Longitudinal relationship between disability and psychosocial factors in patients with chronic nonspecific neck pain
You have full access to this open access article
Downloads
Abstract
Background and objectives: To longitudinally investigate the relationships between neck/arm disability and psychosocial factors in individuals with chronic nonspecific neck pain (NSNP) at baseline, one month, and six months after a standardized physiotherapy intervention. A secondary aim was to compare psychosocial factors of individuals with chronic NSNP to healthy controls at baseline.
Methods: A total of sixty-eight individuals with chronic NSNP and healthy controls were recruited. Neck/arm disability, stress, anxiety, depression, pain catastrophizing, kinesiophobia, health-related quality of life and sleep quality were assessed in individuals with chronic NSNP. For the cross-sectional assessment, psychosocial factors were compared to healthy controls.
Results: Neck/arm disability and psychosocial factors remained unchanged during the study in chronic NSNP individuals. Furthermore, several correlations were found between neck/arm disability and psychosocial factors along the time. Significant intergroup differences were found in stress, anxiety, depression, pain catastrophizing, kinesiophobia, health-related quality of life and sleep quality. However, there were no differences in catastrophizing and kinesiophobia between chronic NSNP and healthy groups.
Conclusions: Psychosocial factors tend to maintain over time in individuals with chronic NSNP despite receiving standardized physiotherapy intervention. Future studies should investigate whether individualized physiotherapy interventions addressing psychosocial factors modify the course of disability over time in individuals with chronic NSNP.
Keywords
- Disability
- nonspecific neck pain
- psychosocial factors
References
Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018;27(Suppl 6):796-801. DOI: https://doi.org/10.1007/s00586-017-5432-9
Côté P, Cassidy DJ, Carroll LJ, Kristman V. The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain. 2004;112(3):267-73. DOI: https://doi.org/10.1016/j.pain.2004.09.004
Bertozzi L, Gardenghi I, Turoni F, Villafañe JH, Capra F, Guccione AA, et al. Effect of therapeutic exercise on pain and disability in the management of chronic nonspecific neck pain: systematic review and meta-analysis of randomized trials. Phys Ther. 2013;93(8):1026-36. DOI: https://doi.org/10.2522/ptj.20120412
Cerezo-Téllez E, Torres-Lacomba M, Mayoral-Del-Moral O, Pacheco-da-Costa S, Prieto-Merino D, Sánchez-Sánchez B. Health related quality of life improvement in chronic non-specific neck pain: secondary analysis from a single blinded, randomized clinical trial. Health Qual Life Outcomes. 2018;16(1):207. DOI: https://doi.org/10.1186/s12955-018-1032-6
Cerezo-Téllez E, Torres-Lacomba M, Mayoral-Del Moral O, Sánchez-Sánchez B, Dommerholt J, Gutiérrez-Ortega C. Prevalence of Myofascial Pain Syndrome in Chronic Non-Specific Neck Pain: A Population-Based Cross-Sectional Descriptive Study. Pain Med. 2016;17(12):2369-77. DOI: https://doi.org/10.1093/pm/pnw114
Kaka B, Ogwumike OO, Adeniyi AF, Maharaj SS, Ogunlade SO, Bello B. Effectiveness of neck stabilisation and dynamic exercises on pain intensity, depression and anxiety among patients with non-specific neck pain: a randomised controlled trial. Scand J Pain. 2018;18(2):321-31. DOI: https://doi.org/10.1515/sjpain-2017-0146
Borghouts JA, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain. 1998;77(1):1-13. DOI: https://doi.org/10.1016/S0304-3959(98)00058-X
Paksaichol A, Lawsirirat C, Janwantanakul P. Contribution of biopsychosocial risk factors to nonspecific neck pain in office workers: A path analysis model. J Occup Health. 2015;57(2):100-9. DOI: https://doi.org/10.1539/joh.14-0124-OA
Vranceanu AM, Bachoura A, Weening A, Vrahas M, Smith RM, Ring D. Psychological factors predict disability and pain intensity after skeletal trauma. J Bone Joint Surg Am. 2014;96(3):e20. DOI: https://doi.org/10.2106/JBJS.L.00479
Sá S, Silva AG. Repositioning error, pressure pain threshold, catastrophizing and anxiety in adolescents with chronic idiopathic neck pain. Musculoskelet Sci Pract. 2017;30:18-24. DOI: https://doi.org/10.1016/j.msksp.2017.04.011
Dimitriadis Z, Kapreli E, Strimpakos N, Oldham J. Do psychological states associate with pain and disability in chronic neck pain patients? J Back Musculoskelet Rehabil. 2015;28(4):797-802. DOI: https://doi.org/10.3233/BMR-150587
Svedmark Å, Björklund M, Häger CK, Sommar JN, Wahlström J. Impact of Workplace Exposure and Stress on Neck Pain and Disabilities in Women-A Longitudinal Follow-up After a Rehabilitation Intervention. Ann Work Expo Health. 2018;62(5):591-603. DOI: https://doi.org/10.1093/annweh/wxy018
Rajala U, Keinänen-Kiukaanniemi S, Uusimäki A, Kivelä SL. Musculoskeletal pains and depression in a middle-aged Finnish population. Pain. 1995;61(3):451-7. DOI: https://doi.org/10.1016/0304-3959(94)00206-T
Luo X, Edwards CL, Richardson W, Hey L. Relationships of clinical, psychologic, and individual factors with the functional status of neck pain patients. Value Health. 2004;7(1):61-9. DOI: https://doi.org/10.1111/j.1524-4733.2004.71264.x
Jull G, Sterling M, Falla D, Treleaven J, O’Leary S. Whiplash, headache and neck pain: research-based directions for physical therapies. China: Churchill Livingstone Elsevier 2008. DOI: https://doi.org/10.1016/B978-0-443-10047-5.50019-9
Sullivan M, Bishop S, Pivik J. The Pain Catastrophizing Scale: Development and Validation. 1995 (17):524-32. DOI: https://doi.org/10.1037/1040-3590.7.4.524
Walton DM, Macdermid JC, Giorgianni AA, Mascarenhas JC, West SC, Zammit CA. Risk factors for persistent problems following acute whiplash injury: update of a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2013;43(2):31-43. DOI: https://doi.org/10.2519/jospt.2013.4507
Kang JH, Chen HS, Chen SC, Jaw FS. Disability in patients with chronic neck pain: heart rate variability analysis and cluster analysis. Clin J Pain. 2012;28(9):797-803. DOI: https://doi.org/10.1097/AJP.0b013e3182442afd
Macías-Toronjo I, Sánchez-Ramos JL, Rojas-Ocaña MJ, García-Navarro EB. Influence of Psychosocial and Sociodemographic Variables on Sickness Leave and Disability in Patients with Work-Related Neck and Low Back Pain. Int J Environ Res Public Health. 2020;17(16). DOI: https://doi.org/10.3390/ijerph17165966
Rampazo É, da Silva VR, de Andrade ALM, Back CGN, Madeleine PM, Arendt-Nielsen L, et al. Sensory, Motor, and Psychosocial Characteristics of Individuals With Chronic Neck Pain: A Case-Control Study. Phys Ther. 2021. DOI: https://doi.org/10.1093/ptj/pzab104
Pedrero-Martin Y, Falla D, Martinez-Calderon J, Liew BXW, Scutari M, Luque-Suarez A. Self-efficacy beliefs mediate the association between pain intensity and pain interference in acute/subacute whiplash-associated disorders. Eur Spine J. 2021;30(6):1689-98. DOI: https://doi.org/10.1007/s00586-021-06731-5
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7. DOI: https://doi.org/10.1016/S0140-6736(07)61602-X
Kashfi P, Karimi N, Peolsson A, Rahnama L. The effects of deep neck muscle-specific training versus general exercises on deep neck muscle thickness, pain and disability in patients with chronic non-specific neck pain: protocol for a randomized clinical trial (RCT). BMC Musculoskelet Disord. 2019;20(1):540. DOI: https://doi.org/10.1186/s12891-019-2880-x
López-de-Uralde-Villanueva I, Gil-Martínez A, Candelas-Fernández P, de Andrés-Ares J, Beltrán-Alacreu H, La Touche R. Validity and reliability of the Spanish-language version of the self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale. Neurologia. 2018;33(8):505-14. DOI: https://doi.org/10.1016/j.nrleng.2016.10.003
Nee RJ, Jull GA, Vicenzino B, Coppieters MW. The validity of upper-limb neurodynamic tests for detecting peripheral neuropathic pain. J Orthop Sports Phys Ther. 2012;42(5):413-24. DOI: https://doi.org/10.2519/jospt.2012.3988
De Andrés J, Pérez-Cajaraville J, Lopez-Alarcón MD, López-Millán JM, Margarit C, Rodrigo-Royo MD, et al. Cultural adaptation and validation of the painDETECT scale into Spanish. Clin J Pain. 2012;28(3):243-53. DOI: https://doi.org/10.1097/AJP.0b013e31822bb35b
Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine (Phila Pa 1976). 2003;28(1):52-62. DOI: https://doi.org/10.1097/00007632-200301010-00014
Alreni ASE, Harrop D, Lowe A, Tanzila Potia, Kilner K, McLean SM. Measures of upper limb function for people with neck pain. A systematic review of measurement and practical properties. Musculoskelet Sci Pract. 2017;29:155-63. DOI: https://doi.org/10.1016/j.msksp.2017.02.004
García González GLA, Aguilar Sierra SF, Rodríguez Ricardo RMC. Validación de la versión en español de la escala de función del miembro superior abreviada: Quick Dash. Revista Colombiana de Ortopedia y Traumatología. 2018;32(4):215-9. DOI: https://doi.org/10.1016/j.rccot.2017.06.012
Andrade Ortega JA, Delgado Martínez AD, Almécija Ruiz R. Validation of the Spanish version of the Neck Disability Index. Spine (Phila Pa 1976). 2010;35(4):E114-8. DOI: https://doi.org/10.1097/BRS.0b013e3181afea5d
Daza P, Novy DM, Stanley MA, al. e. The Depression Anxiety Stress Scale-21: Spanish Translation and Validation with a Hispanic Sample. 2002(24):195–205. DOI: https://doi.org/10.1023/A:1016014818163
Gómez-Pérez L, López-Martínez AE, Ruiz-Párraga GT. Psychometric Properties of the Spanish Version of the Tampa Scale for Kinesiophobia (TSK). J Pain. 2011;12(4):425-35. DOI: https://doi.org/10.1016/j.jpain.2010.08.004
Hapidou EG, O'Brien MA, Pierrynowski MR, de Las Heras E, Patel M, Patla T. Fear and Avoidance of Movement in People with Chronic Pain: Psychometric Properties of the 11-Item Tampa Scale for Kinesiophobia (TSK-11). Physiother Can. 2012;64(3):235-41. DOI: https://doi.org/10.3138/ptc.2011-10
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. DOI: https://doi.org/10.1016/0165-1781(89)90047-4
Hita-Contreras F, Martínez-López E, Latorre-Román PA, Garrido F, Santos MA, Martínez-Amat A. Reliability and validity of the Spanish version of the Pittsburgh Sleep Quality Index (PSQI) in patients with fibromyalgia. Rheumatol Int. 2014;34(7):929-36. DOI: https://doi.org/10.1007/s00296-014-2960-z
Bilbao A, García-Pérez L, Arenaza JC, García I, Ariza-Cardiel G, Trujillo-Martín E, et al. Psychometric properties of the EQ-5D-5L in patients with hip or knee osteoarthritis: reliability, validity and responsiveness. Qual Life Res. 2018;27(11):2897-908. DOI: https://doi.org/10.1007/s11136-018-1929-x
García Campayo J, Rodero B, Alda M, Sobradiel N, Montero J, Moreno S. [Validation of the Spanish version of the Pain Catastrophizing Scale in fibromyalgia]. Med Clin (Barc). 2008;131(13):487-92. DOI: https://doi.org/10.1157/13127277
Jorritsma W, Dijkstra PU, de Vries GE, Geertzen JH, Reneman MF. Detecting relevant changes and responsiveness of Neck Pain and Disability Scale and Neck Disability Index. Eur Spine J. 2012;21(12):2550-7. DOI: https://doi.org/10.1007/s00586-012-2407-8
Brunner E, Dankaerts W, Meichtry A, O'Sullivan K, Probst M. Physical Therapists' Ability to Identify Psychological Factors and Their Self-Reported Competence to Manage Chronic Low Back Pain. Phys Ther. 2018;98(6):471-9. DOI: https://doi.org/10.1093/ptj/pzy012
Javdaneh N, Saeterbakken AH, Shams A, Barati AH. Pain Neuroscience Education Combined with Therapeutic Exercises Provides Added Benefit in the Treatment of Chronic Neck Pain. Int J Environ Res Public Health. 2021;18(16). DOI: https://doi.org/10.3390/ijerph18168848
Bruflat AK, Balter JE, McGuire D, Fethke NB, Maluf KS. Stress management as an adjunct to physical therapy for chronic neck pain. Phys Ther. 2012;92(10):1348-59. DOI: https://doi.org/10.2522/ptj.20110489
Daenen L, Varkey E, Kellmann M, Nijs J. Exercise, not to exercise, or how to exercise in patients with chronic pain? Applying science to practice. Clin J Pain. 2015;31(2):108-14. DOI: https://doi.org/10.1097/AJP.0000000000000099
Borisovskaya A, Chmelik E, Karnik A. Exercise and Chronic Pain. Adv Exp Med Biol. 2020;1228:233-53. DOI: https://doi.org/10.1007/978-981-15-1792-1_16
Elbinoune I, Amine B, Shyen S, Gueddari S, Abouqal R, Hajjaj-Hassouni N. Chronic neck pain and anxiety-depression: prevalence and associated risk factors. Pan Afr Med J. 2016;24:89. DOI: https://doi.org/10.11604/pamj.2016.24.89.8831
Duyur Cakit B, Genç H, Altuntaş V, Erdem HR. Disability and related factors in patients with chronic cervical myofascial pain. Clin Rheumatol. 2009;28(6):647-54. DOI: https://doi.org/10.1007/s10067-009-1116-0
George SZ, Fritz JM, Erhard RE. A comparison of fear-avoidance beliefs in patients with lumbar spine pain and cervical spine pain. Spine (Phila Pa 1976). 2001;26(19):2139-45. DOI: https://doi.org/10.1097/00007632-200110010-00019
Landers MR, Creger RV, Baker CV, Stutelberg KS. The use of fear-avoidance beliefs and nonorganic signs in predicting prolonged disability in patients with neck pain. Man Ther. 2008;13(3):239-48. DOI: https://doi.org/10.1016/j.math.2007.01.010
Thompson DP, Urmston M, Oldham JA, Woby SR. The association between cognitive factors, pain and disability in patients with idiopathic chronic neck pain. Disabil Rehabil. 2010;32(21):1758-67. DOI: https://doi.org/10.3109/09638281003734342
Mutubuki EN, Beljon Y, Maas ET, Huygen FJPM, Ostelo RWJG, van Tulder MW, et al. The longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients. Qual Life Res. 2020;29(1):275-87. DOI: https://doi.org/10.1007/s11136-019-02302-w
Kelly GA, Blake C, Power CK, O'keeffe D, Fullen BM. The association between chronic low back pain and sleep: a systematic review. Clin J Pain. 2011;27(2):169-81. DOI: https://doi.org/10.1097/AJP.0b013e3181f3bdd5
Roh YH, Noh JH, Oh JH, Baek GH, Gong HS. To what degree do shoulder outcome instruments reflect patients' psychologic distress? Clin Orthop Relat Res. 2012;470(12):3470-7. DOI: https://doi.org/10.1007/s11999-012-2503-4
Vranceanu AM, Safren S, Zhao M, Cowan J, Ring D. Disability and psychologic distress in patients with nonspecific and specific arm pain. Clin Orthop Relat Res. 2008;466(11):2820-6. DOI: https://doi.org/10.1007/s11999-008-0378-1
Luque-Suarez A, Martinez-Calderon J, Navarro-Ledesma S, Morales-Asencio JM, Meeus M, Struyf F. Kinesiophobia Is Associated With Pain Intensity and Disability in Chronic Shoulder Pain: A Cross-Sectional Study. J Manipulative Physiol Ther. 2020;43(8):791-8. DOI: https://doi.org/10.1016/j.jmpt.2019.12.009
Ortego G, Lluch E, Herrero P, Boudreau SA, Doménech-García V. Profiling and Association over Time between Disability and Pain Features in Patients with Chronic Nonspecific Neck Pain: A Longitudinal Study. J Clin Med. 2022;11(5). DOI: https://doi.org/10.3390/jcm11051346
Alamam DM, Moloney N, Leaver A, Alsobayel HI, Mackey MG. Multidimensional prognostic factors for chronic low back pain-related disability: a longitudinal study in a Saudi population. Spine J. 2019;19(9):1548-58. DOI: https://doi.org/10.1016/j.spinee.2019.05.010
López-de-Uralde-Villanueva I, Notario-Pérez R, Del Corral T, Ramos-Díaz B, Acuyo-Osorio M, La Touche R. Functional limitations and associated psychological factors in military personnel with chronic nonspecific neck pain with higher levels of kinesiophobia. Work. 2017;58(3):287-97. DOI: https://doi.org/10.3233/WOR-172634
Ortego G, Villafane JH, Domenech-Garcia V, Berjano P, Bertozzi L, Herrero P. Is there a relationship between psychological stress or anxiety and chronic nonspecific neck-arm pain in adults? A systematic review and meta-analysis. J Psychosom Res. 2016;90:70-81. DOI: https://doi.org/10.1016/j.jpsychores.2016.09.006
Beltran-Alacreu H, López-de-Uralde-Villanueva I, Calvo-Lobo C, Fernández-Carnero J, Touche R. Clinical features of patients with chronic non-specific neck pain per disability level: A novel observational study. Rev Assoc Med Bras (1992). 2018;64(8):700-9. DOI: https://doi.org/10.1590/1806-9282.64.08.700
Sanson N, Hach S, Moran R, Mason J. Behavioural activation and inhibition systems in relation to pain intensity and duration in a sample of people experiencing chronic musculoskeletal pain. Musculoskelet Sci Pract. 2020;47:102129. DOI: https://doi.org/10.1016/j.msksp.2020.102129
Dixon KE, Thorn BE, Ward LC. An evaluation of sex differences in psychological and physiological responses to experimentally-induced pain: a path analytic description. Pain. 2004;112(1-2):188-96. DOI: https://doi.org/10.1016/j.pain.2004.08.017
Ruscheweyh R, Nees F, Marziniak M, Evers S, Flor H, Knecht S. Pain catastrophizing and pain-related emotions: influence of age and type of pain. Clin J Pain. 2011;27(7):578-86. DOI: https://doi.org/10.1097/AJP.0b013e31820fde1b
Downloads
License
Copyright (c) 2025 Gorka Ortego Saiz, Enrique Lluch, Victor Doménech-García
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.