Beerstra, T. (Tessa) (2014) Heritability and associations of back pain in adolescents: A twin family case-control study of lifetime prevalence of chronic low back pain and one-month prevalence of thoracolumbar back pain. thesis, Medicine.
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Abstract
Background Non-specific back pain is heritable in adults, but heritability has not been established in children or adolescents. Back pain in adolescence is common and, where there is no definable underlying disease, it is expected to share many of the characteristics, including associations, of the other common non-specific or functional pain disorders Aims This study addressed lifetime prevalence of chronic low back pain (LBP (life)) and current one-month prevalence of thoracolumbar back pain (TLBP (current)). Our primary objective was to investigate the heritability of back pain in adolescent monozygous (MZ) and dizygous (DZ) twins and whether a prior history of injury influenced the assessment of heritability of the two categories of back pain. Furthermore, we explored the associations between TLBP (current) and current one-month prevalence of pain in other body areas, and between back pain and other common paediatric disorders. Methods The design was a twin family case-control study in adolescent twins aged 11-18 years, their biological parents and siblings. Paper and online questionnaires were sent to 2479 twin families through the Australian Twin Registry. The twin pairs’ zygosities had been defined by the results of a DNA test or assessed by a validated zygosity questionnaire. To define the location of pain in other body regions, participants marked all the sites on a body map, and they were asked whether their pain was due to injury. Other assessed paediatric conditions were migraine, headache, growing pains, restless legs syndrome (RLS), recurrent abdominal pain, chronic pain (CP), iron deficiency (ID), anxious depression (AD) and multiple sensory sensitivity (MSS) by validated questionnaires where available. Heritability was examined by using twin pair concordances, logistic regressions and genetic modelling. Results The study sample involved 653 twin pairs who had completed the questionnaires (response rate 26.3%). The prevalence of LBP (life), assessed in DZ twins, was 10.7%. LBP (life) and TLBP (current) were strongly associated in twin individuals (OR 15.91, p<0.001), and a twin individual was approximately 2.5 times more likely to have a history of chronic LBP if a parent or sibling had been affected by back pain. Casewise concordances and tetrachoric correlations for LBP (life) and TLBP (current) were significantly greater in MZ than in DZ twin pairs. The broad-sense heritability of LBP (life) and TLBP (current) was estimated to be respectively 47% and 56%. Statistically significant associations between the back pain categories in twin individuals and their parents and first siblings added to the evidence for heritability. Subgroup analyses showed that history of prior injury did not influence the heritability analysis for LBP (life), but did have a negative influence on the heritability assessment of TLBP (current), reducing the heritability estimate of the total sample. TLBP (current) in twin individuals was significantly associated with current one-month prevalence of each of the investigated pain regions, and in particular with pain in two or more regions (OR 16.95, p<0.001) and in the neck region (OR 13.15, p<0.001). The multivariate analyses showed that the strongest associations as potential predictors of LBP (life) in twin individuals were current one-month prevalence of LBP and parental LBP (life). Pain in the neck region was the strongest predictor for the twin individual having TLBP (current). LBP (life) in twin individuals was significantly associated with all of the investigated pain disorders and RLS, but not with ID, AD and MSS. TLBP (current) in twin’s parents was significantly associated with twin individuals having MSS. If a twin had a history of chronic LBP, he or she was more likely to have another chronic pain disorder (OR 2.34, p<0.001). Conclusions Back pain in adolescence was shown to have evidence for heritability and was associated with having pain in other body regions. We hypothesise that back pain shares common genetic vulnerability with other recurrent or chronic pain disorders of childhood not associated with disease, and with RLS and MSS.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Champion, D. Associate Professor and Department of Anaesthesia and Pain Management and Sydney Children’s Hospital, Randwick and Nijholt, Dr IM and Isala Klinieken, Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:57 |
| Last Modified: | 25 Jun 2020 10:57 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1757 |
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