Exploring the Definition of «Acute» Neck Pain:
A Prospective Cohort Observational Study Comparing the Outcomes of Chiropractic Patients with 0-2 Weeks, 2-4 Weeks and 4-12 Weeks of Symptoms

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SOURCE:   Chiropractic & Manual Therapies 2017 (Aug 16); 25: 24

Luana Nyiro, Cynthia K. Peterson and
B. Kim Humphreys

Department of Chiropractic Medicine,
Orthopaedic University Hospital Balgrist,
Forchstrasse 340, 8008
Zürich, Switzerland

BACKGROUND:   Neck pain is a common complaint in chiropractic patients. Amongst other baseline variables, numerous studies identify duration of symptoms as a strong predictor of outcome in neck pain patients. The usual time frame used for ‘acute’ onset of pain is between 0 and 4 weeks. However, the appropriateness of this time frame has been challenged for chiropractic low back pain patients. Therefore, the purpose of this study was to compare outcomes in neck pain patients with 0–2 vs 2–4 and 4–12 weeks of symptoms undergoing chiropractic treatment.

METHODS:   This is a prospective cohort observational study with 1 year follow-up including 495 patients whose data was collected between October 2009 and March 2015. Patients were divided into high-acute (0–2 weeks), mid-acute (2–4 weeks) and subacute (4–12 weeks) corresponding to duration of their symptoms at initial treatment. Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire for neck pain (BQN) at baseline. At follow-up time points of 1 week, 1 month, 3 months, 6 months and 1 year the NRS and BQN were completed along with the Patient Global Impression of Change (PGIC) scale. The PGIC responses were dichotomized into ‘improved’ and ‘not improved’ patients and compared between the 3 subgroups. The Chi-square test was used to compare improved patients between the 3 subgroups and the unpaired Student’s t-test was used for the NRS and BQN change scores.

RESULTS:   The proportion of patients ‘improved’ was only significantly higher for patients with symptoms of 0–2 weeks compared to 2–4 weeks at the 1 week outcome time point (p = 0.015). The NRS changes scores were significantly greater for patients with 2–4 weeks of symptoms compared to 4–12 weeks of symptoms only at 1 week (p = 0.035).

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CONCLUSIONS:   The time period of 0–4 weeks of symptoms as the definition of “acute” neck pain should be maintained. Independent of the exact duration of symptoms, medium-term and long-term outcome is favourable for acute as well as subacute neck pain patients.

KEYWORDS:   Acute; Chiropractic, spinal manipulative therapy; Neck pain mechanical; Treatment outcome

From the FULL TEXT Article:


The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” [1]. Neck pain is a common complaint throughout the world and experienced by people of all ages, including children and adolescents [2]. In the Global Burden of Disease 2010 study, neck pain is ranked the fourth leading cause of disability (measured in years lived with disability (YLDs) with an estimated global age-standardised point prevalence of neck pain around 4.9% [3], with about 50% of the patients experiencing persistent pain after 1 year [4]. Even though the age and sex distribution across regions is quite similar, slightly more women (5.8%) than men (4.0%) seem to suffer from neck pain [3]. However, the prevalence estimates of different studies show remarkable heterogeneity [2–9]. These variations are most likely caused by diversity in the case definition (i.e. duration of symptoms, anatomical location), inclusion/exclusion criteria and variations in population [3, 5]. Most studies estimate a 12–month prevalence between 30% to 50% in the adult general population with a prevalence peak in middle age [5, 9–11]. The high incidence of neck pain in the general population and the associated distress make neck pain patients common recipients of medical and chiropractic treatment. In chiropractic practice, neck pain patients are second only to low back patients in their frequency [10, 12, 13].

The disability and economic costs associated with neck pain have a large impact on individuals, their families, healthcare systems and businesses [5, 8, 14, 15]. Calculating the exact health costs is not straightforward. Costs vary depending on the severity of symptoms and the duration of work absence. For a specific calculation, several factors have to be considered and the effective costs are divided into direct costs by detection, treatment, rehabilitation and prevention of the disease and indirect costs caused by disability, absence from work or loss of productivity in an employee while they are at work [8, 14]. With longer duration of symptoms and therefore often associated work absenteeism, indirect costs rise. Borghouts et al. [16] estimated that in 1996, The Netherlands spent 1% of their total health care expenditures on neck pain. Of this only 23% were direct costs, while indirect costs amounted to 77% [16].

As a non-invasive treatment method, chiropractic, including both spinal manipulative therapy (SMT) and mobilization, is suggested as effective therapy for neck pain by recent research [9–19]. Certain medical professionals tend to be concerned about the safety of SMT to the cervical spine, considering a possible damage to the vertebral artery. However, recent research found no evidence of increased risk of vertebral artery injury compared to other primary care physicians [20–22]. Bryans et al. [17] recommend a multimodal approach such as a combination of SMT or mobilization and exercise, massage, patient education etc. for treatment of both acute and chronic neck pain.

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