Randomized trials for adolescents with nonspecific back pain

When I started my doctoral program, I didn’t know that people under the age of 18 were experiencing persistent or chronic back pain. I’d helped many adults (usually over the age of 40) to eliminate their back pain as part of the fitness programs I used to teach. But kids? Not in a million years did I think the problem could be affecting them as well.
 
But the research was clear: More and more kids are reporting episodes of back pain and going to the doctor because of the pain.
 
We know from decades of research on adults that nonspecific back pain is a biopsychosocial phenomenon that can be meaningfully affected by individuals’ beliefs, emotions, lifestyle factors, and family and social relationships. Recent guidelines for the treatment of adolescents with persistent nonspecific back pain, as well as those for youth with mixed chronic pain, strongly recommend multidisciplinary care in which adolescents receive treatment for both mind and body. They also recommend against surgical or pharmacological interventions.
 
Thus, with my first PhD study—a systematic scoping review—I set out to (1) examine the interventions evaluated in randomized trials for adolescents with persistent back pain to determine if they correspond to current guidelines, and (2) to reveal future research priorities.

You can see the published protocol for the scoping review on Open Science Framework. We followed the PRISMA guidelines for scoping reviews, which are a set of systematic steps that help to increase the rigor with which such studies are undertaken. I, my supervisors, and my amazing trio of international coauthors charted intervention studies’ characteristics, participant characteristics, and intervention details using the Template for Intervention Description and Replication (TIDieR) checklist.
 
Because I aimed to investigate the trials that included only adolescents with persistent back pain, and not some other diagnosis, only eight reports representing seven randomized trials were eligible for the review. The most common interventions trialed were exercise therapy (n = 6) and back education (n = 4). Five studies employed multiple intervention components, but none was multidisciplinary. Rather, interventions primarily targeted the child’s posture or biomechanical factors. One study included an intervention addressing participants’ fears and beliefs about pain. It was the only study of the 7 to include some form of psychosocial intervention.
 
In my conclusion of the research report, I state that randomized trials for adolescents with persistent back pain have primarily relied upon an outdated, biomechanical explanation of persisting pain. Because the study was completed in 2022, I performed a new search of the same databases in September 2025, a week before my PhD defense.

That search (although not nearly as rigorous as the systematic search performed for the scoping review) showed that still, 3 years later, people studying interventions for adolescent persistent back pain were still leaving out interventions or outcomes related to psychosocial phenomena.
 
Despite my recommendation that future randomized trials should align with current treatment guidelines and measure outcomes across multiple biopsychosocial domains, nobody seems to be doing that yet for this population.
 
You can read the open-access article by clicking the image below.

Hauber SD, Robinson K, Kirby E, Kamper S, Lennox NN, O’Sullivan K. Describing the nonsurgical, nonpharmacological interventions offered to adolescents with persistent back pain in randomized trials: A scoping review. European Journal of Pain. 2023;27(4):459-475. doi:10.1002/ejp.2073

Click to read the full open-access article.