Chronic neck pain patients with traumatic or non-traumatic onset: Differences in characteristics. A cross-sectional study

Inge Ris, Birgit Juul-Kristensen, Eleanor Boyle, Alice Kongsted, Claus Manniche, Karen Søgaard, Inge Ris, Birgit Juul-Kristensen, Eleanor Boyle, Alice Kongsted, Claus Manniche, Karen Søgaard

Abstract

Background and aims: Patients with chronic neck pain can present with disability, low quality of life, psychological factors and clinical symptoms. It is unclear whether patients with a traumatic onset differ from those with a non-traumatic onset, by having more complex and severe symptoms. The purpose of this study was to investigate the clinical presentation of chronic neck pain patients with and without traumatic onset by examining cervical mobility, sensorimotor function, cervical muscle performance and pressure pain threshold in addition to the following self-reported characteristics: quality of life, neck pain and function, kinesiophobia, depression, and pain bothersomeness.

Methods: This cross-sectional study included 200 participants with chronic neck pain: 120 with traumatic onset and 80 with non-traumatic onset. Participants were recruited from physiotherapy clinics in primary and secondary health care. For participants to be included, they were required to be at least 18 years of age, have had neck pain for at least 6 months, and experienced neck-related activity limitation as determined by a score of at least 10 on the Neck Disability Index. We conducted the following clinical tests of cervical range of motion, gaze stability, eye movement, cranio-cervical flexion, cervical extensors, and pressure pain threshold. The participants completed the following questionnaires: physical and mental component summary of the Short Form Health Survey, EuroQol-5D, Neck Disability Index, Patient-Specific Functional Scale, Pain Bothersomeness, Beck Depression Inventory-II, and TAMPA scale of kinesiophobia. The level of significance for all analyses was defined as p<0.01. Differences between groups for the continuous data were determined using either a Student's t-test or Mann Whitney U test.

Results: In both groups, the majority of the participants were female (approximately 75%). Age, educational level, working situation and sleeping patterns were similar in both groups. The traumatic group had symptoms for a shorter duration (88 vs. 138 months p=0.001). Participants in the traumatic group showed worse results on all measures compared with those in the non-traumatic group, significantly on neck muscle function (cervical extension mobility p=0.005, cranio-cervical flexion test p=0.007, cervical extensor test p=0.006) and cervical pressure pain threshold bilateral (p=0.002/0.004), as well on self-reported function (Neck Disability Index p=0.001 and Patient-Specific Functional Scale p=0.007), mental quality of life (mental component summary of the Short Form Health Survey p=0.004 and EuroQol-5D p=0.001) and depression (Beck Depression Inventory-II p=0.001).

Conclusions: This study showed significant differences between chronic neck pain patients when differentiated into groups based on their onset of pain. However, no specific clinical test or self-reported characteristic could differentiate between the groups at an individual patient level.

Implications: Pressure pain threshold tests, cervical muscle performance tests and patient-reported characteristics about self-perceived function and psychological factors may assist in profiling chronic neck pain patients. The need for more intensive management of those with a traumatic onset compared with those with a non-traumatic onset should be examined further.

Trial registration: ClinicalTrials.gov NCT01431261.

Keywords: Chronic neck pain; Clinical outcomes; Cross-sectional; Patient reported outcomes; Whiplash associated disorder.

Copyright © 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

References

    1. Hogg-Johnson S, van der Velde G, Carroll LJ, Holm LW, Cassidy JD, Guzman J, Cote P, Haldeman S, Ammendolia C, Carragee E, Hurwitz E, Nordin M, Peloso P. The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008;33:S39–51.
    1. de Vos Andersen NB. Patientprofilen hos Praktiserende Fysioterapeuter i Danmark. In: Region Nordjylland RM, editor. Region Syddanmark og Region Hovedstaden. 2014.
    1. Guez M, Hildingsson C, Nilsson M, Toolanen G. The prevalence of neck pain: a population-based study from northern Sweden. Acta Orthop Scand 2002;73:455–9.
    1. Fejer R, Hartvigsen J. Neck pain and disability due to neck pain: what is the relation. Eur Spine J 2008;17:80–8.
    1. Boersma K, Linton SJ. Expectancy, fear and pain in the prediction of chronic pain and disability: a prospective analysis. Eur J Pain 2006;10:551–7.
    1. 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;32:1758–67.
    1. Carroll LJ, Holm LW, Hogg-Johnson S, Cote P, Cassidy JD, Haldeman S, Nordin M, Hurwitz EL, Carragee EJ, van der Velde G, Peloso PM, Guzman J. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008;33:S83–92.
    1. Berglund A, Alfredsson L, Jensen I, Cassidy JD, Nygren A. The association between exposure to a rear-end collision and future health complaints. J Clin Epidemiol 2001;54:851–6.
    1. Curatolo M, Petersen-Felix S, Arendt-Nielsen L, Giani C, Zbinden AM, Radanov BP. Central hypersensitivity in chronic pain after whiplash injury. Clin J Pain 2001;17:306–15.
    1. Koelbaek JM, Graven-Nielsen T, Schou OA, Arendt-Nielsen L. Generalised muscular hyperalgesia in chronic whiplash syndrome. Pain 1999;83:229–34.
    1. Sterling M, Jull G, Vicenzino B, Kenardy J. Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain 2003;104:509–17.
    1. Banic B, Petersen-Felix S, Andersen OK, Radanov BP, Villiger PM, Arendt-Nielsen L, Curatolo M. Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain 2004;107:7–15.
    1. Sterling M, Hodkinson E, Pettiford C, Souvlis T, Curatolo M. Psychologic factors are related to some sensory pain thresholds but not nociceptive flexion reflex threshold in chronic whiplash. Clin J Pain 2008;24:124–30.
    1. Scott D, Jull G, Sterling M. Widespread sensory hypersensitivity is a feature of chronic whiplash-associated disorder but not chronic idiopathic neck pain. Clin J Pain 2005;21:175–81.
    1. Carroll LJ, Hogg-Johnson S, van d V, Haldeman S, Holm LW, Carragee EJ, Hurwitz EL, Cote P, Nordin M, Peloso PM, Guzman J, Cassidy JD. Course and prognostic factors for neck pain in the general population: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008;33:S75–82.
    1. Jorritsma W, Dijkstra PU, De Vries GE, Geertzen JH, Reneman MF. Physical dysfunction and nonorganic signs in patients with chronic neck pain: exploratory study into interobserver reliability and construct validity. J Orthop Sports Phys Ther 2014;44:366–76.
    1. Evans R, Bronfort G, Maiers M, Schulz C, Hartvigsen J. I know it’s changed: a mixed-methods study of the meaning of Global Perceived Effect in chronic neck pain patients. Eur Spine J 2014;23:888–97.
    1. Sterling M. Neck pain: much more than a psychosocial condition. J Orthop Sports Phys Ther 2009;39:309–11.
    1. Chien A, Sterling M. Sensory hypoaesthesia is a feature of chronic whiplash but not chronic idiopathic neck pain. Man Ther 2010;15:48–53.
    1. Woodhouse A, Vasseljen O. Altered motor control patterns in whiplash and chronic neck pain. BMCMusculoskeletDisord 2008;9:90.
    1. Elliott J, Jull G, Noteboom JT, Galloway G. MRI study of the cross-sectional area for the cervical extensor musculature in patients with persistent whiplash associated disorders (WAD). Man Ther 2008;3:258–65.
    1. Bosma FK, Kessels RP. Cognitive impairments, psychological dysfunction, and coping styles in patients with chronic whiplash syndrome. Neuropsychiatry Neuropsychol Behav Neurol 2002;15:56–65.
    1. Sullivan MJLP, Adams HBSW, Martel M-OB, Scott WBA, Wideman TBPT. Catastrophizing and perceived injustice risk factors for the transition to chronicity after whiplash injury. Spine 2011;36:S244–9.
    1. Guez M, Brannstrom R, Nyberg L, Toolanen G, Hildingsson C. Neuropsychological functioning and MMPI-2 profiles in chronic neck pain: a comparison of whiplash and non-traumatic groups. J Clin Exp Neuropsychol 2005;27: 151–63.
    1. Sjolander P, Michaelson P, Jaric S, Djupsjobacka M. Sensorimotor disturbances in chronic neck pain, range of motion, peak velocity, smoothness of movement, and repositioning acuity. ManTher 2008;13:122–31.
    1. Verhagen AP, Lewis M, Schellingerhout JM, Heymans MW, Dziedzic K, de Vet HC, Koes BW. Do whiplash patients differ from other patients with non-specific neck pain regarding pain, function or prognosis. Man Ther 2011;16:456–62.
    1. Jull G, Kristjansson E, Dall’Alba P. Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. ManTher 2004;9:89–94.
    1. Represas C, Vieira DN, Magalhaes T, Dias R, Frazao S, Suarez-Penaranda JM, Rodriguez-Calvo MS, Concheiro L, Munoz JI. No cash no whiplash? Influence of the legal system on the incidence of whiplash injury. J Forensic Leg Med 2008;15:353–5.
    1. Ferrari R, Lang C. A cross-cultural comparison between Canada and Germany of symptom expectation for whiplash injury. J Spinal Disord Tech 2005;18:92–7.
    1. Sterling M, Hendrikz J, Kenardy J. Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: a prospective study. Pain 2010;150:22–8.
    1. Worsfold C. When range of motion is not enough: towards an evidence-based approach to medico-legal reporting in whiplash injury. J Forensic Leg Med 2014;25:95–9.
    1. Côté PSH, Ameis A, Carroll L, Mior M, Nordin M, the OPTIMa Collaboration. Enabling recovery from common traffic injuries: a focus on the injured person. Ontario: Rehabilitation. U-CCftSoDPa; 2015.
    1. Malleson A. Chronic whiplash syndrome. Psychosocial epidemic. Can Fam Physician 1994;40:1906–9.
    1. Ferrari R. The whiplash encyclopedia: the facts and myths of whiplash:. Jones & Bartlett Pub; 2005.
    1. Myrtveit SM, Wilhelmsen I, Petrie KJ, Skogen JC, Sivertsen B. What characterizes individuals developing chronic whiplash? The Nord–Trondelag Health Study (HUNT). J Psychosom Res 2013;74:393–400.
    1. Kivioja J, Sjalin M, Lindgren U. Psychiatric morbidity in patients with chronic whiplash-associated disorder. Spine 2004;29:1235–9.
    1. Joud A, Stjerna J, Malmstrom EM, Westergren H, Petersson IF, Englund M. Healthcare consultation and sick leave before and after neck injury: a cohort study with matched population-based references. BMJ Open 2013;3:e003172.
    1. Bostick GP, Brown CA, Carroll LJ, Gross DP. If they can put a man on the moon, they should be able to fix a neck injury: a mixed-method study characterizing and explaining pain beliefs about WAD. Disabil Rehabil 2012;34:1617–32.
    1. Bostick GP, Ferrari R, Carroll LJ, Russell AS, Buchbinder R, Krawciw D, Gross DP. A population-based survey of beliefs about neck pain from whiplash injury, work-related neck pain, and work-related upper extremity pain. Eur J Pain 2009;13:300–4.
    1. Scott W, Trost Z, Milioto M, Sullivan MJ. Barriers to change in depressive symptoms after multidisciplinary rehabilitation for whiplash: the role of perceived injustice. Clin J Pain 2015;31:145–51.
    1. Freeman MD, Croft AC, Rossignol AM, Centeno CJ, Elkins WL. Chronic neck pain and whiplash: a case-control study of the relationship between acute whiplash injuries and chronic neck pain. Pain Res Manag 2006;11:79–83.
    1. Hansen IR, Sogaard K, Christensen R, Thomsen B, Manniche C, Juul-Kristensen B. Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: design of a randomised controlled trial. BMC Muscsuloskelet Disord 2011;12:274.
    1. Ris I, Søgaard K, Gram B, Agerbo K, Boyle E, Juul-Kristensen B. Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain? A randomised control trial with a 4-month follow up. Man Ther 2016, .
    1. Rubinstein SM, Pool JJ, van Tulder MW, Riphagen II, de Vet HC. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J 2007;16:307–19.
    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–71.
    1. World Medical A. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013;310:2191–4.
    1. Jorgensen R, Ris I, Falla D, Juul-Kristensen B. Reliability, construct and discriminative validity of clinical testing in subjects with and without chronic neck pain. BMC Musculoskelet Disord 2014;15:408.
    1. Jull GA, O’Leary SP, Falla DL. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. J Manipulative Physiol Ther 2008;31:525–33.
    1. Bjorner JB, Thunedborg K, Kristensen TS, Modvig J, Bech P. The Danish SF-36 Health Survey: translation and preliminary validity studies. J Clin Epidemiol 1998;51:991–9.
    1. Wittrup-Jensen KU, Lauridsen J, Gudex C, Pedersen KM. Generation of a Danish TTO value set for EQ-5D health states. Scand J Public Health 2009;37:459–66.
    1. Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther 1991;14(7):409–15.
    1. Bunketorp L, Stener-Victorin E, Carlsson J. Neck pain and disability following motor vehicle accidents – a cohort study. Eur Spine J 2005;14:84–9.
    1. Lauridsen HH, O’Neill L, Kongsted A, Hartvigsen J. The Danish Neck Disability Index: new insights into factor structure, generalizability, and responsiveness. Pain Pract 2016.
    1. Stratford P. Assessing disability and change on individual patients: a report of a patient specific measure. Physiother Can 1995;7:258–63.
    1. Stewart M, Maher CG, Refshauge KM, Bogduk N, Nicholas M. Responsiveness of pain and disability measures for chronic whiplash. Spine 2007;32:580–5.
    1. Pietrobon R, Coeytaux RR, Carey TS, Richardson WJ, DeVellis RF. Standard scales for measurement of functional outcome for cervical pain or dysfunction: a systematic review. Spine 2002;27:515–22.
    1. Westaway MD, Stratford PW, Binkley JM. The patient-specific functional scale: validation of its use in persons with neck dysfunction. J Orthop Sports Phys Ther 1998;27:331–8.
    1. Schnohr CW, LD, Bjørner B. Oversættelse og validering af en dansk udgave af PSFS (Patient Specifik Funktionel Skala) – et nyttigt værktøj for terapeuter. Copenhagen: Institut for Folkesundhedsvidenskab KU; 2015.
    1. Cleland JA, Fritz JM, Childs JD. Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with neck pain. Am J Phys Med Rehabil 2008;87:109–17.
    1. Jorgensen MB, Damsgard E, Holtermann A, Anke A, Sogaard K, Roe C. Properties of the Tampa Scale for kinesiophobia across workers with different pain experiences and cultural backgrounds: A Rasch analysis. J Appl Meas 2015;16: 218–27.
    1. Stewart MJ, Maher CG, Refshauge KM, Herbert RD, Bogduk N, Nicholas M. Randomized controlled trial of exercise for chronic whiplash-associated disorders. Pain 2007;128:59–68.
    1. Young IA, Cleland JA, Michener LA, Brown C. Reliability, construct validity, and responsiveness of the neck disability index, patient-specific functional scale, and numeric pain rating scale in patients with cervical radiculopathy. Am J Phys Med Rehabil 2010;89:831–9.
    1. Elliott J, Sterling M, Noteboom JT, Darnell R, Galloway G, Jull G. Fatty infiltrate in the cervical extensor muscles is not a feature of chronic, insidious-onset neck pain. Clin Radiol 2008;63(6):681–7.
    1. Van Oosterwijck J, Nijs J, Meeus M, Paul L. Evidence for central sensitization in chronic whiplash: a systematic literature review. Eur J Pain 2013;17:299–312.
    1. Malfliet A, Kregel J, Cagnie B, Kuipers M, Dolphens M, Roussel N, Meeus M, Danneels L, Bramer WM, Nijs J. Lack of evidence for central sensitization in idiopathic, non-traumatic neck pain: a systematic review. Pain Physician 2015;18:223–36.
    1. Smith AD, Jull G, Schneider G, Frizzell B, Hooper RA, Sterling M. A comparison of physical and psychological features of responders and non-responders to cervical facet blocks in chronic whiplash. BMC Musculoskelet Disord 2013;14.
    1. Dumas JP, Arsenault AB, Boudreau G, Magnoux E, Lepage Y, Bellavance A, Loisel P. Physical impairments in cervicogenic headache: traumatic vs. nontraumatic onset. Cephalalgia 2001;2:884–93.
    1. Sterling M, McLean SA, Sullivan M, Elliott J, Butenhuis J, Kamper SK. Potential processes involved in the initiation and maintenance of Whiplash Associated Disorders (WAD). Spine 2011;36:322–9.
    1. Curatolo M, Bogduk N, Ivancic PC, McLean SA, Siegmund GP, Winkelstein BA. The role of tissue damage in whiplash-associated disorders: discussion paper 1. Spine 2011;36:S309–15.
    1. Uhrenholt L, Grunnet-Nilsson N, Hartvigsen J. Cervical spine lesions after road traffic accidents: a systematic review. Spine 2002;27:1934–41.
    1. Guez M. Chronic neck pain. An epidemiological, psychological and SPECT study with emphasis on whiplash-associated disorders. Acta Orthop Suppl 2006;77:3–33.
    1. Wand BM, O’Connell N, Parkitny L. Depression may contribute to the sensory changes in whiplash patients? Re: Chien, A, Sterling, M. Sensory hypoaesthesia is a feature of chronic whiplash but not chronic idiopathic neck pain. Mantherapy 2010;15:48–53 [Man Ther 2010;15:e1; author reply e2].
    1. Borsbo B, Peolsson M, Gerdle B. Catastrophizing, depression, and pain: correlation with and influence on quality of life and health – a study of chronic whiplash-associated disorders. J Rehabil Med 2008;40:562–9.
    1. 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;28:797–802.
    1. Carroll LJ, Cassidy JD, Cote P. Frequency, timing, and course of depressive symptomatology after whiplash. Spine 2006;31:E551–6.

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