The epidemiology and risk factors of back pain in adolescent idiopathic scoliosis – a large-scale study

Abstract

Introduction: Adolescent idiopathic scoliosis (AIS) presents with a three-dimensional deformity which may affect spinal biomechanics. Thoracic and back pain occur in AIS patients but little is known for their prevalence at various time period and risk factors. Methodology: A total of 987 conservatively treated AIS patients were recruited and filled in structured questionnaire regarding current thoracic pain (TP), low back pain (LBP) and chronic back pain (TP/LBP), pain histories at previous 7-days, 30-days, 12-months and lifetime. Insomnia Severity Index, Epworth Sleepiness Scale, and Depression Anxiety Stress Scales were assessed. These features and scoliotic curvature phenotypes were compared between patients with/without back pain. Risk factors for current and chronic back pain were analyzed using multivariate analyses. Results and Analysis: Various period prevalence for TP and LBP ranged from 5.6% to 14.1%, and 5.5% to 29.3% respectively. Patients with back pain (current/last 12 months) had significantly poorer function, more insomnia and daytime sleepiness (p<0.05) than those without pain. Chronic back pain patients had same problems plus moderate depression (p<0.05). Older age (OR=1.2-1.4), Cobb angle>40° (OR=2.4-3.7), daytime sleepiness (OR=2.4), insomnia (OR=1.8-2.3) were significant risk factors for episodic and/or chronic back pain. Moderate depression (OR=3.3) and brace-wearing (OR=3.0) were independent risk factors for chronic back pain. Discussion and Conclusion: This is the first large-scale study reporting the epidemiology and risk factors of AIS back pain, giving an insight of the impact of biopsychosocial factors. Our results highlight the importance of back pain screening and management for AIS with specific imaging and psychosocial profile.