To effectively treat pain, especially chronic pain, we must take a biopsychosocial approach, regardless of a patient’s age. Prospective research shows adults are more likely to develop chronic low back pain if they experience low back pain as a child. Risk factors for initial bouts of chronic low back pain include poor sleep, anxiety, depression, low life satisfaction, and low self-esteem. To effectively help patients, we need to address the causes, not chase symptoms. This means examining and potentially involving family and other social elements. The questions this recent scoping review (PMID: 36587243) sought to answer were whether including psychosocial components of care improved outcomes for adolescents with back pain and whether families were involved in the treatment process.
The review was limited to randomized trials assessing the treatment of adolescents aged 12 to 17 years old with persistent or recurrent low back pain. Recurrent could be as little as two episodes and they did not define the duration to be classified as persistent. Most research uses 3- or 6-month marks. Only 8 studies met the inclusion criteria. Unfortunately, the trials did not provide great detail regarding the interventions, limiting the ability to draw conclusions about the importance of psychosocial considerations. One of the biggest limitations of randomized trials can’t be addressed as it would change the nature of the design – the need for standardization. No two people are the same, thus, no psychosocial assessment and intervention should ever be identical. It is hard/impossible to test tailored psychosocial interventions in a standardized manner and conclude the exact methodology to use with future patients.
What we can conclude from this review is that updated research is lacking regarding adolescents. The trials focused on a biomechanical approach to pain and families were not involved aside from providing consent. We likely would use the same educational strategies for a 12-year-old as a 52-year-old, but that doesn’t mean psychosocial contributions to pain should be ignored.