Prognosis

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Adolescent back pain generally has a better prognosis than adult back pain. Mechanical causes usually respond to conservative treatment, as they are only rarely caused by degenerative or progressive conditions such as spinal stenosis or disk herniation. Nonspecific back pain in adolescents is also thought to have a better outcome than adult nonspecific back pain. Few adolescents (7-11%) seek medical treatment for their back pain, and only rare cases are hospitalized or become disabled (4,6,15,19,20,5,70,75). In contrast, back pain in adults is the fifth most common reason for physician visits (76), and although most adults with acute LBP will improve within three months, 6% to 20% will develop chronic back pain, and 25% to 75% still have back pain one year later (13,72,73,77). In adults, preexisting psychological distress, work compensation issues, other chronic pain issues and job dissatisfaction are all associated with an increased risk of developing chronic LBP (73). Other associated factors include poor self-rated health, low level of physical activity, and smoking (78).

A few prospective studies have been done that followed adolescents into adulthood to evaluate long-term prognosis and risk factors for incident or persistent back pain, and they have shown that having had back pain during adolescence was associated with a somewhat higher likelihood of having LBP later in adulthood (33,47,79). Other risk factors for developing adult back pain appear to include a family history of LBP (47), emotional or behavioral disorders during childhood, and lower parental education in childhood (32), but one large prospective study did not find a significant association between childhood emotional problems and onset of LBP in the preceding year (80). A dose-response relationship between smoking and adult LBP was reported in another large prospective study of adolescents, but no association was found for alcohol consumption or being overweight as an adolescent (34). Exercise may be beneficial: adolescents who continued to exercise 3 hours/week or more into adulthood were found to have a lower prevalence of LBP as adults in a small study (81). However, being physically active was also associated with a lower frequency of smoking, being sick, being unemployed, being in a low socioeconomic class, and a shorter school education, so other factors may be important for the observed reduction in back pain prevalence (81). Additional long-term prospective studies in adolescents are needed to better understand the factors that determine the development of LBP as adults.

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