Germs, J. (Janny) (2012) Low back pain in adolescents: heritability, individual and family comorbidities :A twin family case control study. thesis, Medicine.
Full text available on request.Abstract
Background and aims: Low back pain (LBP) is prevalent in childhood and particularly in adolescence. However, there has been little research to examine the heritability at this age. Chronic and recurrent pains without disease or significant injury are known to be comorbid with functional pain syndromes (FPS) and with psychological factors. The first aim of this twin family case control study was to assess the heritability of LBP in adolescents aged 11-18 years. The second aim was to determine possible associations which might represent shared genetic factors between LBP and FPS. Additionally the hypothesis that LBP is associated with anxious depression and higher sensitivity to sensory stimuli was tested. The hypothesis that a history of chronic LBP might be heritable associated with FPS and with anxious depression would shed light on LBP in adolescents as a FPS. Methods: A twin family case control study was conducted with twins aged 11 to 18 years. Twins, their biological parents and their siblings completed questionnaires to assess the presence of LBP, several FPS, anxious depression and a higher sensitivity for sensory stimuli. Cases were twins that experienced LBP without spinal disease or significant injury for at least 3 months during their lifetime. Families with at least one twin experiencing LBP for at least 3 months were considered "case families". In control families, neither twin had life prevalence of LBP for at least 3 months. Casewise concordance was calculated to determine the genetic influence of LBP. Chi square tests, independent sample t-tests and odds ratios were used to explore the association between LBP and FPS, anxious depression and sensory sensitivity. Results: Of the 374 twin families approached by the Australian Twin Registry, 242 (64.4%) responses were received for analysis. Fifty-nine twin families had at least one twin who had reported LBP for at least 3 months. Ten of 32 monozygous (MZ) twin pairs were concordant for LBP, compared with 2 of 27 dizygous (DZ) pairs. Casewise concordance for MZ twins was 0.48, which was significantly different from the casewise concordance of 0.14 for DZ twins. Twin individuals with LBP had significant associations compared with controls with migraine, chronic pain in other regions recurrent abdominal pain (RAP) and growing pains (GP). GP and chronic pain in mothers were associated with LBP in twins. Migraine in siblings was more common in LBP families. No significant differences between cases and controls were found between LBP and anxious depression in twin individuals with LBP and LBP families. Similarly, no association was found between sensory sensitivity and LBP. Conclusion: This study was the first paediatric twin study to support the hypothesis that LBP in adolescents is causally genetically influenced. The evidence for heritability and the individual and familial associations with FPS suggest that LBP in adolescents when not caused by spinal disease or significant injury has characteristics of a FPS as currently defined.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Nijholt, Dr. |
| Supervisor name: | Supervisor: and Champion, David Associate Professor and Institute: Department of Anaesthesia and Pain Medicine and Sydney Children’s Hospital |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:42 |
| Last Modified: | 25 Jun 2020 10:42 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/362 |
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