Teenage pain often dismissed as growing pains

teenage child back hip neck chronic pain

A common belief is that pain in children will just go away or be forgotten when life takes over.

In the absence of an identifiable injury such as a sprain or fracture, childhood and adolescent pain is often disregarded – by doctors and parents alike.

The most common type of pain is spinal (back or neck), and many more adolescents complain of pain than is commonly recognised. Between one-third and half of all adolescents aged 13 and over report back pain about every month or even more often1. In fact, the prevalence of these conditions rises so sharply in early adolescence the rates approach adult levels by 18 years.

It’s becoming increasingly clear so-called non-specific “musculoskeletal conditions”, the leading causes of disability worldwide, are significant health issues in children.

Non-specific conditions mean that pain cannot be attributed to a defined and diagnosable anatomical cause. In adults, these conditions are recognised as complex disease states that have biological, psychological and socioenvironmental underpinning.

For a significant proportion of adolescents, non-specific pain has extensive impacts on health and quality of life. For example, in a study in Western Australia, about 20% of 17-year-olds reported either missing school, seeking health care, taking medication, interference with normal activities, or interference with physical/sporting activities due to back pain2. There is also evidence that persistent pain symptoms in adolescence predict chronic pain problems in adulthood3.

The blame for pain in kids is often directed at school bags, computer and small-screen device usage, posture, and/or other biomechanical targets. It is also sometimes believed (permanent) damage is being done to the spine, with lifelong consequences.

However, there is little evidence this is true.

Studies show socioeconomic, lifestyle, cognitive and psychological factors are just as strongly, or even more strongly, related to pain (particularly chronic pain) as physical factors4. These societal beliefs about “physical” causes of pain may be not only incorrect, but detrimental if they cause worry about the spine being fragile and discourage children from physical activity.

To date the complex interaction between painful events, the growing body, health influences, social or environmental influences from family, health care providers and schooling is not fully understood. In particular, very little is known about what brings on initial episodes of painful conditions and whether this underpins the link with future chronic pain.

Given wide recognition that early life events are critical in shaping health as people grow older, understanding the context of common painful conditions in early life is critical to inform future health.

It is important to provide effective treatment to those at risk of developing persistent pain. It is also important not to create medical problems out of transient aches and pains, i.e. not every child needs to be sent off for diagnostic imaging and intensive treatments. But a shift away from the narrow and outdated focus on school bags, posture and damaged spines as the only source of problems is a must.

Efforts to update the narrative around pain are as important for children as for adults.

References:

  1. Kamper, S.J., et al., Musculoskeletal pain in children and adolescents. Braz J Phys Ther. http://dx.doi.org/10.1590/bjpt-rbf.2014.0149
  2. Beales, D.J., et al., Low back pain in 17 year olds has substantial impact and represents an important public health disorder: a cross-sectional study. BMC Public Health, 2012. 5 (12): p. 100.
  3. Hestbaek, L., et al., The course of low back pain from adolescence to adulthood: eight-year follow-up of 9600 twins. Spine, 2006. 31(4): p. 468-72.
  4. Chambers, C.T., et al., The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain, 2011. 152(12): p. 2729-38.

Rib pain referral patterns

Costovertebral (rib) joints are starting to be recognised as a source of pain.

Mid-back pain is often misdiagnosed as either spinal (vertebral) pain or muscular pain. The figure below depicts pain referral patterns of various costovertebral joints – where the rib head joins the spine. This is a joint that when subluxated can induce its own pain patterns.

rib pain referral

Reference:

Young, B.A., et al., Thoracic costotransverse joint pain patterns: a study in normal volunteers. BMC Musculoskelet Disord., 2008. 9 (1): p140.

Osteoarthritis

osteoarthritis degeneration back painDegeneration of the spine is a prevalent problem that generally advances with age, though is not always restricted to the elderly1.

The presence of osteoarthritis is not always consistent with pain either. While progressive joint failure may cause pain and disability, approximately 50% of people with osteoarthritic changes don’t have any symptoms2. This is known as the “structure-symptom discord”.

How the spine degenerates and how pain is experienced is multifactorial. Firstly, osteoarthritis begins when there is an imbalance of mechanical load that exceeds the limit of what joint tissues can handle. Bony changes and inflammation cause dysfunction and instability of the joints. Secondly, changes to the nervous system occur around the spine, then spinal cord, and finally brain. How people move starts to change; muscle strength changes; and finally sensory awareness of their body changes. When these systems break down, the person experiences persistent pain (Fig. 1).

biopsychosocial model structure symptom_550

Figure 1. Biospsychosocial model depicting the relation of structural pathology to the experience of pain

How such dramatic alterations in shape of the spine occur over time (Fig. 2) is primarily due to a decrease in nutrition to the discs between the vertebrae3. The primary source of nutrition for the intervertebral discs are the end plates of the vertebrae. As degeneration progresses, fissures, cracks, clefts and fractures occur in the end plates, resulting in them thinning and water volume being lost from within the disc. This reduces disc height, misaligning mechanical forces and changing the shape of the spine (Fig. 3). As a consequence, more stress and strain is placed on the joints of the spine creating back pain. Long term pain can lead to more permanent, dysfunctional changes in the central nervous system ■

spinal degeneration disc compression_550

Figure 2. Spinewave case example of degeneration of the lumbar spine over 23 years resulting in scoliosis to the right and persistent low back pain

disc degeneration

Figure 3. Qualitative stress distribution across vertebral end plate for normal and degenerated intervertebral disc under pure compressive and eccentric compressive loading

Read more


  • Symptoms (72)
  • Most Recent Symptoms

  • Archives

  • Search

    Loading
  • Case of the Month

    Reviews of complex cases are frequently researched and updated in this category. Alternatively use the search bar above.
  • VIDEO AUDIO EBOOKS

    Video Audio Ebooks
  • SpineWave Bulletin

    Sign up to receive our newsletter: a cutting edge knowledge update including case studies, research, videos, blog, and Dr Neil's periodic existential outrospection.
  • Contact

    09 522 0025
    Suite 1, 102 Remuera Road, Auckland
    Click here for practice hours
  • Social Media