Low back pain in schoolchildren: occurrence and characteristics Kath D. Watson a,b , Ann C. Papageorgiou a , Gareth T. Jones a,b , Stewart Taylor a , Deborah P.M. Symmons a , Alan J Silman a , Gary J. Macfarlane a,b, * a Arthritis Research Campaign (ARC) Epidemiology Unit, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, UK b Unit of Chronic Disease Epidemiology, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, UK Received 18 May 2001; received in revised form 14 December 2001; accepted 19 December 2001 Abstract Low back pain in adolescents is perceived to be uncommon in the clinic setting. However, previous studies have suggested that it may be an important and increasing problem in this age-group. The aim of this study was to determine the prevalence and important symptom characteristics of low back pain such as duration, periodicity, intensity, disability and health seeking behaviour at young ages. A population- based cross-sectional study was conducted including 1446 children aged 11–14 years in the North-West of England. A self-complete questionnaire was used to assess low back pain prevalence, symptom characteristics, associated disability and health seeking behaviour. An additional self-complete questionnaire amongst parents sought to validate pain reporting. The 1-month period prevalence of low back pain was 24%. It was higher in girls than boys (29 vs. 19%; x 2 ¼ 14:7, P , 0:001) and increased with age in both sexes ðP , 0:001Þ. Of those reporting low back pain, 94% experienced some disability, with the most common reports being of difficulty carrying school bags. Despite this high rate of disability, few sought medical attention. Adolescent low back pain is common although medical attention is rarely sought. Such symptoms in childhood, particularly as they are so common, may have important consequences for chronic low back pain in adulthood. q 2002 Published by Elsevier Science B.V. on behalf of International Association for the Study of Pain. Keywords: Low back pain; Adolescents; Cross-sectional; Prevalence; Disability; Consultation 1. Introduction Low back pain in adolescents is perceived to be uncom- mon in the clinic setting. Nevertheless, some studies have suggested that it is a relatively common symptom in this age-group, although comparison of results between studies is hampered by the use of different definitions. Even when the same recall period is used, different prevalence rates are reported. For example, an American study amongst 1242 children aged 12–15 years reported a low back pain preva- lence of 22% (‘Have you had pain or other trouble with the lower part of your back within the last twelve months’) while a study from Denmark amongst 1395 children aged 13–16 years reported the prevalence of low back pain to be 51% (‘Did you have low back pain in the past year?’) (Olsen et al., 1992; Harreby et al., 1999). Some of the variation in reported rates may be due to age differences of the popula- tions studied, different geographical location of study popu- lations (although there is little evidence in adults that prevalence rates vary amongst industrialised countries), but most likely it indicates the necessity for standard defini- tions which specify time period recall, symptoms and anato- mical area of interest. Amongst young persons with low back pain, serious underlying disorders are uncommon. Despite this, studies of low back pain in younger populations have demonstrated that disability is frequently reported. A previous Finnish study found that 8% of children reported recurrent or contin- uous low back pain and of those with chronic low back pain, 86% reported interference with daily activities (Salminen et al., 1992). Adolescent experience of low back pain may herald the onset of intermittent or chronic trouble in adult- hood (Olsen et al., 1992). This hypothesis is supported by the findings of a prospective study which showed that those children reporting low back pain in school were more likely to subsequently report low back pain in adulthood (Harreby et al., 1995). In a sample of schoolchildren aged between 11 and 14 years, we aimed to determine: (a) the 1-month period preva- lence of low back pain (using definitions of back pain Pain 97 (2002) 87–92 0304-3959/02/$20.00 q 2002 Published by Elsevier Science B.V. on behalf of International Association for the Study of Pain. PII: S0304-3959(02)00008-8 www.elsevier.com/locate/pain * Corresponding author. Tel.: 144-161-275-5191; fax: 144-161-275- 5216. E-mail address: g.macfarlane@man.ac.uk (G.J. Macfarlane).