Etiology, Risk Factors, and Diagnosis of Back Pain in Children and Adolescents: Evidence- and Consensus-Based Interdisciplinary Recommendations
Children (Basel, Switzerland) · 2022 · DACH
Source and licence
- Authors
- Michael Frosch, Maximilian D Mauritz, Stefan Bielack et al.
- Title
- Etiology, Risk Factors, and Diagnosis of Back Pain in Children and Adolescents: Evidence- and Consensus-Based Interdisciplinary Recommendations
- Journal
- Children, 2022
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC8870422
Licence statement of the original publication
Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
3.1.1. Causes and Red Flags for Specific back Pain in Childhood and Adolescence
- Recommendation 1Detection of the red flags presented in Table 1 should prompt diagnosis for specific causes of disease.A, expert consensus 100%
- Recommendation 2If one or more red flags for specific causes of disease are detected in children or adolescents, extended diagnostics should be performed.A, expert consensus 100%
3.1.2. Risk Factors for Non-Specific Back Pain in Childhood and Adolescence
- Recommendation 3When diagnosing non-specific back pain in adolescence, the presence of any evidence-based risk factor presented in Table 2 should be assessed.A, level of evidence 1–2, consensus 100%
3.1.3. Risk Factors for Chronicity of Non-Specific Back Pain (“Yellow Flags”) in Children and Adolescents
- Recommendation 4When risk factors for a chronic course are identified in pediatric patients with non-specific back pain (see Table 3), this should be reflected in treatment planning.A, level of evidence 2, consensus 100%
3.1.4. Prognosis of Non-Specific Back Pain in Childhood and Adolescence
- Recommendation 5When prognostic factors of a chronic course are identified in pediatric patients with non-specific back pain (see Table 4), this should be reflected in treatment planning.B, level of evidence 1–2, consensus 100%
3.2. Diagnostics
- Recommendation 6The initial consultant for back pain in children and adolescents should be conducted by a primary care pediatrician or a general practitioner.A, expert consensus 100%
3.2.1. Medical History
- Recommendation 7The medical history should systematically record pain characteristics, onset of symptoms, possible triggers, concomitant symptoms, and red flags for underlying diseases.A, expert consensus 100%
- Recommendation 8The medical history in children and adolescents with back pain should includean assessment of possible non-specific back pain. Evidence-based risk factors for non-specific back pain should be considered (see Table 2).A, expert consensus 100%
3.2.2. Physical Examination
- Recommendation 9Physical examination of children and adolescents with back pain should include inspection, testing of locomotor function, and a neurological examination. Red flags for underlying diseases should be systematically considered and assessed (see Table 1).A, expert consensus 100%
3.2.3. Diagnostic Imaging
- Recommendation 10If the history and physical examination reveal evidence of a specific cause of disease in pediatric back pain, a targeted imaging examination should be performed.A, level of evidence 2, consensus 100%
- Recommendation 11Depending on the symptoms and findings, an X-ray examination and/or MRI is recommended. The MRI examination protocol should be adapted to age-specific questions and include the paravertebral soft tissues. The MRI should be evaluated by a radiologist with expertise in pediatric radiology.A, expert consensus 100%
3.2.5. Screening of Psychological and Social Risk Factors
- Recommendation 12If there is evidence of psychosocial risk factors, psychological diagnostic tests should be performed.A, level of evidence 1–2, consensus 100%
- Recommendation 13In the case of a chronic course of non-specific back pain in pediatric patients, medical and psychological diagnoses should be made in a specialized facility such as an outpatient pain clinic for children and adolescents.A, expert consensus 100%
3.2.6. Multidisciplinary Assessment
- Recommendation 14If the diagnosis confirms indications of a specific cause of the disease in children and adolescents with back pain, a specialized multidisciplinary medical evaluation (e.g., pediatric surgery, pediatric hematology and oncology, pediatric orthopedics, pediatric radiology, pediatric rheumatology, neurosurgery, or pediatric neurology) should be performed.B, expert consensus 100%
Abstract
Using a structured approach and expert consensus, we developed an evidence-based guideline on the diagnosis of back pain and the treatment of non-specific back pain in children and adolescents. The first part comprises etiology, risk factors, and diagnosis. The second part, published in the same issue, includes treatment and prevention. A comprehensive and systematic literature search was conducted to identify relevant guidelines and studies. Based on the findings of this literature search, recommendations on risk factors and diagnosis were formulated and voted on by experts in a structured consensus-building process. Notable red flags for specific back pain and evidence-based risk factors for non-specific back pain in children and adolescents were identified. Only three evidence-based recommendations could be formulated for causes, red flags, and risk factors for back pain, while two recommendations are based on expert consensus. Regarding diagnostics, eight expert consensus recommendations and one evidence-based recommendation could be provided. Despite the importance of adequate diagnosis for the treatment of back pain in children and adolescents, results of this work confirm the deficit in research investment in this area.
Contents of the original publication
The section headings of the original.
- 1. Introduction
- 2. Materials and Methods
- 3. Results
- 3.1. Causes, Red Flags and Risk Factors
- 3.2. Diagnostics
- 4. Discussion
- Supplementary Materials
- Institutional Review Board Statement
- Informed Consent Statement
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