Skip to main content
Log in

Genetic and environmental influences on non-specific low back pain in children: a twin study

European Spine Journal Aims and scope Submit manuscript

Abstract

Aggregation of low back symptoms in families of children with low back pain (LBP) has been described. However, this may be due to genetic factors or common exposure to environmental factors. The aim of this study was to evaluate the relative contribution of genetic and environmental factors to childhood LBP by comparing the pairwise similarity of LBP in pairs of monozygotic (MZ) and dizygotic (DZ) twin children. Data was collected from 1995 to 1998 from a national sample of Finnish 11-year-old twins born between 1984 and 1987. This study sample constituted of 1,790 twin pairs: 610 MZ pairs, 598 same-sex DZ pairs, 582 opposite-sex DZ pairs. LBP pain was determined by using a validated pain questionnaire designed to assess musculoskeletal pains during the preceding 3 months. The outcome measure, LBP, was considered in three categories: none, once a month and at least once a week. Twin similarity in the report of LBP was quantified by correlations. Variance components for genetic and environmental factors were estimated by using biometric structural equation modelling techniques. The prevalence of LBP at least once a month was 15.7%, and at least once a week was 6.6%. The prevalence of frequent LBP in boys was significantly higher than that in girls (P = 0.04). In both genders, there were no differences in LBP reporting by zygosity (P > 0.2). There were no statistically significant differences between polychoric correlations in male MZ and DZ pairs and between polychoric correlations in female MZ and DZ pairs, suggesting little genetic influence. Results obtained from the best-fitting genetic model suggests that, of the total variance in LBP, 41% (95% CI 34–48) could be attributed to shared environmental factors within families; and 59% (52–66) to unique (unshared) environmental factors. Our results suggest that genetic factors play, at most, a minor role in LBP in children; instead, symptoms seem to be related to a mixture of shared and unshared environmental factors. This study underscore the need for further high-quality research, preferably prospective studies, to identify important modifiable risk factors in order to guide interventions that may prevent LBP in childhood.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Balague F, Dutoit G, Waldburger M (1988) Low-back pain in school children. An epidemiological study. Scand J Rehabil Med 20:175–179

    PubMed  CAS  Google Scholar 

  2. Balagué F, Skovron ML, Nordin M, Dutoit G, Waldburger M (1995) Low back pain in schoolchildren. A study of familial and psychological factors. Spine 20:1265–1270

    PubMed  Google Scholar 

  3. Balague F, Troussier B, Salminen JJ (1999) Non-specific low back pain in children and adolescents: risk factors. Eur Spine J 8:429–438

    Article  PubMed  CAS  Google Scholar 

  4. Battié MC, Videman T, Gibbons LE, Fisher LD, Manninen H, Gill K (1995) Determinants of lumbar disc degeneration. A study relating lifetime exposures and magnetic imaging findings in identical twins. Spine 20:2601–2612

    Article  PubMed  Google Scholar 

  5. Battie MC, Videman T, Levalahti E, Gill K, Kaprio J (2007) Heritability of low back pain and the role of disc degeneration. Pain 131:272–280

    Article  PubMed  Google Scholar 

  6. Bengtsson B, Thorson J (1991) Back pain: a study of twins. Acta Genet Med Gemellol (Roma) 40:83–90

    CAS  Google Scholar 

  7. Brattberg G (2004) Do pain problems in young school children persist into early adulthood? A 13-year follow-up. Eur J Pain 8:187–199

    Article  PubMed  Google Scholar 

  8. Burton AK, Clarke RD, McClune TD, Tillotson KM (1996) The natural history of low-back pain in adolescents. Spine 20:2323–2328

    Article  Google Scholar 

  9. Bønnelykke B, Hauge M, Holm N, Kristoffersen K, Gurtler H (1989) Evaluation of zygosity diagnosis in twin pairs below age seven by means of a mailed questionnaire. Acta Genet Med Gemellol (Roma) 38:305–313

    Google Scholar 

  10. Christensen K, Petersen I, Skytthe A, Herskind A M, McGue M, Bingley P (2006) Comparison of academic performance of twins and singletons in adolescence: follow-up study. BMJ 333:1095–1097

    Article  PubMed  Google Scholar 

  11. Christiansen L, Frederiksen H, Schousboe K, Skytthe A, Wurmb-Schwark N, Christensen K (2003) Age- and sex-differences in the validity of questionnaire-based zygosity in twins. Twin Res 6:275–278

    Article  PubMed  Google Scholar 

  12. Gao W, Li L, Cao W, Zhan S, Lv J, Qin Y, Pang Z, Wang S, Chen W, Chen R, Hu Y (2006) Determination of zygosity by questionnaire and physical features comparison in Chinese adult twins. Twin Res Hum Genet 9:266–271

    Article  PubMed  Google Scholar 

  13. Goldsmith HH (1991) A zygosity questionnaire for young twins: a research note. Behav Genet 21:257–269

    Article  PubMed  CAS  Google Scholar 

  14. Harreby M, Neergaard K, Hesselsoe G, Kjer J (1995) Are radiologic changes in the thoracic and lumbar spine of adolescents risk factors for low back pain in adults? A 25-year prospective cohort study of 640 school children. Spine 20:2298–2302

    Article  PubMed  CAS  Google Scholar 

  15. Heikkila JK, Koskenvuo M, Heliovaara M, Kurppa K, Riihimaki H, Heikkila K, Rita H, Videman T (1989) Genetic and environmental factors in sciatica. Evidence from a nationwide panel of 9365 adult twin pairs. Ann Med 21:393–398

    PubMed  CAS  Google Scholar 

  16. Hestbaek L, Iachine IA, Leboeuf-Yde C, Kyvik KO, Manniche C (2004) Heredity of low back pain in a young population: a classical twin study. Twin Res 7:16–26

    Article  PubMed  Google Scholar 

  17. Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C (2006) The course of low back pain from adolescence to adulthood: eight-year follow-up of 9600 twins. Spine 31:468–472

    Article  PubMed  Google Scholar 

  18. Jones GT, Macfarlane GJ (2005) Epidemiology of low back pain in children and adolescents. Arch Dis Child 90:312–316

    Article  PubMed  CAS  Google Scholar 

  19. Jones GT, Watson KD, Silman AJ, Symmons DPM, Macfarlane GJ (2003) Predictors of low back pain in British schoolchildren: a population-based prospective cohort study. Pediatrics 111:822–828

    Article  PubMed  Google Scholar 

  20. Joseph J (2002) Twin studies in psychiatry, psychology science or pseudoscience? Psychiatr Q 73:71–82

    Article  PubMed  Google Scholar 

  21. Kaprio J, Koskenvuo M, Rose RJ (1990) Population-based twin registries: illustrative applications in genetic epidemiology and behavioural genetics from the Finnish Twin Cohort Study. Acta Genet Med Gemellol (Roma) 39:427–439

    CAS  Google Scholar 

  22. Kaprio J, Pulkkinen L, Rose RJ (2002) Genetic and environmental factors in health-related behaviors: Studies on Finnish twins and twin families. Twin Res 5:366–371

    Article  PubMed  Google Scholar 

  23. Kringlen E (1967) Heredity and environment in the functional psychoses: an epidemiological-clinical study. Universitetsforlaget, Oslo

    Google Scholar 

  24. Kyvik KO (2000) Generalisability and assumptions of twin studies. In: Spector TD, Snieder H, MacGregor AJ (eds) Advances in twin and sib-pair analysis. Greenwich Medical Media Ltd, London, pp 67–77

    Google Scholar 

  25. Loehlin JC, Nichols RC (1976) Heredity, environment and personality: a study of 850 sets of twin pairs. University of Texas Press, Austin

    Google Scholar 

  26. MacGregor AJ, Andrew T, Sambrook PN, Spector TD (2004) Structural, psychological, and genetic influences on low back and neck pain: a study of adult female twins. Arthritis Rheum 51:160–167

    Article  PubMed  Google Scholar 

  27. Mikkelsson M, Salminen JJ, Kautiainen H (1997) Non-specific musculoskeletal pain in preadolescents. Prevalence and 1-year persistence. Pain 73:29–35

    Article  PubMed  CAS  Google Scholar 

  28. Neale MC, Cardon LR (1992) Methodology for genetic studies of twins and families. Kluwer, Dordrecht

    Google Scholar 

  29. Newcomer K, Sinaki M (1994) Occurrence of low-back pain in children and its relationships to back strength and level of physical activity. Arch Phys Med Rehabil 75:1048–1049

    Google Scholar 

  30. Olsen TL, Anderson RL, Dearwater SR, Kriska AM, Cauley JA, Aaron DJ, La Porte RE (1992) The epidemiology of low back pain in an adolescent population. Am J Public Health 82:606–608

    Article  PubMed  CAS  Google Scholar 

  31. Pulkkinen L, Vaalamo I, Hietala R, Kaprio J, Rose RJ (2003) Peer reports of adaptive behaviour in twins and singletons: is twinship a risk or an advantage? Twin Res 6:106–118

    Article  PubMed  Google Scholar 

  32. Richardson K, Norgate S (2005) The equal environments assumption of classical twin studies may not hold. Br J Educ Psychol 75:339–350

    Article  PubMed  Google Scholar 

  33. Salminen JJ, Pentti J, Terho P (1992) Low back pain and disability in 14-year-old schoolchildren. Acta Paediatr 81:1035–1039

    Article  PubMed  CAS  Google Scholar 

  34. Salminen JJ (1984) The adolescent back: a field survey of 370 Finnish school children. Acta Paediatr Scand 315(Suppl):8–122

    Google Scholar 

  35. Sambrook PN, MacGregor AJ, Spector TD (1999) Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum 42:366–372

    Article  PubMed  CAS  Google Scholar 

  36. Sarna S, Kaprio J, Sistonen P, Koskenvuo M (1978) Diagnosis of twin zygosity by mailed questionnaire. Hum Hered 28:241–254

    PubMed  CAS  Google Scholar 

  37. Watson KD, Papageorgiou AC, Jones GT, Taylor S, Symmons DPM, Silman AJ, Macfarlane GJ (2002) Low back pain in schoolchildren: occurrence and characteristics. Pain 97:87–92

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research analysis was funded by the Spine Society of Europe. Data collection in FinnTwin12 has been supported by the National Institute of Alcoholism and Alcohol Abuse (grants AA-12502, AA-00145, and AA-09203 to RJR), the Academy of Finland (grants # 100499, 205585, 118555 to JK) and the Finnish Centre of Excellence Programme (to Lea Pulkkinen and Jaakko Kaprio). We would also like to thank the children and parents who participated in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ashraf El-Metwally.

Rights and permissions

Reprints and permissions

About this article

Cite this article

El-Metwally, A., Mikkelsson, M., Ståhl, M. et al. Genetic and environmental influences on non-specific low back pain in children: a twin study. Eur Spine J 17, 502–508 (2008). https://doi.org/10.1007/s00586-008-0605-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-008-0605-1

Keywords

Navigation