Importance of Psychological Factors for the Recovery From a First Episode of Acute Non-specific Neck Pain –
A Longitudinal Observational Study

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2016 (Mar 16); 24: 9

Brigitte Wirth, B. Kim Humphreys and Cynthia Peterson

Chiropractic Medicine Department,
Faculty of Medicine,
University of Zurich and University Hospital Balgrist

It has been established that psychological factors (appear to play) an important role in chronic non-specific neck pain. Particularly anxiety, depression and catastrophizing appear to negatively affect pain intensity and disability in this patient group. [5]

To test whether these emotional elements are the natural side-effect of chronic pain as opposed to being causal, these researchers worked with 850 patients with acute non-specific neck pain with no history of previous neck or arm pain.

The results were quite fascinating:

  • They found that the psychological factors measured at baseline had no influence on the self-reported outcome at 1 week and 1 month

  • A high reduction in anxiety between 1 week and 1 month after the first consultation was linked to a significantly higher chance for self-reported improvement at 1 month in both models

  • Poor outcome at 1 and 3 months went along with high levels of anxiety. High baseline anxiety was not a risk factor for poor outcome, but its reduction during the first month was highly related to favorable recovery.

  • In contrast, high level of depression at baseline was fairly related to poor recovery at 3 months.

Thus, patients with acute non-specific neck pain might benefit from adequate information and communication that targets at reducing anxiety by encouraging self-management of the problem.

Background   The influence of psychological factors on acute neck pain is sparsely studied. In a secondary analysis of prospectively collected data, this study investigated how several psychological factors develop in the first three months of acute neck pain and how these factors influence self-perceived recovery.

Methods   Patients were recruited in various chiropractic practices throughout Switzerland between 2010 and 2014. The follow-up telephone interviews were conducted for all patients by research assistants in the coordinating university hospital following a standardized procedure. The population of this study consisted of 103 patients (68 female; mean age = 38.3 ± 13.8 years) with a first episode of acute (<4 weeks) neck pain. Prior to the first treatment, the patients filled in the Bournemouth Questionnaire (BQ). One week and 1 and 3 months later, they completed the BQ again along with the Patient Global Impression of Change (PGIC). The temporal development (repeated measure ANOVA) of the BQ questions 4 (anxiety), 5 (depression), 6 (fear-avoidance) and 7 (pain locus of control) as well as the influence of these scores on the PGIC were investigated (binary logistic regression analyses, receiver operating curves (ROC)).

Results   All psychological parameters showed significant reduction within the first month. The parameter ‘anxiety’ was associated with outcome at 1 and 3 months (p = 0.013, R2 = 0.40 and p = 0.039, R2 = 0.63, respectively). Baseline depression (p = 0.037, R2 = 0.21), but not baseline anxiety, was a predictor for poor outcome. A high reduction in anxiety within the first month was a significant predictor for favorable outcome after 1 month (p < 0.001; R2 = 0.57).

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Conclusions   Psychological factors emerged from this study as relevant in the early phase of acute neck pain. Particularly persistent anxiety and depression at baseline might be risk factors for a transition to chronic pain that should be addressed in the early management of neck pain patients.

Keywords   Acute Neck pain Psychological factors Recovery

From the FULL TEXT Article:


Neck pain is one of the leading causes for global years lived with a disability. [1] In the general population, its 12 months prevalence ranges from 4.8 to 79.5 % (mean 25.8 %). [2] Its course is typically fluctuating, but the majority of patients do not completely recover from their symptoms [3] and about 5–10 % of all neck problems become chronic. [4]

It is widely established that psychological factors play an important role in chronic non-specific neck pain. Particularly anxiety, depression and catastrophizing seem to negatively affect pain intensity and disability in this patient group. [5] Although different psychological variables might be crucial at different time points in the course of neck pain, patient populations are often rather heterogeneous in terms of symptom duration [6], and only very little is known about this temporal aspect. [7] In patients with sub-acute (and chronic) neck pain, coping strategies that involved self-assurance resulted in better disability outcomes after 6 months [8], while fear of movement hindered short-term (3 months) and long-term (12 months) outcome of sub-acute neck pain as assessed by global perceived recovery, pain and disability. [4] Prognostic factors in acute neck pain are widely investigated in whiplash, but studies in acute non-specific neck pain are sparse. An overview of systematic reviews on prognostic factors for the outcome of a current neck pain episode [9] found two reviews that addressed non-specific neck pain. These reviews [10, 11] revealed two studies that included psychological factors. [12, 13]

Bot et al. studied patients with a new episode of neck and shoulder symptoms in general practice and found that pain intensity at baseline, the duration of symptoms before seeking health care, a history of previous neck or shoulder symptoms, reduced vitality and more resting negatively affected self-perceived outcome after 3 months. [12] After 12 months, also more worrying and multiple musculoskeletal symptoms hindered recovery. Hill et al. investigated patients with neck pain in the last month. [13] The strongest risk factor for persistent neck pain after 12 months was age. Further main risk factors were mainly not working at the time of baseline, comorbid low back pain, but also poor general and psychological health were significantly associated with pain persistence. Thus, there is little data available on the impact of psychological factors in the early phase of a non-specific neck pain episode.

This might be the reason why Walton et al. concluded in their overview of systematic reviews that in non-whiplash-related neck pain, only older age and other musculoskeletal disorders could be regarded as risk factors for poor recovery, while inconsistent results existed for pain intensity at baseline. [14] The outcome parameters of most studies on psychological risk factors for neck pain were either pain intensity, disability or return to work. [7] However, global ratings of change such as the ‘Patient global impression of change’ (PGIC), which allow the patient to integrate different aspects into one single rating [15] were shown to be more sensitive and to correlate better with the patient’s satisfaction than serial assessments such as pain rating by a visual analogue scale. [16] The above mentioned studies by Bot et al. and Hill et al. assessed global recovery, but used non-validated recovery measures. [12, 13]

Thus, in order to prevent acute neck pain from becoming chronic, the goals of this study were to investigate how psychological factors (anxiety, depression, fear avoidance, health locus of control) develop in the first 3 months after a first episode of acute neck pain, and how these psychological factors are associated with self-perceived recovery (assessed by PGIC). We hypothesized that

i)   the investigated psychological variables decreased in the first 3 months,

ii)   high psychological distress co-occurred with poor outcome,

iii)   high scores in the psychological variables at baseline were predictive for poor outcome, and

iv)   reduction in psychological distress led to favorable outcome.

SOURCE:   Read the rest of this Full Text article now!