young • Amber Beynon • Katherine A Pohlman • Lise Hestbæk • Mark J Hancock • Simon D French • Christopher G Maher • Michael S Swain

Faculty of Medicine and Health,
The University of Sydney,
Sydney, New South Wales, Australia


Design:   Prospective feasibility study.

Objectives:   To inform the design and conduct of a large-scale clinical cohort study investigating adolescents with moderate-to-severe spinal pain.

Setting:   Chiropractic care in Sydney, Australia.

Participants:   Adolescents aged 12-17 years with spinal pain (≥4/10 pain intensity score).

Methods:   Adolescents and chiropractors completed baseline and week-12 follow-up questionnaires, with adolescents reporting pain intensity and recovery weekly via text messages during weeks 1-11. Questionnaire measures included spinal pain, pain coping, quality of life, physical activity, clinical assessment findings and care delivered. Chiropractors provided usual clinical care. We conducted a descriptive feasibility analysis.

Primary outcomes:   (1) Recruitment rate, (2) response rate to each data collection instrument and (3) retention rate.

Results:   From May 2021 to February 2023, 20 chiropractors from 10 clinics were enrolled (invited n=85). 10 chiropractors recruited 45 adolescents (15.4±1.4 years, 43% female) over 13.5 months, excluding an 8-month pause due to COVID-19 disruptions. The average recruitment rate was 0.6 adolescents/recruiting chiropractor/month. We achieved a 100% response to chiropractor baseline and follow-up questionnaires, 98% to adolescent baseline, 94% average response to combined weekly text messages and 93% retention of adolescents at study completion.

Conclusions:   Our high response and retention rates demonstrate feasible data collection methods in this population. Addressing low recruitment by expanding the number and type of clinicians is necessary for a successful larger study.

Keywords:   Adolescent; Back pain; Prognosis.

STRENGTHS AND LIMITATIONS OF THIS STUDY.


  • This study used a prospective clinical cohort design to investigate the feasibility of studying adolescents with moderate to severe spinal pain in Australian chiropractic care.

  • Weekly data collection tracked pain intensity and recovery, providing valuable insight into the clinical course of spinal pain in adolescents.

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    SPINAL PAIN IN CHILDREN Section

  • As a feasibility study, our primary focus was assessing recruitment, data collection methods and retention. As such, our findings regarding clinical courses are descriptive and should be interpreted with caution.

From the Full-Text Article:

Background

Spinal pain, pain felt in the neck and mid or lower back, is common during adolescence. Approximately one-third of young people experience spinal pain each month, and up to one-quarter experience chronic or recurrent spinal pain lasting longer than 3 months. [1, 2] Ongoing pain significantly impacts adolescents and their families, leading to reduced participation in school, sports, play and social activities and increased use of medication and healthcare services. [3] Spinal pain can also worsen mental health, including heightened anxiety and fear of future pain [4] and is linked to higher odds of alcohol and tobacco use. [5] The burden of spinal pain extends beyond the teenager and their family, significantly affecting society. From age 10 to 20, low back pain progresses from the fifth cause of years lived with disability to the first and is the primary cause of non-fatal health loss globally. [6]

Adolescence is a critical period for establishing health behaviours, which can significantly impact long-term health, including susceptibility to chronic disease later in life. [7] Moderate-quality evidence suggests that a history of back pain is a risk factor for future episodes. [8] Specifically, persistent low back pain during adolescence quadruples the odds (OR 4.3, 95% CI 3.5 to 5.3) of persistent low back pain in adulthood. [9] Unlike in adults, the prognosis, clinical course and response to treatment for adolescents with spinal pain may be influenced by developmental factors, such as biological maturity and psychosocial changes. [10, 11] Accordingly, applying findings from the extensive adult research to younger populations would be problematic, highlighting the need to expand the evidence base on spinal pain in adolescents. [12, 13]

Understanding the overall prognosis and prognostic factors for spinal pain in adolescents is crucial for designing effective healthcare approaches, informing clinical practice and shaping healthcare policy. Despite the burden of adolescent spinal pain, little evidence exists identifying individuals at high risk of ongoing pain. [14, 15] Additionally, research investigating the clinical course of spinal pain in adolescents seeking healthcare is lacking. [16, 17] Effective management of spinal pain in young people may yield long-term benefits in preventing and reducing chronic spinal pain later in life. [18]

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