Pain pattern classification and directional preference for patients with neck pain

Abstract

Pain Pattern Classification (PPC) and Directional Preference (DP) have been shown to be predictive of health care outcomes and serve to guide orthopedic clinical decision making. We conducted a prospective, observational cohort study to verify the association between PPC, DP, and clinical outcomes. Clinical outcome measures including pain intensity and disability were completed at first examination and follow-up by 335 patients. A Pearson's chi-squared test was used to determine differences in prevalence rates for the categorical variables, and two-sample t-tests were used to determine differences in rates for the continuous variables. A Tukey's range test was used to determine differences in follow-up pain intensity and disability for neck pain dual-classification schemes. The prevalence of DP was 82.4%. The prevalence of CEN, Non-CEN, and Non-Classifiable (NC) was 15.2%, 42.1%, and 25.1%, respectively. The prevalence of DP was lowest for patients with sub-acute symptoms and who were <45 years old. Patients classified as DP CEN had, on average 2.62 NDI units less than patients classified as Non-DP. Patients classified as DP CEN had, on average, 0.90 pain intensity units less than patients classified as Non-DP at follow-up. Patients who demonstrated DP CEN did not have clinically significant lower pain intensity or disability at follow-up than patients who demonstrated Non-DP. The results of this investigation need to be interpreted with caution with respect to the study design and it's subsequent strengths and limitations. 1b.

Effects of a Therapeutic Exercise Protocol for the Prevention of Vertebral Pain in Patients with Chronic Non-Specific Back Pain in Primary Health Care: A Single-Group Retrospective Cohort Study

“…The percentage of change of improvement of disability in our study has reached 30,7%, that outcomes are lower than previous studies where they reached between 50% to 77,77% from immediately to 3 months after (57)(58)(59), but in a recent study no differences for disability was found for McKenzie exercise (60). Two previous observational studies without a control group have shown that the McKenzie method allows for the classification of patients with neck pain and provides improvements in patients in terms of neck disability (61,62). In a recent published systematic review with meta-analysis, they concluded that McKenzie provides very small but statistically significant improvements in neck pain of all severity compared to control interventions (63).…”

Immediate neck hypoalgesic effects of craniocervical flexion exercises and cervical retraction exercises among individuals with non-acute neck pain and a directional preference for retraction or extension: preliminary pretest-posttest randomized experimental design

“…Therefore, this study decided on a final sample size with 18 participants who had the derangement syndrome with a DP of cervical retraction or extension. In the general population, the percentage of patients with the derangement syndrome has been reported to be 82% [ 18 ]. Acute and/or traumatic neck pain was excluded in the current study.…”

Directional preference constructs for patients’ neck pain in the absence of centralization

“…We conducted a secondary analysis of data from a prospective, observational cohort study which examined the association between Pain Pattern Classification (PPC), DP, and clinical outcomes [20]. The current study analyzed data collected from consecutive patients with non-specific neck pain who presented to outpatient clinics and exhibited DP at the first examination in the absence of CEN (see Figure 1).…”

“…Patients were included in this analysis if they presented with complaints of non-specific neck pain with or without radiation into the upper extremities and their cervical spine challenge was classified as DP Non-CEN or DP NC (Non-Classifiable) at first examination; the PPC and DP framework have been described elsewhere [20]. Patients were excluded from the study if they had cervical spine surgery within the preceding 12 months.…”

“…The aim of this investigation was to examine the DP assessment framework used by providers with advanced training in MDT for patients with cervical spine challenges during routine clinical practice. Spinal DP in the absence of CEN and spinal DP in the presence of CEN represent distinct diagnostic categories and have been shown to exhibit differences in prevalence and prognostic validity [5,12,[16][17][18][19][20], yet no studies have examined the criteria used to establish a spinal DP in the absence of CEN and its subsequent association with outcome. We specifically sought to understand the prevalence of DP constructs and their relation to outcome for patients with cervical spine challenges that did not exhibit CEN at the first examination.…”