Importance of psychological factors for the recovery from a first episode of acute non-specific neck pain - a longitudinal observational study

Abstract

BackgroundThe 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.MethodsPatients 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)).ResultsAll 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).ConclusionsPsychological 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.

Pragmatic cluster randomised double-blind pilot and feasibility trial of an active behavioural physiotherapy intervention for acute non-specific neck pain: a mixed-methods protocol

“…Participants aged 20–60 years presenting with non-specific neck pain within the previous 4 weeks 11 23…”

“…Physical (eg, pain and disability)1 2 and psychological (eg, anxiety, depression and fear avoidance)11–13 problems are observed in patients with non-specific neck pain. The current clinical guidelines14 15 and low-to-moderate quality evidence16 17 suggest that manual and exercise therapy may be useful in managing patients with non-specific neck pain.…”

“…Additionally, the use of paracetamol (3000–4000 mg total) and NSAIDs (the median duration of included trial=7 days) are documented to contribute a 4 times increase in abnormal liver function20 and 2.5 times increased the risk of gastrointestinal reactions, respectively 21. Owing to these unwanted side effects from pharmacological management, non-specific neck pain is commonly managed by physiotherapists,14 15 22 and effective conservative management in the acute stage (≤4 weeks)11 23 is required to prevent the transition to chronicity and recurrence.…”

“…According to the current evidence, non-specific neck pain is a complex biopsychosocial disorder 1 2 11–13. Subsequently, the management of patients with non-specific neck pain can be complex, encompassing both physical and psychological perspectives.…”

“…Subsequently, the management of patients with non-specific neck pain can be complex, encompassing both physical and psychological perspectives. All individuals with acute non-specific neck pain can be variously impacted by psychological problems, which can lead to poor recovery 11. Unfortunately, using multimodal therapy or multifaceted implementation strategies to date have not been useful 24.…”