Low back pain in children and adolescents: to treat or not?

Recent cohort data has shown that low back pain is a common symptom in adolescents that, by the age of 16, approaches the level found in adults. The symptoms are frequently recurrent, but are not usually associated with disability. Spells are frequently forgotten, and medical attention is not generally sought. Although the possibility of serious spinal pathology must be considered, the majority of adolescent back trouble may be considered a normal life experience. The efficacy of treatment for non-specific back pain in this age group is undetermined, but the similarities with adult symptoms suggests that management should follow current clinical guidelines for adults (early activation and advice stressing the benign nature of the problem). Persisting root pain may best respond to chemonucleolysis. There is no evidence that treatment or lifestyle changes at this age will reduce symptoms in adult life, but inappropriate medical attention may have detrimental psychosocial consequences.