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PubMed1997

Is epidural anesthesia in labor associated with chronic low back pain? A prospective cohort study.

UNLABELLED: The association between epidural anesthesia during labor and subsequent postpartum low back pain remains unclear. The objective of this follow-up cohort study was to determine whether epidural anesthesia was associated with chronic back pain 1 yr after delivery. We contacted 329 women by telephone and asked them to complete a standardized questionnaire 1 yr (+/-1 mo) after delivery. One hundred sixty-four women had received epidural analgesia for labor and delivery, and 165 had not. Subjects were asked to quantify their back pain (yes/no, numeric rating score, and interference with daily activities). Differences between the two groups were tested by using the chi2 test and the Mann-Whitney U-test, and logistic regression was used to control for confounding variables. The response rate was 244 of 329 (74%). Responders and nonresponders were similar in their demographic and clinical characteristics. There was no difference in the prevalence of back pain between women who had received epidural anesthesia (12 of 121, 10%) and those who had not (17 of 123, 14%). The adjusted relative risk of low back pain at 1 yr (epidural versus nonepidural) was 0.63 (95% confidence interval 0.25, 1.56). There were also no differences between the two groups on numeric rating scores or level of interference with activities. This prospective follow-up study demonstrated no association between epidural anesthesia for labor and delivery and chronic back pain 1 yr after delivery. IMPLICATIONS: We evaluated the presence of low back pain 1 yr after delivery in two groups of women-those who chose epidural analgesia for labor and those who did not. There was no increased risk of back pain in women who had used epidural analgesia. This finding is consistent with those of other North American studies.

Adult↗
PubMed1993

Back pain after epidural anesthesia with chloroprocaine.

BACKGROUND: Chloroprocaine has been associated with severe back pain after epidural anesthesia. Factors proposed to contribute to this problem are: 1) the preservative disodium ethylenediaminetetraacetic acid (EDTA), 2) large volumes of chloroprocaine, 3) low pH of chloroprocaine, and 4) local infiltration with chloroprocaine. METHODS: Using a prospective, balanced, randomized study design, 100 patients aged 18-65 yr who were undergoing outpatient knee surgery during continuous epidural anesthesia received one of five local anesthetics (all containing epinephrine 1:200,000). Group I received a bolus of 30 ml 2% lidocaine, followed by 10 ml every 45 min. Group II received 15 ml of 3% chloroprocaine (containing EDTA), plus 5 ml every 45 min. Group III received 30 ml of 3% chloroprocaine plus 10 ml every 45 min. Group IV received 30 ml of 3% chloroprocaine (containing metabisulfite as the preservative but no EDTA) plus 10 ml every 45 min. Group V received 30 ml of 3% chloroprocaine with the pH adjusted to 7.3, plus 10 ml every 45 min. After the anesthesia dissipated and before any analgesic agents were given, the patients were asked to rank maximum knee and back pain on a visual analog scale (0-10) and to give a description of back pain. A telephone interview was conducted 24 h after surgery to determine if back pain returned. Back pain scoring was assessed using a verbal analog scale. RESULTS: After dissipation of anesthesia, the back pain reported by patients fell into two distinct categories. Type 1 pain was described commonly as superficial and localized to the site of needle insertion. There was no difference among groups in incidence of type 1 pain. Type 2 pain was described as deep, aching, burning, and poorly localized in the lumbar region (5% of the patients in group I, 10% in groups II and IV, 50% in group III, and 25% in group V). The incidence of type 2 pain was significantly greater in group III than in groups I, II, or IV. Group III also had a significantly greater mean visual analog scale pain score (types 1 and 2) than all other groups. CONCLUSIONS: Large doses (> or = 40 ml) of chloroprocaine containing EDTA resulted in a greater incidence of deep burning lumbar back pain. Using 25 ml or less of the same solution resulted in an incidence of both types 1 and 2 postepidural anesthesia back pain similar to that in the lidocaine control group.

Adolescent↗
PubMed1992

Chronic low back pain patients around the world: cross-cultural similarities and differences.

OBJECTIVE: The current study sought to determine whether there were any significant cross-cultural differences in medical-physical findings, or in psychosocial, behavioral, vocational, and avocational functioning, for chronic low back pain patients. DESIGN: Partially double-blind controlled comparison of six different culture groups. SETTING: Subjects were selected from primarily ambulatory care facilities specializing in treating chronic pain patients. PATIENTS-SUBJECTS: Subjects consisted of 63 chronic low back pain patients and 63 healthy controls. Low back pain patients were randomly selected from six different culture groups (American, Japanese, Mexican, Colombian, Italian, and New Zealander). Ten to 11 were gathered per culture from a pool of patients treated at various pain treatment programs. Likewise, 10 or 11 control group subjects were obtained from each culture from a pool of healthy support staff. MAIN OUTCOME MEASURES: The Sickness Impact Profile and the Medical Examination and Diagnostic Information Coding System were used as primary outcome measures. RESULTS: Findings showed that (a) low back pain subjects across all cultures had significantly more medical-physical findings and more impairment on psychosocial, behavioral, vocational, and avocational measures than controls did; (b) Mexican and New Zealander low back pain subjects had significantly fewer physical findings than other low back pain groups did; (c) the American, New Zealander, and Italian low back pain patients reported significantly more impairment in psychosocial, recreational, and/or work areas, with the Americans the most dysfunctional; and (d) findings were not a function of working class, age, sex, pain intensity, pain duration, previous surgeries, or differences in medical-physical findings. CONCLUSIONS: It was concluded that there were important cross-cultural differences in chronic low back pain patients' self-perceived level of dysfunction, with the American patients clearly the most dysfunctional. Possible explanations included cross-cultural differences in social expectation; attention; legal-administrative requirements; financial gains; attitudes-expectations about usage, type, and availability of health care; and self-perceived ability and willingness to cope.

Adult↗
PubMed1998

Spontaneous onset of back pain.

OBJECTIVES: To assess the frequency with which patients attribute low back pain to spontaneous onset. DESIGN: A consecutive sample of two distinct groups of patients seeking treatment for back pain: those without need to identify cause (study group, n = 4,689) and those required to report a specific event to qualify for benefits paid for by a third party (compensated group, n = 6,687). SETTING: Active exercise-based back pain rehabilitation clinics. SUMMARY OF BACKGROUND DATA: Research on the natural history of back pain has revealed frequent reports of spontaneous recovery, usually within 8-12 weeks after onset. There is little comparable literature pertaining to the report of spontaneous onset. METHODS: Data were collected for two groups of consecutive patients who attended for initial assessments of their back pain at 16 Canadian Back Institute locations, between May 1, 1994 and February 28, 1995. Patient responses were collected using a standardized, professionally administered questionnaire. RESULTS: In the group without need to identify cause, 66.7% of patients could not identify an event producing their symptoms. For those required to report a specific event, only 9.8% of patients failed to attribute cause. Multivariate logistic regression revealed that the required-to-report group was approximately 15 times more likely to report an event (odds ratio = 14.95; 95% confidence interval = 13.44, 16.65) than the study group; those pursuing litigation were more than 2.5 times more likely to report a causative event (odds ratio = 2.68; 95% confidence interval = 2.09, 3.49). CONCLUSIONS: Back pain occurred spontaneously in approximately 67% of patients seeking treatment in the study group. The authors consider spontaneous onset to be part of the natural history of back pain for this group.

Adult↗
PubMedDate not supplied

The use of bone scan to investigate back pain in children and adolescents.

Children with back pain frequently undergo detailed investigation because of the perception that a high percentage will have a treatable spinal condition. The purposes of this study was (i) to determine the percentage of children with disabling back pain presenting to our institution who had a diagnosis (i.e., to explain their back pain), (ii) to evaluate the clinical markers that should alert clinicians to underlying pathology, (iii) and to determine the prognosis of children with back pain and no specific diagnosis. This study was a retrospective analysis of consecutive children undergoing single-photon emission computed tomography for a primary complaint of back pain. Data collection included chart review, radiographic analysis, and clinical follow-up with the Roland and Morris scale for pain and disability. Two hundred and seventeen patients with an average age of 13 years (range, 2.7-17.7) were reviewed on average 4.4 years after presentation (range, 1.1-7.2 years). One hundred and seventy children (78.3%) had no specific diagnosis to explain their back pain, 15 children (6.9%) had spondylosis, 10 children (4.6%) had tumor, and the remaining 22 children (10.1%) had various diagnoses including infection, Scheuermann's kyphosis, herniated disc, kidney disease, facet arthritis, degenerative disc disease, congenital anomalies, and tethered cord. Factors associated with positive diagnoses were constant pain and male gender. Night pain, constant pain, and duration of symptoms <3 months were associated with the diagnosis of a tumor. Although the majority of children presenting with persistent back pain had no demonstrable cause, of 132 contactable patients 94 (71%) had persisting pain at the time of clinical follow-up. In conclusion, the majority of children with disabling back pain has no demonstrable cause and the majority will continue to have pain years after initial presentation.

Adolescent↗
PubMed1998

Do back support belts cause gastroesophageal reflux?

A competent lower esophageal sphincter (LES) prevents gastroesophageal reflux disease (GERD) in the setting of increased abdominal pressure. Therefore, we have assessed whether a back support belt causes gastroesophageal reflux (GER). Ten healthy volunteers underwent esophageal manometric studies to locate the LES. Subsequently, each subject underwent two separate 8-hour intra-esophageal pH monitor studies on different days, the first without wearing a back support belt, and the subsequent one wearing a back support belt. A symptom diary and continuous intra-esophageal pH data were obtained during both study periods. The mean LES pressure (LESP) was 14 +/- 3.6 mm Hg without a back support belt and 15.8 +/- 4.3 mm Hg with a back support belt which was not significantly different. There were no significant differences in total episodes of GER, esophageal acid exposure, or any other parameters monitored. Symptoms of GER were the same comparing the back support belt with no back support belt. We conclude that healthy people with normal LESP do not have increased GER as a result of wearing a back support belt.

Abdomen↗
PubMed1995

Factors associated with choosing a chiropractor for episodes of back pain care.

Back pain is a common illness and chiropractors provide a large proportion of back pain care in the United States. This is the first study to systematically compare chiropractic patients with those who saw other providers for back pain. The authors analyzed data from the RAND Health Insurance Experiment, a community-based study of the use of health services. Insurance claims forms were examined for all visits specified by the patient as occurring for back pain. Visits were grouped into episodes using decision rules and clinical judgment. The primary provider of back pain care was defined as the provider who delivered most of the services. Sociodemographic and health status and attitudes variables of patients were examined for association with the choice of chiropractor. Multivariate logistic regression models were constructed to calculate adjusted odds ratios for independent predictors. There were 1020 episodes of back pain care made by 686 different persons and encompassing 8825 visits. Results indicated that chiropractors were the primary provider for 40% of episodes, and retained as primary provider a greater percentage of their patients (92%) who had a second episode of back pain care than did medical doctors. Health insurance experiment site, white race, male sex, and high school education were independent predictors of choosing a chiropractor. Conclusions suggested that chiropractors were the choice of one third of all patients who sought back pain care, and provided care for 40% of all episodes of care. Geographic site, education, gender, and income were independent patient factors predicting chiropractic use.

Adult↗
PubMed2001

The treatment of neck and low back pain: who seeks care? who goes where?

BACKGROUND: Neck and low back pain are leading causes of morbidity and health care utilization. However, little is known about the characteristics that differentiate those who seek from those who do not seek health care for their pain. OBJECTIVES: The objectives of this study were to: 1) describe health care utilization for neck and back pain; 2) determine the characteristics of individuals seeking health care for neck and back pain; and 3) identify the characteristics of patients who consult medical doctors, chiropractors, or both. DESIGN: Population-based cross-sectional mailed survey. SUBJECTS: Subjects were randomly selected adults from the Saskatchewan Health Insurance and Registration File. MEASURES: Demographic, socio-economic, general health, comorbidity, health-related-quality-of-life, pain severity and health care utilization data were collected. The main outcome was whether subjects with prevalent neck or low back pain visited a health care provider in the previous month. RESULTS: Twenty-five percent of individuals with neck or low back pain visited a health care provider. Seeking health care was associated with disabling neck or back pain, digestive disorders, worse bodily pain and worse physical-role-functioning. Compared with medical patients, fewer chiropractic patients lived in rural areas or reported arthritis, but they reported better social and physical functioning. More patients consulting both providers reported disabling neck or back pain. CONCLUSIONS: Individuals seeking care for neck or back pain have worse health status than those who do not seek care. Patients consulting chiropractors alone report fewer comorbidities and are less limited in their activities than those consulting medical doctors.

Adult↗
PubMed1987

Design and evaluation of a back injury prevention program within a geriatric hospital.

Two phases of a back injury prevention program were studied using 2035 accident reports filed between 1979 and 1984. Phase 1, Personnel Program, was designed to decrease the duration of wage-loss claims by increasing the effectiveness of the existing procedures used to process these claims. This program significantly lowered the proportion of high-hour claims (P less than .05) and significantly reversed a trend of increasing accident rates (P less than .05). Phase 2, Back Program, was designed to lower the incidence of back injuries through a feedback-oriented educational program. The Back Program itself could not demonstrate a significant reduction in back injuries primarily due to the powerful and confounding effect of the Personnel Program. The combination of the Personnel Program and the Back Program significantly lowered back injuries for nurses when compared with a similar group of injuries that occurred at geriatric hospitals (P less than .001). The large effect of the Personnel Program and the small effect of the Back Program have design implications for any injury prevention program.

Aged↗
PubMed1987

1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain.

Because there is increasing concern about low-back disability and its current medical management, this analysis attempts to construct a new theoretic framework for treatment. Observations of natural history and epidemiology suggest that low-back pain should be a benign, self-limiting condition, that low back-disability as opposed to pain is a relatively recent Western epidemic, and that the role of medicine in that epidemic must be critically examined. The traditional medical model of disease is contrasted with a biopsychosocial model of illness to analyze success and failure in low-back disorders. Studies of the mathematical relationship between the elements of illness in chronic low-back pain suggest that the biopsychosocial concept can be used as an operational model that explains many clinical observations. This model is used to compare rest and active rehabilitation for low-back pain. Rest is the commonest treatment prescribed after analgesics but is based on a doubtful rationale, and there is little evidence of any lasting benefit. There is, however, little doubt about the harmful effects--especially of prolonged bed rest. Conversely, there is no evidence that activity is harmful and, contrary to common belief, it does not necessarily make the pain worse. Experimental studies clearly show that controlled exercises not only restore function, reduce distress and illness behavior, and promote return to work, but actually reduce pain. Clinical studies confirm the value of active rehabilitation in practice. To achieve the goal of treating patients rather than spines, we must approach low-back disability as an illness rather than low-back pain as a purely physical disease. We must distinguish pain as a purely the symptoms and signs of distress and illness behavior from those of physical disease, and nominal from substantive diagnoses. Management must change from a negative philosophy of rest for pain to more active restoration of function. Only a new model and understanding of illness by physicians and patients alike makes real change possible.

Back Pain↗
PubMed1991

Evaluation of a physician education intervention to improve primary care for low-back pain. I. Impact on physicians.

In an effort to improve the cost-effectiveness of primary care for low-back pain, we developed, implemented, and evaluated a physician education intervention. The program was designed to provide family physicians with specific information, tools, and techniques that our previous studies and the literature suggested should be associated with more satisfying and cost-effective care for low-back pain. The in-clinic educational intervention included feedback of the findings of our previous studies of care for back pain (comparing family physicians and chiropractors), an up-to-date summary of scientific knowledge relevant to the management of back pain in primary care, a videotape contrasting ineffective and effective patient encounters, and a clinical assessment form for low-back pain. The back pain-related beliefs, attitudes, and behaviors of 15 primary care providers in a large health maintenance organization clinic and of 14 family physicians in six group practices were assessed before and after the intervention. Significant increases were noted in the proportions of providers who felt confident they knew how to manage low-back pain, who believed their patients were satisfied, and who claimed they reassured patients that they did not have serious disease. The intervention, however, had little impact on the prevalence of negative feelings about patients with back pain or frustration with patients who wanted their doctor to "fix" their problem. The intervention had a similar impact on health maintenance organization and fee-for-service physicians.

Back Pain↗
PubMed1992

Self-reported low back symptoms in urban bus drivers exposed to whole-body vibration.

The prevalence of self-reported low back symptoms was investigated by a postal questionnaire in a group of 234 urban bus drivers exposed to whole-body vibration and postural stress and in a control group of 125 maintenance workers employed at the same bus municipal company. The average vertical whole-body vibration magnitude measured on the seat pan of the buses was 0.4 m/s2. After controlling for potential confounders, the prevalence odds ratios for the bus drivers compared to the controls significantly exceeded 1 for several types of low back symptoms (leg pain, acute low back pain, low back pain). The occurrence of low back symptoms increased with increasing whole-body vibration exposure expressed in terms of total (lifetime) vibration dose (years m2/s4), equivalent vibration magnitude (m/s2), and duration of exposure (years of service). The highest prevalence of disc protrusion was found among the bus drivers with more severe whole-body vibration exposure. Frequent awkward postures at work were also related to some types of low back symptoms. It is concluded that bus driving is associated with an increased risk for low back troubles. This excess risk may be due to both whole-body vibration exposure and prolonged sitting in a constrained posture. The findings of this study also indicated that among the bus drivers low back symptoms occurred at whole-body vibration exposure levels that were lower than the health-based exposure limits proposed by the International Standard ISO 2631/1.

Adult↗
PubMed1994

The cost of 1989 workers' compensation low back pain claims.

STUDY DESIGN: Cost data were gathered from computerized records of the Liberty Mutual Insurance Company for low back pain workers' compensation claims (N = 119,107) and for all claims (N = 731,087) initiated from 45 jurisdictions (states) during 1989. OBJECTIVE: This study provided more current, accurate, and additional information to estimate the costs and incidence associated with compensable low back pain compared with all compensation claims. METHODS: The first group of data included all compensable low back claims selected by specific codes: body part codes consisted of low back area, sacrum and coccyx, disc, and multiple trunk; injury codes consisted of strain, sprain, inflammation, rupture, hernia, fracture, and contusion. The second sample included all compensable claims, including both occupational injuries and illnesses. RESULTS: Low back pain cases represented 16% of all claims but 33% of all claims costs; 55.4% of the low back pain cases received medical payments only (i.e., did not receive indemnity payments for lost time). The mean cost per case for low back pain was $8321; median cost per case was $396. Medical costs represented 32.4% of the total costs; indemnity costs (i.e., payment for lost time) represented 65.8%. CONCLUSIONS: Since indemnity costs represent the greatest percentage of workers' compensation expenditure, the primary goal of low back pain management should be the prevention or reduction of prolonged disability.

Costs and Cost Analysis↗
PubMed1994

The relationship between intramuscular pressure of the paraspinal muscles and low back pain.

STUDY DESIGN: The relationship between lumbar intramuscular pressure and backache with degenerative lumbar spine diseases was examined. Lumbar intramuscular pressure in 102 patients with low back pain and in 20 normal adults was compared in different positions using Miller's microtip catheter transducer. OBJECTIVES: This study sought to study the relationship between intramuscular pressure of the lumbar back muscles and degenerative lumbar diseases. SUMMARY OF BACKGROUND DATA: Measurement of intramuscular pressure is an objective technique for diagnosing lumbar compartment syndrome. The diagnosis of chronic compartment syndrome of the lumbar back muscles is confirmed when an association between an increase in intramuscular pressure and the onset of back pain is established. As spinal alignment changes from lordosis to kyphosis, the intramuscular pressure increases and blood flow decreases. METHODS: Intramuscular pressure measurements of the lumbar back muscles were performed in various positions and loading. Results in patients with low back pain and in normal adults were compared. RESULTS: The intramuscular pressure levels were found to be closely related to position and loading. The pattern of changes in pressure depended on the type of disease. The changes in intramuscular pressure in the patients with backache were classified into four distinct patterns. Chronic compartment syndrome of the lumbar back muscles showed two pattern: waxing and plateau. CONCLUSIONS: Measurement of intramuscular pressure of the lumbar back muscles might be an important method of obtaining a greater knowledge about backache.

Biomechanical Phenomena↗
PubMed1994

Back muscle injury after posterior lumbar spine surgery. Part 2: Histologic and histochemical analyses in humans.

STUDY DESIGN: The histologic and histochemical changes in back muscle were studied in virgin surgery patients with lumbar spine disorders and in patients who underwent repeat posterior lumbar surgery. OBJECTIVES: The results were correlated to provide the evidences of histologic changes of back muscle after posterior lumbar surgery. SUMMARY OF BACKGROUND DATA: Back muscles were examined histologically and histochemically after posterior lumbar surgery. No previous study has assessed these changes. METHODS: Back muscles were obtained before and after retraction from 18 virgin surgery cases with lumbar spine disorders. In four patients, the retraction pressure was monitored and the retraction pressure-time products ([P][T]) were calculated. In 21 repeat lumbar surgery cases, muscle samples were obtained before muscle retraction. Samples were evaluated by histologic and histochemical methods. RESULTS: Abnormal findings were slight in virgin surgery cases. Early back muscle injury tended to depend on operation time and [P][T] products. Late back muscle injury in reoperated patients was marked. Various types of neurogenic changes were observed more than 10 months after the first operation. CONCLUSIONS: Histologic damages of back muscle due to previous surgical intervention were long-lasting. To avoid permanent muscle injury, the retraction time and pressure should be shortened or the pressure on the back muscle should be monitored during posterior surgery.

Adult↗
PubMed1995

"Cross-sectional" study of low back pain among workers at an industrial enterprise in Russia.

STUDY DESIGN: A representative sample of 18- to 65-year-old workers from a machine-building factory was studied using a standardized questionnaire. OBJECTIVES: To study the prevalence of low back pain syndrome among workers at an industrial enterprise and to estimate the association between low back pain syndrome and certain factors. METHODS: This was a cross-sectional study of 800 workers (400 men and 400 women), who were invited to participate in the study. Seven-hundred-and-one (87.6%) persons took part in the study--339 (84.7%) men and 362 (90.5%) women. RESULTS: The life-time prevalence of low back pain complaints was 48.2%. The prevalence during the last year was 31.5%, and point prevalence was 11.5%. The number of patients with low back pain complaints increased with age. The duration of a low back pain episode was less than 2 weeks in 88.2% of the patients, and more than 12 weeks in only in 1.8% of the patients. Analysis of some social, individual, and professional factors revealed associations between low back pain and low level of education, marital status, absence of sports activity, intensity of smoking, and frequent lifting and bending during the work day. CONCLUSION: Our study revealed a high prevalence of low back pain among workers at an industrial enterprise. This low back pain was primarily of an acute nature.

Acute Disease↗
PubMed1995

The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men.

STUDY DESIGN: Historical cohort, including selected subgroups. OBJECTIVES: To understand the long-term effects of exercise on back-related outcomes, back pain, sciatica, back-related hospitalizations, pensions, and magnetic resonance imaging findings were studied among former elite athletes. SUMMARY OF BACKGROUND DATA: Exercise and sports participation have become increasingly popular, as have recommendations of exercises for back problems, but little is known about their long-term effects. METHODS: Questionnaires were returned by 937 former elite athletes and 620 control subjects (83% response rate). Identification codes allowed record linkage to hospital discharge and pension registers. Magnetic resonance images were obtained of selected subgroups with contrasting physical loading patterns. RESULTS: Odds ratios for back pain were lower among athletes than among control subjects, with significant differences in endurance, sprinting and game sports, and wrestling and boxing. No differences in the occurrence of sciatica or in back-related pensions and hospitalizations were seen. When comparing lumbar magnetic resonance images of 24 runners, 26 soccer players, 19 weight lifters, and 25 shooters, disc degeneration and bulging were most common among weight lifters; soccer players had similar changes in the L4-S1 discs. No significant differences were seen in the magnetic resonance images of runners and shooters. CONCLUSIONS: Maximal weight lifting was associated with greater degeneration throughout the entire lumbar spine, and soccer with degeneration in the lower lumbar region. No signs of accelerated disc degeneration were found in competitive runners. However, back pain was less common among athletes than control subjects and there were no significant differences in hospitalizations or pensions. No benefits were shown for vigorous exercise compared with lighter exercise with respect to back findings.

Adolescent↗
PubMed1995

Low back pain in schoolchildren. A study of familial and psychological factors.

STUDY DESIGN: The results of a survey organized in the school system of the Swiss canton of Fribourg. An original questionnaire was developed for this study are reported. OBJECTIVES: The goal of this study was to evaluate the possible role of familial or psychological factors in schoolchildren reporting nonspecific low back pain. SUMMARY OF BACKGROUND DATA: Previous surveys have shown a high prevalence of nonspecific low back. pain among schoolchildren, particularly teen-agers. The reported familial incidence raises, among others, the question of a possible role of psychological or behavioral factors. METHODS: This survey was performed with a validated 43-item self-administered questionnaire eliciting information about back pain history, family characteristics, children's activities, and psychological parameters. All schoolchildren (n = 615), ages 12-17 years, in two secondary schools (Fribourg, Switzerland) were surveyed. The response rate was 98%. RESULTS: Reported lifetime prevalence of back pain was 74%. Lumbar pain was the most frequent localization of pain (69% of back pain). The measured psychological factors were significantly associated with reported nonspecific low back pain and its consequences as well as with sibling history of low back pain. CONCLUSIONS: The study suggests that psychological factors play a role in children's reporting of nonspecific low back pain.

Adolescent↗