Early-life programming of pain sensation? Spinal pain in pre-adolescents with pain experience in early life
Neurobiological mechanisms can be involved in early programming of pain sensitization. We aimed to investigate the association between early-life pain experience and pre-adolescence spinal pain. We conducted a study of 29,861 pre-adolescents (age 11–14) from the Danish National Birth Cohort. As indicators of early-life pain, we used infantile colic and recurrent otitis media, reported by mothers when their children were 6 and 18 months. Self-reported spinal pain (neck, middle back, and/or low back pain) was obtained in the 11-year follow-up, classified according to severity. Associations between early-life pain and spinal pain in pre-adolescents were estimated using multinomial logistic regression models. To account for sample selection, inverse probability weighting was applied. Children experiencing pain in early life were more likely to report severe spinal pain in pre-adolescence. The association appeared stronger with exposure to two pain exposures (relative risk ratio, 1.31; 95% CI, 1.02–1.68) rather than one (relative risk ratio, 1.14; 95% CI, 1.05–1.24). We observed similar results when using headache and abdominal pain as outcome measures, underpinning a potential neurobiological or psychosocial link in programming of pain sensitization.
What is Known:
• Spinal pain in pre-adolescents is common, causes marked discomfort and impairment in everyday life, and may be an important predictor of spinal pain later in life.
• Neurobiological mechanisms have been suggested as involved in early programming of pain sensitization.
What is New:
• Pain exposure in early postnatal life in terms of infantile colic and recurrent otitis media is associated with spinal pain in pre-adolescence; thus, experience of such painful conditions in the early postnatal period may seemingly influence programming of future pain sensation.
KeywordsBack pain, Spinal pain, Pain sensitivity, Pre-adolescence, Epidemiology
The Danish National Birth Cohort
The 11-year follow-up in the Danish National Birth Cohort
Inverse probability weighting
International Standard Classification of Education
Relative risk ratio
- Spinal pain
Neck pain, middle back pain, and/or low back pain
The Young Spine Questionnaire
- 95% CI
95% confidence interval
The Danish National Birth Cohort was established with a significant grant from the Danish National Research Foundation. Additional support was obtained from the Danish Regional Committees, the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Health Foundation, and other minor grants. The DNBC biobank has been supported by the Novo Nordisk Foundation and the Lundbeck Foundation. Follow-up of mothers and children have been supported by the Danish Medical Research Council (SSVF 0646, 271-08-0839/06-066023, O602-01042B, 0602-02738B), the Lundbeck Foundation (195/04, R100-A9193), the Innovation Fund Denmark 0603-00294B (09-067124), the Nordea Foundation (02-2013-2014), Aarhus Ideas (AU R9-A959-13-S804), University of Copenhagen Strategic Grant (IFSV 2012), and the Danish Council for Independent Research (DFF-4183-00594 and DFF-4183-00152).
Joergensen, MSc, conceptualized and designed the study, contributed to methods development, carried out data management and analyses and interpretation of results, and drafted the manuscript.
Prof. Nybo Andersen conceptualized and designed the study, contributed to methods development and to the interpretation of results and critical revision of the manuscript.
Dr. Hestbaek contributed to the conceptualization and design of the study, to methods development, to interpretation of results and to critical revision of the manuscript.
Dr. Lucas contributed to the conceptualization and design of the study, to methods development, to the interpretation of results and to critical revision of the manuscript.
Prof. Kragh Andersen supervised in statistical methods and analyses and contributed to the interpretation of results and critical revision of the manuscript.
All authors approved the final manuscript as submitted and agree to be accountable for all aspects of this article.
The study was supported by the Danish Council for Independent Research (DFF-7016-00344).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Approval of the study was obtained from the Danish Data Protection Agency through the joint notification of the Faculty of Health and Medical Sciences at the University of Copenhagen and the DNBC Steering Committee.
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