{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T22:09:36Z","timestamp":1792447776946,"version":"4.5.0"},"reference-count":55,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:00:00Z","timestamp":1773446400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:00:00Z","timestamp":1773446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007602","name":"Programme Grants for Applied Research","doi-asserted-by":"publisher","award":["NIHR203281"],"award-info":[{"award-number":["NIHR203281"]}],"id":[{"id":"10.13039\/501100007602","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007602","name":"Programme Grants for Applied Research","doi-asserted-by":"publisher","award":["NIHR203281"],"award-info":[{"award-number":["NIHR203281"]}],"id":[{"id":"10.13039\/501100007602","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007602","name":"Programme Grants for Applied Research","doi-asserted-by":"publisher","award":["NIHR203281"],"award-info":[{"award-number":["NIHR203281"]}],"id":[{"id":"10.13039\/501100007602","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007602","name":"Programme Grants for Applied Research","doi-asserted-by":"publisher","award":["NIHR203281"],"award-info":[{"award-number":["NIHR203281"]}],"id":[{"id":"10.13039\/501100007602","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007602","name":"Programme Grants for Applied Research","doi-asserted-by":"publisher","award":["NIHR203281"],"award-info":[{"award-number":["NIHR203281"]}],"id":[{"id":"10.13039\/501100007602","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007602","name":"Programme Grants for Applied Research","doi-asserted-by":"publisher","award":["NIHR203281"],"award-info":[{"award-number":["NIHR203281"]}],"id":[{"id":"10.13039\/501100007602","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007602","name":"Programme Grants for Applied Research","doi-asserted-by":"publisher","award":["NIHR203281"],"award-info":[{"award-number":["NIHR203281"]}],"id":[{"id":"10.13039\/501100007602","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007602","name":"Programme Grants for Applied Research","doi-asserted-by":"publisher","award":["NIHR203281"],"award-info":[{"award-number":["NIHR203281"]}],"id":[{"id":"10.13039\/501100007602","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007602","name":"Programme Grants for Applied Research","doi-asserted-by":"publisher","award":["NIHR203281"],"award-info":[{"award-number":["NIHR203281"]}],"id":[{"id":"10.13039\/501100007602","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100022244","name":"National Institute for Health Research Applied Research Collaboration West","doi-asserted-by":"publisher","award":["NIHR200165"],"award-info":[{"award-number":["NIHR200165"]}],"id":[{"id":"10.13039\/501100022244","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR 300957"],"award-info":[{"award-number":["NIHR 300957"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Research on the primary care management of back pain in children and young people (CYP) is scarce. Sociodemographic factors may influence presentation and management, potentially contributing to disparities in care and outcomes. This study aimed to describe the management of back pain in CYP and examine associations with sociodemographic characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were extracted from the Clinical Practice Research Datalink (CPRD) Aurum for 425,000 randomly sampled CYP aged 8\u201318 years with a new musculoskeletal pain episode between 2005 and 2021. Analgesia prescriptions, referrals and imaging within 6 months of an index consultation for back pain were extracted. Adjusted risk ratios (aRR) were calculated for age, gender, deprivation, ethnicity, region and index year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 51,335 CYP presenting with back pain, 78% had symptom-based codes for back pain or low back pain, and 12% had more specific diagnostic codes such as spinal deformities. 19% patients reconsulted for back pain in the 6 months following the index date. Analgesia was prescribed to 36% with higher prescribing rates among older CYP and those from more deprived areas (aRR most vs. least deprived 1.64; 95% CI 1.56, 1.72). Referrals (28%) and imaging (13%) were more common in older adolescents but less frequent among more deprived and minority ethnic groups. Prescribing declined over time (46% in 2005\u20132009 to 16% in 2020\u20132021), whereas referrals increased (17% to 40%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Back pain in CYP often recurs and is primarily managed with analgesia and referrals. Socioeconomic and ethnic disparities in management highlight the need for equitable access to specialist care and consistent, evidence-based approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00586-026-09867-4","type":"journal-article","created":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T15:12:52Z","timestamp":1773501172000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sociodemographic disparities in primary care management of back pain in children and young people: a population-based cohort study"],"prefix":"10.1007","author":[{"given":"Kayleigh J","family":"Mason","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin P","family":"Jordan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Bailey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Protheroe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin J","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faraz","family":"Mughal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Saxne J\u00f6ud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Jowett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kym I E","family":"Snell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate M","family":"Dunn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,14]]},"reference":[{"key":"9867_CR1","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1136\/annrheumdis-2012-202634","volume":"73","author":"KP Jordan","year":"2014","unstructured":"Jordan KP, J\u00f3ud A, Bergknut C et al (2014) International comparisons of the consultation prevalence of musculoskeletal conditions using population-based healthcare data from England and Sweden. Ann Rheum Dis 73:212\u2013218. https:\/\/doi.org\/10.1136\/annrheumdis-2012-202634","journal-title":"Ann Rheum Dis"},{"key":"9867_CR2","doi-asserted-by":"publisher","unstructured":"Jordan KP, Kadam UT, Hayward R et al (2010) Annual consultation prevalence of regional musculoskeletal problems in primary care: An observational study. BMC Musculoskelet Disord 11. https:\/\/doi.org\/10.1186\/1471-2474-11-144","DOI":"10.1186\/1471-2474-11-144"},{"key":"9867_CR3","doi-asserted-by":"publisher","first-page":"179","DOI":"10.2147\/CLEP.S337323","volume":"14","author":"D Yu","year":"2022","unstructured":"Yu D, Missen M, Jordan KP et al (2022) Trends in the Annual Consultation Incidence and Prevalence of Low Back Pain and Osteoarthritis in England from 2000 to 2019: Comparative Estimates from Two Clinical Practice Databases. Clin Epidemiol 14:179\u2013189. https:\/\/doi.org\/10.2147\/CLEP.S337323","journal-title":"Clin Epidemiol"},{"key":"9867_CR4","doi-asserted-by":"publisher","first-page":"1603","DOI":"10.1016\/S0140-6736(16)31460-X","volume":"388","author":"NJ Kassebaum","year":"2016","unstructured":"Kassebaum NJ, Arora M, Barber RM et al (2016) Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990\u20132015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1603\u20131658. https:\/\/doi.org\/10.1016\/S0140-6736(16)31460-X","journal-title":"Lancet"},{"key":"9867_CR5","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1093\/PTJ\/PZX067","volume":"97","author":"GC Machado","year":"2017","unstructured":"Machado GC, Maher CG, Ferreira PH et al (2017) Can recurrence after an acute episode of low back pain be predicted? Phys Ther 97:889\u2013895. https:\/\/doi.org\/10.1093\/PTJ\/PZX067","journal-title":"Phys Ther"},{"key":"9867_CR6","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1002\/EJP.1474","volume":"24","author":"BE \u00d8iestad","year":"2020","unstructured":"\u00d8iestad BE, Hilde G, Tveter AT et al (2020) Risk factors for episodes of back pain in emerging adults. A systematic review. Eur J Pain (United Kingdom) 24:19\u201338. https:\/\/doi.org\/10.1002\/EJP.1474","journal-title":"Eur J Pain (United Kingdom)"},{"key":"9867_CR7","doi-asserted-by":"publisher","unstructured":"Artus M, Campbell P, Mallen CD et al (2017) Generic prognostic factors for musculoskeletal pain in primary care: A systematic review. BMJ Open 7. https:\/\/doi.org\/10.1136\/BMJOPEN-2016-012901","DOI":"10.1136\/BMJOPEN-2016-012901"},{"key":"9867_CR8","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1136\/BMJ.B3694","volume":"339","author":"EM Hay","year":"2009","unstructured":"Hay EM, Dunn KM (2009) Prognosis of low back pain in primary care. BMJ (Online) 339:816. https:\/\/doi.org\/10.1136\/BMJ.B3694","journal-title":"BMJ (Online)"},{"key":"9867_CR9","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1590\/BJPT-RBF.2014.0149","volume":"20","author":"SJ Kamper","year":"2016","unstructured":"Kamper SJ, Henschke N, Hestbaek L et al (2016) Musculoskeletal pain in children and adolescents. Braz J Phys Ther 20:275\u2013284. https:\/\/doi.org\/10.1590\/BJPT-RBF.2014.0149","journal-title":"Braz J Phys Ther"},{"key":"9867_CR10","doi-asserted-by":"publisher","first-page":"S114","DOI":"10.1097\/J.PAIN.0000000000001862","volume":"161","author":"TM Palermo","year":"2020","unstructured":"Palermo TM (2020) Pain prevention and management must begin in childhood: The key role of psychological interventions. Pain 161:S114\u2013S121. https:\/\/doi.org\/10.1097\/J.PAIN.0000000000001862","journal-title":"Pain"},{"key":"9867_CR11","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/S2352-4642(20)30277-7","volume":"5","author":"C Eccleston","year":"2021","unstructured":"Eccleston C, Fisher E, Howard RF et al (2021) Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission. Lancet Child Adolesc Health 5:47\u201387","journal-title":"Lancet Child Adolesc Health"},{"key":"9867_CR12","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1097\/PHM.0000000000001720","volume":"100","author":"S Masiero","year":"2021","unstructured":"Masiero S, Sarto F, Cattelan M et al (2021) Lifetime Prevalence of Nonspecific Low Back Pain in Adolescents A Cross-sectional Epidemiologic Survey. Am J Phys Med Rehabil 100:1170\u20131175. https:\/\/doi.org\/10.1097\/PHM.0000000000001720","journal-title":"Am J Phys Med Rehabil"},{"key":"9867_CR13","doi-asserted-by":"publisher","first-page":"3280","DOI":"10.1007\/S00586-023-07751-Z","volume":"32","author":"N Azevedo","year":"2023","unstructured":"Azevedo N, Ribeiro JC, Machado L (2023) Back pain in children and adolescents: a cross-sectional study. Eur Spine J 32:3280\u20133289. https:\/\/doi.org\/10.1007\/S00586-023-07751-Z","journal-title":"Eur Spine J"},{"key":"9867_CR14","doi-asserted-by":"publisher","first-page":"554","DOI":"10.2519\/JOSPT.2022.10819","volume":"52","author":"VS Santos","year":"2022","unstructured":"Santos VS, Leite MN, Camargo BIA et al (2022) Three in Every 10 School-aged Children in Brazil Report Back Pain in Any Given Year: 12-Month Prospective Cohort Study of Prevalence, Incidence, and Prognosis. J Orthop Sports Phys Ther 52:554\u2013562. https:\/\/doi.org\/10.2519\/JOSPT.2022.10819","journal-title":"J Orthop Sports Phys Ther"},{"key":"9867_CR15","doi-asserted-by":"publisher","first-page":"2028","DOI":"10.1002\/ART.34347","volume":"64","author":"D Hoy","year":"2012","unstructured":"Hoy D, Bain C, Williams G et al (2012) A systematic review of the global prevalence of low back pain. Arthritis Rheum 64:2028\u20132037. https:\/\/doi.org\/10.1002\/ART.34347","journal-title":"Arthritis Rheum"},{"key":"9867_CR16","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1007\/S00431-021-04255-0\/FIGURES\/1","volume":"181","author":"BE Holstein","year":"2022","unstructured":"Holstein BE, Damsgaard MT, Madsen KR et al (2022) Chronic backpain among adolescents in Denmark: trends 1991\u20132018 and association with socioeconomic status. Eur J Pediatr 181:691\u2013699. https:\/\/doi.org\/10.1007\/S00431-021-04255-0\/FIGURES\/1","journal-title":"Eur J Pediatr"},{"key":"9867_CR17","doi-asserted-by":"publisher","first-page":"1727","DOI":"10.1007\/S00431-021-04369-5","volume":"181","author":"JJ H\u00e9bert","year":"2022","unstructured":"H\u00e9bert JJ, Beynon AM, Jones BL et al (2022) Spinal pain in childhood: prevalence, trajectories, and diagnoses in children 6 to 17 years of age. Eur J Pediatr 181:1727\u20131736. https:\/\/doi.org\/10.1007\/S00431-021-04369-5","journal-title":"Eur J Pediatr"},{"key":"9867_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2431-13-14\/TABLES\/5","volume":"13","author":"I Calvo-Mu\u00f1oz","year":"2013","unstructured":"Calvo-Mu\u00f1oz I, G\u00f3mez-Conesa A, S\u00e1nchez-Meca J (2013) Prevalence of low back pain in children and adolescents: A meta-analysis. BMC Pediatr 13:1\u201312. https:\/\/doi.org\/10.1186\/1471-2431-13-14\/TABLES\/5","journal-title":"BMC Pediatr"},{"key":"9867_CR19","doi-asserted-by":"publisher","first-page":"2630","DOI":"10.1097\/BRS.0B013E318158D70B","volume":"32","author":"LJ Jeffries","year":"2007","unstructured":"Jeffries LJ, Milanese SF, Grimmer-Somers KA (2007) Epidemiology of adolescent spinal pain: A systematic overview of the research literature. Spine (Phila Pa 1976) 32:2630\u20132637. https:\/\/doi.org\/10.1097\/BRS.0B013E318158D70B","journal-title":"Spine (Phila Pa 1976)"},{"key":"9867_CR20","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.jpain.2021.07.002","volume":"23","author":"R Roy","year":"2022","unstructured":"Roy R, Gal\u00e1n S, S\u00e1nchez-Rodr\u00edguez E et al (2022) Cross-National Trends of Chronic Back Pain in Adolescents: Results From the HBSC Study, 2001\u20132014. J Pain 23:123\u2013130. https:\/\/doi.org\/10.1016\/j.jpain.2021.07.002","journal-title":"J Pain"},{"key":"9867_CR21","doi-asserted-by":"publisher","first-page":"E428","DOI":"10.1093\/PUBMED\/FDZ141","volume":"42","author":"N Prathivadi Bhayankaram","year":"2021","unstructured":"Prathivadi Bhayankaram N, Lacey RJ, Barnett LA et al (2021) Musculoskeletal consultations from childhood to adulthood: A longitudinal study. J Public Health (United Kingdom) 42:E428\u2013E434. https:\/\/doi.org\/10.1093\/PUBMED\/FDZ141","journal-title":"J Public Health (United Kingdom)"},{"key":"9867_CR22","doi-asserted-by":"publisher","unstructured":"Mason KJ, Jordan KP, Bailey J et al (2025) Trends of musculoskeletal pain in children and young people consulting primary care: an electronic primary health care record study. BMC Pediatrics 2025 25:1 25:961-. https:\/\/doi.org\/10.1186\/S12887-025-06296-Y","DOI":"10.1186\/S12887-025-06296-Y"},{"key":"9867_CR23","doi-asserted-by":"publisher","unstructured":"Frosch M, Leinwather S, Bielack S et al (2022) Treatment of Unspecific Back Pain in Children and Adolescents: Results of an Evidence-Based Interdisciplinary Guideline. Children 9: https:\/\/doi.org\/10.3390\/CHILDREN9030417","DOI":"10.3390\/CHILDREN9030417"},{"key":"9867_CR24","unstructured":"NICE (2019) Overview | Low back pain and sciatica in over 16s: assessment and management | Guidance | NICE. Guidelines"},{"key":"9867_CR25","doi-asserted-by":"publisher","first-page":"E804","DOI":"10.1097\/PR9.0000000000000804","volume":"5","author":"SJ Friedrichsdorf","year":"2020","unstructured":"Friedrichsdorf SJ, Goubert L (2020) Pediatric pain treatment and prevention for hospitalized children. Pain Rep 5:E804. https:\/\/doi.org\/10.1097\/PR9.0000000000000804","journal-title":"Pain Rep"},{"key":"9867_CR26","unstructured":"The Scottish Government (2018) Management of chronic pain in children and young people: summary. 3\/10\/2017 60"},{"key":"9867_CR27","doi-asserted-by":"publisher","first-page":"e081620","DOI":"10.1136\/BMJOPEN-2023-081620","volume":"14","author":"L Herlitz","year":"2024","unstructured":"Herlitz L, Ashford E, Powell C et al (2024) Access to primary care for children and young people (CYP) in the UK: a scoping review of CYP\u2019s, caregivers\u2019 and healthcare professionals\u2019 views and experiences of facilitators and barriers. BMJ Open 14:e081620. https:\/\/doi.org\/10.1136\/BMJOPEN-2023-081620","journal-title":"BMJ Open"},{"key":"9867_CR28","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1080\/24740527.2022.2104699","volume":"6","author":"N Atkins","year":"2022","unstructured":"Atkins N, Mukhida K (2022) The relationship between patients\u2019 income and education and their access to pharmacological chronic pain management: A scoping review. Can J Pain 6:142. https:\/\/doi.org\/10.1080\/24740527.2022.2104699","journal-title":"Can J Pain"},{"key":"9867_CR29","doi-asserted-by":"publisher","first-page":"e078505","DOI":"10.1136\/BMJOPEN-2023-078505","volume":"14","author":"K Herbert","year":"2024","unstructured":"Herbert K, Herlitz L, Woodman J et al (2024) Patient and caregiver characteristics associated with differential use of primary care for children and young people in the UK: a scoping review. BMJ Open 14:e078505. https:\/\/doi.org\/10.1136\/BMJOPEN-2023-078505","journal-title":"BMJ Open"},{"key":"9867_CR30","unstructured":"Health inequalities in a nutshell | The King\u2019s Fund. https:\/\/www.kingsfund.org.uk\/insight-and-analysis\/data-and-charts\/health-inequalities-nutshell. Accessed 28 Jul 2025"},{"key":"9867_CR31","doi-asserted-by":"publisher","first-page":"101566","DOI":"10.1016\/J.BERH.2020.101566","volume":"34","author":"HE Foster","year":"2020","unstructured":"Foster HE, Scott C, Tiderius CJ et al (2020) Improving musculoskeletal health for children and young people \u2013 A \u2018call to action\u2019. Best Pract Res Clin Rheumatol 34:101566. https:\/\/doi.org\/10.1016\/J.BERH.2020.101566","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"9867_CR32","doi-asserted-by":"publisher","unstructured":"CPRD (2022) Release Notes: CPRD Aurum May 2022. https:\/\/doi.org\/10.48329\/t89s-kf12. Accessed 15 May 2023","DOI":"10.48329\/t89s-kf12"},{"key":"9867_CR33","doi-asserted-by":"publisher","first-page":"1740","DOI":"10.1093\/ije\/dyz034","volume":"48","author":"A Wolf","year":"2019","unstructured":"Wolf A, Dedman D, Campbell J et al (2019) Data resource profile: Clinical Practice Research Datalink (CPRD) Aurum. Int J Epidemiol 48:1740\u20131740. https:\/\/doi.org\/10.1093\/ije\/dyz034. G","journal-title":"Int J Epidemiol"},{"key":"9867_CR34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S12963-023-00302-0\/TABLES\/2","volume":"21","author":"SI Shiekh","year":"2023","unstructured":"Shiekh SI, Harley M, Ghosh RE et al (2023) Completeness, agreement, and representativeness of ethnicity recording in the United Kingdom\u2019s Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES). Popul Health Metr 21:1\u201313. https:\/\/doi.org\/10.1186\/S12963-023-00302-0\/TABLES\/2","journal-title":"Popul Health Metr"},{"key":"9867_CR35","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1136\/JECH-2022-219200","volume":"76","author":"P Mahadevan","year":"2022","unstructured":"Mahadevan P, Harley M, Fordyce S et al (2022) Completeness and representativeness of small area socioeconomic data linked with the UK Clinical Practice Research Datalink (CPRD). J Epidemiol Community Health 76:880\u2013886. https:\/\/doi.org\/10.1136\/JECH-2022-219200","journal-title":"J Epidemiol Community Health"},{"key":"9867_CR36","doi-asserted-by":"publisher","first-page":"rkad044","DOI":"10.1093\/rap\/rkad044","volume":"7","author":"C Burton","year":"2023","unstructured":"Burton C, Bajpai R, Mason KJ et al (2023) The impact of the COVID-19 pandemic on referrals to musculoskeletal services from primary care and subsequent incidence of inflammatory rheumatic musculoskeletal disease: an observational study. Rheumatol Adv Pract 7:rkad044. https:\/\/doi.org\/10.1093\/rap\/rkad044","journal-title":"Rheumatol Adv Pract"},{"key":"9867_CR37","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2022.0648","author":"V Welsh","year":"2023","unstructured":"Welsh V, Mason K, Bailey J et al (2023) Trends in musculoskeletal consultations and prescribing: an electronic primary care records study. Br J Gen Pract BJGP. https:\/\/doi.org\/10.3399\/BJGP.2022.0648. .2022.0648","journal-title":"Br J Gen Pract BJGP"},{"key":"9867_CR38","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1002\/j.1532-2149.2012.00189.x","volume":"17","author":"J Bedson","year":"2013","unstructured":"Bedson J, Belcher J, Martino OI et al (2013) The effectiveness of national guidance in changing analgesic prescribing in primary care from 2002 to 2009: An observational database study. Eur J Pain (United Kingdom) 17:434\u2013443. https:\/\/doi.org\/10.1002\/j.1532-2149.2012.00189.x","journal-title":"Eur J Pain (United Kingdom)"},{"key":"9867_CR39","unstructured":"Gender Recognition Act (2004) https:\/\/www.legislation.gov.uk\/ukpga\/2004\/7\/contents. Accessed 21 Aug 2025"},{"key":"9867_CR40","doi-asserted-by":"publisher","unstructured":"Tan A, Strauss VY, Protheroe J, Dunn KM (2018) Epidemiology of paediatric presentations with musculoskeletal problems in primary care. BMC Musculoskelet Disord 19. https:\/\/doi.org\/10.1186\/S12891-018-1952-7","DOI":"10.1186\/S12891-018-1952-7"},{"key":"9867_CR41","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1001\/JAMAPEDIATRICS.2016.3334","volume":"171","author":"J MacDonald","year":"2017","unstructured":"MacDonald J, Stuart E, Rodenberg R (2017) Musculoskeletal low back pain in school-aged children a review. JAMA Pediatr 171:280\u2013287. https:\/\/doi.org\/10.1001\/JAMAPEDIATRICS.2016.3334","journal-title":"JAMA Pediatr"},{"key":"9867_CR42","doi-asserted-by":"publisher","first-page":"2548","DOI":"10.1093\/RHEUMATOLOGY\/KEAB714","volume":"61","author":"R Costello","year":"2022","unstructured":"Costello R, McDonagh J, Hyrich KL, Humphreys JH (2022) Incidence and prevalence of juvenile idiopathic arthritis in the United Kingdom, 2000\u20132018: Results from the Clinical Practice Research Datalink. Rheumatol (United Kingdom) 61:2548\u20132554. https:\/\/doi.org\/10.1093\/RHEUMATOLOGY\/KEAB714","journal-title":"Rheumatol (United Kingdom)"},{"key":"9867_CR43","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1002\/PDS.5377","volume":"31","author":"R Masarwa","year":"2022","unstructured":"Masarwa R, Lefebvre C, Platt RW, Filion KB (2022) General practitioner prescribing trends among pediatric patients in the United Kingdom: 1998\u20132018. Pharmacoepidemiol Drug Saf 31:302\u2013313. https:\/\/doi.org\/10.1002\/PDS.5377","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"9867_CR44","unstructured":"NHS England \u00bb Policy guidance: conditions for which over the counter items should not be routinely prescribed in primary care. https:\/\/www.england.nhs.uk\/publication\/policy-guidance-conditions-for-which-over-the-counter-items-should-not-be-routinely-prescribed-in-primary-care\/. Accessed 4 Apr 2025"},{"key":"9867_CR45","doi-asserted-by":"publisher","first-page":"e201","DOI":"10.3399\/BJGP20X714101","volume":"71","author":"H Reichel","year":"2021","unstructured":"Reichel H, Stanbrook R, Johnson H et al (2021) Guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in England. Br J Gen Pract 71:e201. https:\/\/doi.org\/10.3399\/BJGP20X714101","journal-title":"Br J Gen Pract"},{"key":"9867_CR46","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/J.BIOPSYCHO.2015.12.003","volume":"114","author":"SN Garfinkel","year":"2016","unstructured":"Garfinkel SN, Tiley C, O\u2019Keeffe S et al (2016) Discrepancies between dimensions of interoception in autism: Implications for emotion and anxiety. Biol Psychol 114:117\u2013126. https:\/\/doi.org\/10.1016\/J.BIOPSYCHO.2015.12.003","journal-title":"Biol Psychol"},{"key":"9867_CR47","doi-asserted-by":"publisher","first-page":"440","DOI":"10.3399\/BJGP24X739461","volume":"74","author":"ER Rengasamy","year":"2024","unstructured":"Rengasamy ER, Hiscock H, Newlove-Delgado T, Mughal F (2024) Optimising access to primary care services for young people: lessons from England and Australia. Br J Gen Pract 74:440\u2013442. https:\/\/doi.org\/10.3399\/BJGP24X739461","journal-title":"Br J Gen Pract"},{"key":"9867_CR48","unstructured":"Fair, Society Healthy Lives The Marmot Review"},{"key":"9867_CR49","unstructured":"Tackling inequalities in healthcare access, experience, and outcomes Actionable Insights"},{"key":"9867_CR50","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3399\/BJGPOPEN20X101076","volume":"4","author":"MN Al-Saffar","year":"2020","unstructured":"Al-Saffar MN, Hayhoe BW, Harris MJ et al (2020) Children as frequent attenders in primary care: a systematic review. BJGP Open 4:1\u20138. https:\/\/doi.org\/10.3399\/BJGPOPEN20X101076","journal-title":"BJGP Open"},{"key":"9867_CR51","doi-asserted-by":"publisher","unstructured":"Russell J, Boswell L, Ip A et al (2024) How is diagnostic uncertainty communicated and managed in real world primary care settings? BMC Primary Care 2024 25:1 25:296-. https:\/\/doi.org\/10.1186\/S12875-024-02526-X","DOI":"10.1186\/S12875-024-02526-X"},{"key":"9867_CR52","unstructured":"Neal RD, Heywood PL, Morley S (2000) \u2019I always seem to be there\u2019--a qualitative study of frequent attenders. Br J Gen Pract 50(458):716\u201323"},{"key":"9867_CR53","doi-asserted-by":"publisher","first-page":"e128","DOI":"10.3399\/BJGP.2021.0426","volume":"72","author":"A Turner","year":"2022","unstructured":"Turner A, Farr M, Banks J et al (2022) Unintended consequences of online consultations: a qualitative study in UK primary care. Br J Gen Pract 72:e128\u2013e137. https:\/\/doi.org\/10.3399\/BJGP.2021.0426","journal-title":"Br J Gen Pract"},{"key":"9867_CR54","unstructured":"NHS England \u00bb Jess\u2019s Rule Three strikes and we rethink. https:\/\/www.england.nhs.uk\/long-read\/jesss-rule-three-strikes-and-we-rethink\/. Accessed 23 Jan 2026"},{"key":"9867_CR55","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1016\/j.berh.2017.04.003","volume":"30","author":"SJ Kamper","year":"2016","unstructured":"Kamper SJ, Yamato TP, Williams CM (2016) The prevalence, risk factors, prognosis and treatment for back pain in children and adolescents: An overview of systematic reviews. Best Pract Res Clin Rheumatol 30:1021\u20131036. https:\/\/doi.org\/10.1016\/j.berh.2017.04.003","journal-title":"Best Pract Res Clin Rheumatol"}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-026-09867-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-026-09867-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-026-09867-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T20:07:41Z","timestamp":1781640461000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-026-09867-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,14]]},"references-count":55,"alternative-id":["9867"],"URL":"https:\/\/doi.org\/10.1007\/s00586-026-09867-4","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"value":"0940-6719","type":"print"},{"value":"1432-0932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,14]]},"assertion":[{"value":"21 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 January 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 March 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study was approved by the CPRD Research Data Governance process (ref 22_002318). The approved protocol was made available to the reviewers.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}}]}}