Low back pain is a common pediatric condition. The prevalence of low back pain rises with age: 1 percent at age 7, 6 percent at age 10 and 18 percent at ages 14-16.1 However, no established, evidence-based guidelines exist regarding the treatment for LBP in the pediatric population.
Recent Research
Recently, a research team from Stanford University School of Medicine, Johns Hopkins Hospital and the University of Chicago investigated patterns of pharmacological prescribing in the pediatric population with low back pain.2 This research team performed an assessment using the MarketScan commercial claims database (2008-2015) for patients age 5-17 at time of low back pain diagnosis. The sample included 268,228 opioid-naive pediatric patients diagnosed with LBP. The mean age was 13.6, and 57.1 percent were female.
This research team found that a total of 35,274 of pediatric low back pain patients (13.2 percent) filled an opioid prescription from their diagnosis, and 23.9 percent filled a second opioid prescription. Moreover, opioid prescribing decreased very little over the study period (2008-2015): age group 5-9 decreased 2.5 percent, age group 10-14 decreased 2.6 percent and age group 15-18 decreased 3.8 percent.
The Consequences
In adults, opioids are not recommended for low back pain because multiple research studies have demonstrated they are neither effective nor safe.3 In children, there are no published studies demonstrating benefit or safety. The results from this study have strong implications for clinical practice, reinforcing the need for early non-opioid therapy options for pediatric LBP patients.
Research has shown that as opioid prescribing has increased in pediatric patients, the rate of opioid abuse and opioid-related death have also increased among these patients.4 Young people who report receiving a medical provider prescription for a narcotic pain medication by 12th grade are significantly more likely to abuse prescription pain medications in the future.5
Clinical / Practice Pearls
Chiropractors can offer an alternative treatment package of manipulation and spinal rehab that provides benefit without risk of serious harms. In a prospective cohort study, researchers found that spinal manipulation improves pain in children with low back pain.6 Ahlqwist, et al., conducted a randomized clinical trial that demonstrated practitioner-led spinal rehabilitation is effective in treating children with low back pain.7
Moreover, researchers have found no reported serious or catastrophic adverse events in studies of manipulation or spinal rehabilitation in children.8
Patients are not the only ones who need this information. Medical providers need education about safe and beneficial alternatives to opioids. Even though you might think it is up to medical schools and medical societies to provide this education, it is also our responsibility. Providing this information to your local medical providers is a great way to make meaningful relationships within the health care community.
Approached in a professional manner, most medical providers are open to communication from chiropractors. If you want to be effective with medical providers, you must train yourself in appropriate evidence-based protocols and materials. You only get one chance to make a good first impression!
Editor's Note: The research presented in this article is also available in video format at https://chiroevidence.com/research-capsule-240.
References
- MacDonald J, Stuart E, Rodenberg R. Musculoskeletal low back pain in school-aged children: a review. JAMA Pediatr, 2017;171:280-287.
- Azad TD, Harries MD, Veeravagu A, et al. Opioid prescribing patterns for low back pain among commercially insured children. Spine, 2020;45:E1365-E1366.
- Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med, 2017;166:514-30.
- McCabe SE,West BT, Veliz P, et al. Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976-2015. Pediatrics, 2017;139:e20162387.
- Miech R, Johnston L, O'Malley PM, et al. Prescription opioids in adolescence and future opioid misuse. Pediatrics, 2015;136:e1169-e1177.
- Hayden JA, Mior SA, Verhoef MJ. Evaluation of chiropractic management of pediatric patients with low back pain: a prospective cohort study. J Manipulative Physiol Ther, 2003;26:1-8.
- Ahlqwist A, Hagman M, Kjellby-Wendt G, et al. Physical therapy treatment of back complaints on children and adolescents. Spine, 2008;33:E721-7.
- Humphreys BK. Possible adverse events in children treated by manual therapy: a review. Chiropr Osteopat, 2010;18:12.
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