Psychosocial, Physical, and Neurophysiological Risk Factors for Chronic Neck Pain: A Prospective Inception Cohort Study

Comparative effectiveness of conservative and pharmacological interventions for chronic non-specific neck pain: Protocol of a systematic review and network meta-analysis

BACKGROUND

Neck Pain (NP) has been ranked as one of the top chronic pain conditions in terms of prevalence and years lived with disability in the latest Global Burden of Disease. NP has remarkable socio-economic consequences however, research efforts are limited. Discrepancies among guidelines recommendations on management of chronic neck pain exist. The purpose of this study protocol is to provide the methods for a review with network meta-analysis to identify the most effective interventions for chronic neck pain.

METHODS

The following databases will be searched from their inception to February 2019: Cochrane Controlled Trials Register (CENTRAL), PubMed, CINAHL, Scopus, ISI Web of Science and PEDro.Randomized controlled trials (RCTs) on pharmacological and not pharmacological interventions will be included and their risk of bias will be evaluated using the Cochrane Risk of bias tool. Primary outcomes will be reduction in pain and disability. A network meta-analysis will be carried out and pairwise meta-analysis will be conducted using Stata 15 software. Grading of recommendations assessment, development, and evaluation (GRADE) will be applied to assess quality of the body of the evidence.

RESULTS

The results of this review will be submitted to a peer-review journal for publication.

CONCLUSION

This network meta-analysis will provide a comprehensive review on the most effective treatments for the management of chronic neck pain providing key evidence-based information to patients, clinicians and other relevant stakeholders. Registration: PROSPERO (registration number CRD42019124501).

Impairment of Inhibition of Trigeminal Nociception via Conditioned Pain Modulation in Persons with Migraine Headaches

OBJECTIVE

To assess conditioned pain modulation efficiency in persons with and without migraine headaches.

DESIGN

Cross-sectional assessment of experimental pain.

SETTING

University campus and surrounding community in a large Midwestern US city.

SUBJECTS

Twenty-three adults with and 32 without a history of migraine headaches participated in the study. Participants were mostly female (N = 40) with an average age of 23 years.

METHODS

Four electrocutaneous stimulations of the supraorbital branch of the left trigeminal nerve were delivered at 150% of an individually determined pain threshold. Conditioned pain modulation was assessed by applying a noxious counterstimulus (forearm ischemia) and delivering four more electrocutaneous stimulations. After each stimulation, pain and the nociceptive blink reflex were assessed. Depression and pain catastrophizing were assessed to control for the potential influence of these variables on pain modulation.

RESULTS

Participants with and without migraine headaches had similar baseline pain responsivity, without significant differences in pain report or nociceptive blink reflexes. Pain report was inhibited by conditioned pain modulation in both the migraine and control groups. However, unlike nonmigraine controls, participants with migraines did not exhibit an inhibition of nociceptive blink reflexes during the ischemia task. This pattern persisted after controlling for level of pain catastrophizing and depression.

CONCLUSIONS

Migraine sufferers exhibited impaired conditioned pain modulation of the nociceptive blink reflex, suggesting a deficiency in inhibition of trigeminal nociception, which may contribute to the development of migraine headaches.

Upper back pain in postmenopausal women and associated physical characteristics

The physical characteristics of postmenopausal women that are associated with upper back pain are not well-understood. The aim of this cross-sectional study was to identify the physical characteristics associated with presence and severity of upper back pain in healthy postmenopausal women. Self-reported upper back pain presence (within the previous month) and severity (numerical rating scale) were examined against the physical characteristics: height; weight; body mass index; breast size; breast ptosis; upper back extensor muscle endurance (isometric chest raise test); head, shoulder and upper back posture (photogrammetry); thoracic extension mobility (photogrammetry); bone mineral density (dual-energy x-ray absorptiometry (DXA)); body composition (DXA); and thoracic kyphosis, thoracic osteoarthritis and thoracic vertebral fracture (all radiography). A multivariable logistic regression model, adjusted for age, was built using physical characteristics with a significant univariate association with upper back pain. Censored Tobit regression, adjusted for age, was used to examine each physical characteristic against upper back pain severity. Postmenopausal women (n = 119) with a mean (SD) age of 61.4 (7.0) years participated in the study. After adjusting for age, the physical characteristics independently associated with upper back pain were: height (OR: 0.50, 95% CI: 0.31–0.79); and upper back extensor muscle endurance (OR: 0.46, 95%CI: 0.28–0.75). This model explained 31% of the variance in upper back pain (p<0.001). After adjusting for age, being taller and having better upper back extensor muscle endurance were associated with lower odds for upper back pain. After adjusting for age, differences in upper back pain severity were explained by upper back extensor muscle endurance (p = <0.001) and lean mass (p = 0.01). Conclusion: As a modifiable physical characteristic of postmenopausal women with upper back pain, upper back extensor muscle endurance is worth considering clinically.

The effect of trunk muscle fatigue on postural control of upright stance: A systematic review

BACKGROUND

Fatigability and postural control deficits are both serious concerns in a variety of chronic musculoskeletal conditions. Research has shown that muscle fatigue may adversely affect postural control. This is while the evidence on the relevance of fatigue to postural control has never been summarized nor critically appraised.

RESEARCH QUESTION

Is there sufficient and strong enough evidence to accept trunk muscle fatigue as a contributing factor to postural control alterations during upright standing posture?.

METHODS

EMBASE, Scopus, ELSEVIER, PubMed, ProQuest, Google scholar and reference lists of the relevant articles were searched through April 2018. Studies having investigated the trunk muscle fatigue effect on postural control in asymptomatic individuals were included in the study. Only those studies having assessed postural control in terms of center of pressure driven variables were included.

RESULTS

Twelve studies (218 asymptomatic participants) matched the inclusion criteria of this systematic review. Their results supported the hypothesis that fatigue has a significant effect on postural control in terms of the time domain variables. Sway velocity was consistently found to be affected by fatigue. The results were inconsistent in the frequency domain. The only study on the structural dynamics of center of pressure displacements also confirmed such a relationship.

SIGNIFICANCE

The present review indicates that postural control is altered in asymptomatic individuals following trunk muscle fatigue. This may suggest that trunk muscle endurance training is crucial to address postural impairment in chronic spine musculoskeletal conditions.

Development of a short form of the Hong Kong Chinese orebro musculoskeletal pain screening questionnaire

Background:

The Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) is a valid screening tool to identify those musculoskeletal patients at risk of developing chronicity and disability. A Hong Kong Chinese version of the OMPSQ (COMPSQ-HK) was developed with satisfactory construct validity and predictive validity.

Objective:

The aim of this study was to develop a 10-item short form of the COMPSQ-HK (COMPSQ-HK10) and examine its measurement properties.

Methods:

The 10 items were identified from the suggestion by the original author of OMPSQ. The data of the 10 items were extracted from the main study to develop the COMPSQ-HK conducted from 2010 to 2013. The internal consistency using Cronbach’s alpha, test–retest reliability examining intraclass correlation coefficient (ICC1,1), minimum detectable change and 95% limits of agreement, construct validity by correlating COMPSQ-HK10 with pain, disability score, kinesiophobia score and Medical Outcomes Study Short Form 12, and predictive validity investigating receiver operating characteristic (ROC) curve analyses with sick leave >60 days and return-to-work status at one year were calculated.

Results:

A total of 305 back patients and 160 neck patients were recruited with about 30% of patients lost to follow-up at one year. Both the internal consistency (Cronbach’s alpha as 0.732 to 0.757) and test–retest reliabilities (ICC1,1 as 0.868 for both back and neck patients) were satisfactory. The correlations between COMPSQ-HK10 and COMPSQ-HK for back and neck patients were excellent (Pearson r as 0.919 and 0.896, respectively, p<0.001). The areas under the ROC curves for back and neck patients were similar for COMPSQ-HK10 and COMPSQ-HK, ranging from 0.603 to 0.712. A cut-off score of 54 of COMPSQ-HK10 was recommended in predicting “sick leave of more than 60 days at one year” and “return to work for at least four consecutive weeks at one year”.

Conclusion:

The COMPSQ-HK10 has comparable measurement properties with the COMPSQ-HK. It is recommended to use the COMPSQ-HK10 for routine screening to identify patients of back and neck pain at risk of developing chronic pain and disability.

A preliminary biopsychosocial analysis of online information on causes of neck pain

OBJECTIVE

The aim of the present study was to analyse the freely available online information on the causes of neck pain based on the biopsychosocial model of pain.

METHODS

A preliminary biopsychosocial analysis tool was developed, after an extensive literature review of the pathoanatomical and psychosocial contributors for neck pain. The websites that commonly appeared after the search term "causes of neck pain" in the first two pages of the search engines (Google, Yahoo and Bing) were selected for the biopsychosocial analysis. In addition, the websites were reviewed for Health on Net (HON) certification.

RESULTS

Ten websites were analysed, of which eight were identified to contain a predominant biomedical orientation, as they reported only the pathoanatomical causes of neck pain. The remaining two websites were determined to represent limited psychosocial information and described only two psychological contributors to the neck pain.

CONCLUSIONS

The online information on the causes of neck pain appears to contain limited biopsychosocial orientation. Further detailed analysis is essential to obtain firm conclusions on the content validity of online information on neck pain.

The effect of psychosocial measures of resilience and self-efficacy in patients with neck and lower back pain

BACKGROUND CONTEXT

Psychosocial risk factors may predispose to progression of back and neck pain to chronic pain or disability. Resilience (the ability to recover from stress) and pain self-efficacy (confidence that one can perform daily activities despite pain) are important psychometric properties shown to affect health and illness.

PURPOSE

To examine the relationships among resilience, pain self-efficacy, and disability in spine patients.

DESIGN/SETTING

Prospective, single-center orthopedic spine clinic.

PATIENT SAMPLE

One hundred and ninety five patients in a tertiary spine practice recruited between December 2016 and March 2017.

OUTCOME MEASURES

Self-reported measures: Brief Resilience Scale (BRS), Pain Self-Efficacy Questionnaire 2 (PSEQ-2) Short Form, Neck Disability Index (NDI), and Oswestry Disability Index (ODI).

METHODS

A prospective study was conducted of new patients visiting an orthopedic spine clinic complaining of neck pain or low back pain, with or without radiculopathy. Enrolled patients completed a survey of demographic information, the six-question BRS, the two-question PSEQ-2 Short Form, and NDI or ODI for neck or back pain, respectively. The relationship between BRS and NDI or ODI was examined, and the relationship between PSEQ-2 and NDI or ODI was also examined.

RESULTS

A total of 195 patients were evaluated. After excluding those with incomplete NDI or ODI, 180 patients were included in the analysis (46.1% men [83/180]; mean age 53 [standard deviation: 17] years). 139 (77.2%) subjects complained of low back pain and 41 (22.8%) subjects complained of neck pain. BRS was strongly negatively correlated with NDI (r=-0.61, p<.0001) and moderately negatively correlated with ODI (r=-0.34, p<.0001). PSEQ-2 was strongly negatively correlated with NDI (r=-0.69, p<.0001) and strongly negatively correlated with ODI (r=-0.62, p<.0001). BRS was moderately positively correlated with PSEQ-2 (r=0.36, p<.0001). For the low back pain cohort, the correlation between PSEQ-2 and ODI was significantly greater than the correlation between BRS and ODI (p=.0003); this difference was not noted in the neck pain cohort (p=.34).

CONCLUSIONS

Low resilience and low pain self-efficacy are both independently associated with greater functional disability in neck and low back pain patients. Spine surgeons may find it useful to incorporate the BRS and PSEQ-2 into preoperative assessment. Future studies should examine the utility of these simple validated questionnaires in predicting response to treatments, including surgical intervention.

Possible Role of Myopia as a Risk Factor for Mechanical Neck Pain in Medical Students : A Pilot Study

Background

Mechanical neck pain (MNP) is a common health concern. Some studies suggested a relationship between neck pain and visual activity. We assessed the role of myopia as a contributing factor in the development of chronic MNP.

Materials and Methods

All medical students at Shiraz University School of Medicine, who were 18 to 22 years old, were invited to participate in this retrospective case-control study from March 2016 to March 2017. Numeric Pain Rating Scale (NPRS) was used to assess the average neck pain severity over the past 6 months in order to enroll participants as the case (≥3) or control (<3) groups. Demographic data and medical profile were obtained. After identifying eligible cases, we assigned age- and sex-matched controls, who also met the study criteria. Subsequently, participants completed the Neck Disability Index (NDI) and Neck Pain and Disability Scale (NPDS) questionnaires and were evaluated for myopia severity. Variables were compared between the case and control groups as well as within the case group. P-value<0.05 was considered statistically significant.

Results

From over 700 medical students, around 150 cooperated. Eventually, 31 eligible cases (and 31 controls) were studied. NDI and NPDS were significantly higher in the case group (P<0.001). However, no significant differences were noticed between the groups regarding the severity (P=0.123) and the duration (P=0.417) of myopia. Also, the correlation of myopia severity with NDPS (ρ=0.159, P=0.216) and NDI (ρ=0.201, P=0.116) was non-significant within the case group.

Conclusion

Our findings have not supported the influential role of myopia in the development of chronic MNP.

Comparisons of Conditioned Pain Modulation and Physical Activity Between Hispanic and Non-Hispanic White Adults

It is well-documented that adults of racial/ethnic minorities experience pain more frequently and suffer from more severe pain compared to non-Hispanic White (NHW) adults. These observations are consistent with laboratory findings that adults of racial/ethnic minorities show increased sensitivity to laboratory pain stimuli compared to NHW adults. Research generally shows that central pain inhibitory processing, as quantified using conditioned pain modulation (CPM), serves as a risk factor of clinical pain. Currently, racial/ethnic differences in CPM are poorly understood, and research suggests that physical activity (PA) may help understand potential racial/ethnic differences in CPM. However, very little is known regarding CPM in Hispanic compared to NHW adults. Therefore, the present study compared CPM and PA between Hispanic and NHW adults. Twenty-one young, healthy Hispanic and 21 NHW adults completed validated questionnaires to assess PA, pain catastrophizing, and dispositional optimism. The participants then completed the CPM test to quantify changes in pain ratings to electrical stimuli delivered to the ankle during concurrent application of pressure pain applied to the finger compared to baseline. Results indicated that Hispanic and NHW adults exhibited comparable CPM responses and PA levels, along with similar levels of pain catastrophizing and dispositional optimism (p > 0.05). These results suggest that young, healthy Hispanic and NHW adults may possess a similar risk of clinical pain when they are comparable in PA, pain catastrophizing, and dispositional optimism. More research is needed to explore the role of PA in racial/ethnic disparities in clinical pain and central pain inhibitory processing.

Does the Use of Electrotherapies Increase the Effectiveness of Neck Stabilization Exercises for Improving Pain, Disability, Mood, and Quality of Life in Chronic Neck Pain?: A Randomized, Controlled, Single-Blind Study

STUDY DESIGN

This study was a prospective, randomized, controlled study.

OBJECTIVE

The aim of this study was to determine whether transcutaneous electrical nerve stimulation (TENS) or interferential current (IFC) increase the effectiveness of neck stabilization exercises (NSEs) on pain, disability, mood and quality of life for chronic neck pain (CNP).

SUMMARY OF BACKGROUND DATA

Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Electrotherapies, such as IFC and TENS, have been applied solo or combined with exercise for management of neck pain; however, the efficacy of these combinations is unclear.

METHODS

A total of 81 patients with CNP were included in this study. Patients were randomly assigned into three groups regarding age and gender. First group had NSE, second group had TENS and NSE, and third group had IFC and NSE. Pain levels [visual analogue scale (VAS)], limits of cervical range of motion (ROM), quality of life (short form-36), mood (Beck depression inventory), levels of disability (Neck Pain and Disability Index), and the need for analgesics of all patients were evaluated before treatment, at 6th and 12th week follow-up. Physical therapy modalities were applied for 15 sessions in all groups. All participants had group exercise accompanied by a physiotherapist for 3 weeks and an additional 3 weeks of home exercise program.

RESULTS

According to the intragroup assessment, the study achieved its purpose of pain reduction, ROM increase, improvement of disability, quality of life, mood and reduction in drug use in all three treatment groups (P < 0.05). However, clinical outcomes at 6th and 12 th week had no significant difference among the three groups (P > 0.05).

CONCLUSION

TENS and IFC therapies are effective in the treatment of CNP patients. However, they have no additional benefit or superiority over NSE.

LEVEL OF EVIDENCE

2.

Inactive individuals with chronic neck pain have changes in range of motion and functional performance of the shoulder

OBJECTIVE

To correlate the range of movement and functional performance of the shoulder with pain measures in inactive individuals with and without neck pain. In addition, comparisons were made between the groups.

METHODS

The sample comprised two groups of inactive adults, aged 18-45 years: chronic neck pain (n = 30) and healthy subjects (n = 30). All participants had no clinical dysfunction in the shoulder joint. Aspects related to neck pain were evaluated with the Numerical Rating Scale, Neck Disability Index, and the Catastrophic Thoughts about Pain Scale. Range of motion and shoulder functionality was evaluated by means of goniometry and the Closed Kinetic Chain Upper Extremity Stability (CKCUES) test, respectively.

RESULTS

Individuals with neck pain presented reduction in CKCUES test (absolute score, mean difference [MD] = -1.50, 95% confidence interval [CI] [-2.87, -0.12]) and in abduction (MD = -7.36°, 95% CI [-13.84, -0.89]) and lateral rotation (MD = -8.61°, CI [-15.94, -1.28]) range of motion. Moreover, weak, significant, and negative association (p < 0.05, r = -0.262 to -0.384) was observed between the CKCUES test and pain intensity at rest and during active cervical movements, as well as catastrophizing. A weak, significant, and negative association (p < 0.05, r = -0.256 to -0.389) was also observed between the lateral rotation range of motion and catastrophizing, as well as pain intensity both at rest and during active movements.

CONCLUSION

The greater the neck pain intensity and catastrophizing, the lower the functional performance and lateral rotation range of motion of the shoulder.

Measurement of Cervical Multifidus and Longus Colli Muscle Dimensions in Patients With Cervical Radiculopathy and Healthy Controls Using Ultrasonography: A Reliability Study

BACKGROUND

Cervical radiculopathy is a musculoskeletal disorder with an increasing prevalence in office workers. In recent years, ultrasonography (US) has been reported to be a valid, inexpensive, and noninvasive technique for the objective evaluation of muscle morphology. However, measuring deep cervical paraspinal muscle dimensions using US in patients with cervical radiculopathy has not been described.

OBJECTIVE

To evaluate intrasession and intersession reliabilities of US to measure dimensions of deep cervical muscles at rest in patients with chronic cervical radiculopathy and healthy controls.

DESIGN

Reliability study.

SETTING

Outpatients who presented for treatment at an outpatient university physiotherapy clinic.

PARTICIPANTS

Fifteen patients with cervical radiculopathy and 15 healthy controls.

INTERVENTIONS

US measurements.

OUTCOME

Cervical multifidus and longus colli muscle dimensions at separate occasions.

METHODS

Two measurements separated by a 1-hour interval were taken on the same day and the third measurement was taken 5 days later. The intraclass correlation coefficient (ICC), SE of measurement, and minimal detectable change were used to evaluate relative and absolute reliabilities.

RESULTS

US was a highly reliable method for measuring the multifidus and longus colli muscle dimensions in patients and healthy subjects. The highest reliability scores were found for the anteroposterior dimension measurement of the multifidus muscle (ICC = 0.92) and the lateral dimension measurement of the longus colli muscle (ICC = 0.97) in healthy subjects.

CONCLUSIONS

The results indicated that US is a highly reliable method of measuring deep cervical muscle dimensions in patients with cervical radiculopathy and healthy controls when measured by the same investigator.

LEVEL OF EVIDENCE

III.

Cost-effectiveness of exercise therapy in the treatment of non-specific neck pain and low back pain: a systematic review with meta-analysis

OBJECTIVE

To investigate the cost-effectiveness of exercise therapy in the treatment of patients with non-specific neck pain and low back pain.

DESIGN

Systematic review of economic evaluations.

DATA SOURCES

The search was performed in 5 clinical and 3 economic electronic databases.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included economic evaluations performed alongside randomised controlled trials. Differences in costs and effects were pooled in a meta-analysis, if possible, and incremental cost-utility ratios (ICUR) were descriptively analysed.

RESULTS

Twenty-two studies were included. On average, exercise therapy was associated with lower costs and larger effects for quality-adjusted life-year (QALY) in comparison with usual care for subacute and chronic low back pain from a healthcare perspective (based on ICUR). Exercise therapy had similar costs and effect for QALY in comparison with other interventions for neck pain from a societal perspective, and subacute and chronic low back pain from a healthcare perspective. There was limited or inconsistent evidence on the cost-effectiveness of exercise therapy compared with usual care for neck pain and acute low back pain, other interventions for acute low back pain and different types of exercise therapy for neck pain and low back pain.

CONCLUSIONS

Exercise therapy seems to be cost-effective compared with usual care for subacute and chronic low back pain. Exercise therapy was not (more) cost-effective compared with other interventions for neck pain and low back pain. The cost-utility estimates are rather uncertain, indicating that more economic evaluations are needed.

REGISTRATION

PROSPERO, CRD42017059025.

Validity and Responsiveness of the Pain Self-Efficacy Questionnaire in Patients With Neck Pain Disorders

Study Design Longitudinal clinimetric study. Background Pain self-efficacy predicts poor recovery and mediates the relationship between pain and disability in patients with neck pain disorders (NPDs). The Pain Self-Efficacy Questionnaire (PSEQ) is a frequently used instrument to measure pain self-efficacy; however, its measurement properties have never been evaluated in a group of patients with NPDs. Objectives This study aimed to assess validity and responsiveness of the PSEQ in patients with NPDs. Methods Patients with NPDs (n = 161) were included. Confirmatory and exploratory factor analysis was used to assess structural validity. Twelve hypotheses on expected correlations with other instruments were formulated a priori to assess construct validity. Responsiveness was evaluated in 146 patients with NPDs who underwent multimodal rehabilitation by testing 12 hypotheses on expected effect sizes, area under the curve, and correlations with change in other instruments. Results Factor analyses showed that the PSEQ is a unidimensional instrument with moderate construct validity and responsiveness (50% to 75% of hypotheses met). Validity was consistent when analyzed separately for patients with whiplash-associated disorders and idiopathic neck pain, and responsiveness was better in patients with idiopathic neck pain. Conclusion The PSEQ is a unidimensional measure of pain self-efficacy in patients with NPDs, as found by previous studies in other populations. Nevertheless, in contrast with previous studies, its construct validity and responsiveness were found to be suboptimal in NPDs, suggesting that the content validity of the PSEQ and of the comparator instruments used in this study should be better assessed. J Orthop Sports Phys Ther 2018;48(3):204-216. Epub 19 Dec 2017. doi:10.2519/jospt.2018.7605.

Identifying risk factors for first-episode neck pain: A systematic review

Neck pain affects 15.1% of the United States' general population every 3 months, and ranks fourth in global disability. Because of the tendency for neck pain to become a chronic issue, it is important to identify risk factors that could encourage prevention and early diagnosis. The purpose of this systematic review was to identify risk factors for a first episode of neck pain. Three databases were searched with key words such as "neck pain" and "first incidence." Risk factors from the resulting articles were reported as either a physical or psychosocial risk factor and ranked by the strength of their odds/risk/hazard ratio: <1.0 (protective factor), 1.0-1.5 (minor risk), 1.5-2.0 (moderate risk), or 2.0+ (major risk). Out of 878 total articles, 10 articles met our inclusion criteria. Of these studies, a global incidence rate for neck pain was calculated to be 16.2%. The strongest psychosocial risk factors were depressed mood, high role conflict, and perceived muscular tension. There were no major physical risk factors (2.0+), but the most commonly reported risk factor was work in awkward/sustained postures. Protective measures found included high perceived empowering leadership, high perceived social climate, leisure physical activity, and cervical extensor endurance. Most risk factors found for neck pain were related to psychosocial characteristics, rather than physical characteristics. A number of these risk factors were mediating factors, suggesting that a prevention-based program may be useful in modifying the existence of the risk factors before the occurrence of neck pain.

Workplace-Based Interventions for Neck Pain in Office Workers: Systematic Review and Meta-Analysis

Background

At present, there is no consolidated evidence for workplace-based interventions for the prevention and reduction of neck pain in office workers.

Purpose

The purpose of this review was to investigate the effectiveness of workplace-based interventions for neck pain in office workers.

Data Sources

MEDLINE, PEDro, CINAHL, and CENTRAL were searched for trials published since inception and before May 31, 2016.

Study Selection

Randomized controlled trials (RCTs) were considered when they met the following criteria: population consisted of office workers, intervention(s) was performed at the workplace, outcome measures included neck and/or neck/shoulder pain intensity and incidence/prevalence, and comparator groups included no/other intervention.

Data Extraction

Data were extracted by 1 reviewer using predefined data fields and checked by a second reviewer. Risk of bias was assessed by 2 independent reviewers using the 2015 Cochrane Back and Neck Group guidelines. Evidence quality was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system.

Data Synthesis

Twenty-seven RCTs were included. There was moderate-quality evidence that neck/shoulder strengthening exercises and general fitness training were effective in reducing neck pain in office workers who were symptomatic, although the effect size was larger for strengthening exercises. Greater effects were observed with greater participation in exercise. Ergonomic interventions were supported by low-quality evidence.

Limitations

Data could not be obtained from some studies for meta-analysis and assessment of risk of bias. Reporting bias might have been present because only studies in the English language were included.

Conclusions

Workplace-based strengthening exercises were effective in reducing neck pain in office workers who were symptomatic, and the effect size was larger when the exercises were targeted to the neck/shoulder. Future RCTs of ergonomic interventions targeted at office workers who are symptomatic are required. More research on neck pain prevention is warranted.

Psychosocial Influences on Exercise-Induced Hypoalgesia

Objective

The purpose of this study was to examine psychosocial influences on exercise-induced hypoalgesia (EIH).

Design

Randomized controlled trial.

Setting

Clinical research unit in a hospital.

Subjects

Fifty-eight healthy men and women (mean age = 21 ± 3 years) participated in this study.

Methods

Participants were first asked to complete a series of baseline demographic and psychological questionnaires including the Pain Catastrophizing Scale, the Fear of Pain Questionnaire, and the Family Environment Scale. Following this, they were familiarized with both temporal summation of heat pain and pressure pain testing protocols. During their next session, participants completed the Profile of Mood States, rated the intensity of heat pulses, and indicated their pressure pain thresholds and ratings before and after three minutes of submaximal, isometric exercise. Situational catastrophizing was assessed at the end of the experimental session.

Results

Results indicated that experimental pain sensitivity was significantly reduced after exercise ( P  < 0.05). Men and women did not differ on any of the measured psychosocial variables ( P  > 0.05). Positive family environments predicted attenuated pain sensitivity and greater EIH, whereas negative and chronic pain-present family environments predicted worse pain and EIH outcomes. Situational catastrophizing and negative mood state also predicted worse pain and EIH outcomes and were additionally associated with increased ratings of perceived exertion and muscle pain during exercise.

Conclusions

This study provides preliminary evidence that psychosocial variables, such as the family environment and mood states, can affect both pain sensitivity and the ability to modulate pain through exercise-induced hypoalgesia.

Wilson A, M. Palermo T. Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: a prospective study

Strategies directed at the prevention of disabling pain have been suggested as a public health priority, making early identification of youth at risk for poor outcomes critical. At present, limited information is available to predict which youth presenting with acute pain are at risk for persistence. The aims of this prospective longitudinal study were to identify biopsychosocial factors in the acute period that predict the transition to persistent pain in youth with new-onset musculoskeletal (MSK) pain complaints. Participants were 88 children and adolescents (age 10-17 years) presenting to the emergency department (n = 47) or orthopedic clinic (n = 41) for evaluation of a new MSK pain complaint (<1 month duration). Youth presented for 2 study visits (T1≤1 month post pain onset; T2= 4-month follow-up) during which they completed questionnaires (assessing pain characteristics, psychological factors, sleep quality) and participated in a laboratory task assessing conditioned pain modulation. Regression analyses tested T1 predictors of longitudinal pain outcomes (pain persistence, pain-related disability, quality of life [QOL]). Results revealed approximately 35% of youth had persistent pain at 4-month follow-up, with persistent pain predicted by poorer conditioned pain modulation and female sex. Higher depressive symptoms at T1 were associated with higher painrelated disability and poorer QOL at T2. Findings highlight the roles of depressive symptoms and pain modulation in longitudinally predicting pain persistence in treatment-seeking youth with acute MSK pain and suggest potential mechanisms in the transition from acute to chronic MSK pain in children and adolescents.

Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: a prospective study

Strategies directed at the prevention of disabling pain have been suggested as a public health priority, making early identification of youth at risk for poor outcomes critical. At present, limited information is available to predict which youth presenting with acute pain are at risk for persistence. The aims of this prospective longitudinal study were to identify biopsychosocial factors in the acute period that predict the transition to persistent pain in youth with new-onset musculoskeletal (MSK) pain complaints. Participants were 88 children and adolescents (age 10-17 years) presenting to the emergency department (n = 47) or orthopedic clinic (n = 41) for evaluation of a new MSK pain complaint (<1 month duration). Youth presented for 2 study visits (T1 ≤1 month post pain onset; T2 = 4-month follow-up) during which they completed questionnaires (assessing pain characteristics, psychological factors, sleep quality) and participated in a laboratory task assessing conditioned pain modulation. Regression analyses tested T1 predictors of longitudinal pain outcomes (pain persistence, pain-related disability, quality of life [QOL]). Results revealed approximately 35% of youth had persistent pain at 4-month follow-up, with persistent pain predicted by poorer conditioned pain modulation and female sex. Higher depressive symptoms at T1 were associated with higher pain-related disability and poorer QOL at T2. Findings highlight the roles of depressive symptoms and pain modulation in longitudinally predicting pain persistence in treatment-seeking youth with acute MSK pain and suggest potential mechanisms in the transition from acute to chronic MSK pain in children and adolescents.

Adaptations in Evoked Pain Sensitivity and Conditioned Pain Modulation after Development of Chronic Neck Pain

Numerous studies demonstrate elevated pain sensitivity and impaired conditioned pain modulation (CPM) in patients with chronic musculoskeletal pain compared to healthy individuals; however, the time course of changes in pain sensitivity and CPM after the development of a chronic pain condition is unclear. Secondary analysis of data from a prospective investigation examined changes in evoked pain sensitivity and CPM before and after development of chronic neck pain (CNP). 171 healthy office workers participated in a baseline assessment, followed by monthly online questionnaires to identify those who developed CNP over the subsequent year. These individuals (N = 17) and a cohort of participants (N = 10) who remained pain-free during the follow-up period returned for a 12-month follow-up assessment of mechanical and thermal pain sensitivity and CPM. Pain sensitivity measures did not differ between groups at baseline; however, cold pain threshold decreased in the CNP group at follow-up (p < 0.05). CPM was lower at baseline in the CNP group compared to those who reported no neck pain (p < 0.02) and remained unchanged one year later. These findings indicate that CPM is reduced in healthy individuals prior to the development of chronic neck pain and the subsequent reduction of thresholds for cold but not pressure pain.

Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors: A Study Using Data From the 2010 National Health Interview Survey

OBJECTIVES

The objectives of this study were to estimate prevalence of low back pain, to investigate associations between low back pain and a set of emerging workplace risk factors, and to identify worker groups with an increased vulnerability for low back pain in the United States.

METHODS

The data used for this cross-sectional study came from the 2010 National Health Interview Survey, which was designed to collect data on health conditions and related risk factors from the US civilian population. The variance estimation method was used to compute weighted data for prevalence of low back pain. Multivariable logistic regression analyses stratified by sex and age were performed to determine the odds ratios (ORs) and the 95% confidence interval (CI) for low back pain. The examined work-related psychosocial risk factors included work-family imbalance, exposure to a hostile work environment, and job insecurity. Work hours, occupation, and other work organizational factors (nonstandard work arrangements and alternative shifts) were also examined.

RESULTS

The prevalence of self-reported low back pain in the previous 3 months among workers in the United States was 25.7% in 2010. Female or older workers were at increased risk of experiencing low back pain. We found significant associations between low back pain and a set of psychosocial factors, including work-family imbalance (OR 1.27, CI 1.15-1.41), exposure to hostile work (OR 1.39, CI 1.25-1.55), and job insecurity (OR 1.44, CI 1.24-1.67), while controlling for demographic characteristics and other health-related factors. Older workers who had nonstandard work arrangements were more likely to report low back pain. Women who worked 41 to 45 hours per week and younger workers who worked >60 hours per week had an increased risk for low back pain. Workers from several occupation groups, including male health care practitioners, female and younger health care support workers, and female farming, fishing, and forestry workers, had an increased risk of low back pain.

CONCLUSIONS

This study linked low back pain to work-family imbalance, exposure to a hostile work environment, job insecurity, long work hours, and certain occupation groups. These factors should be considered by employers, policymakers, and health care practitioners who are concerned about the impact of low back pain in workers.

Workplace psychosocial and organizational factors for neck pain in workers in the United States

BACKGROUND

Neck pain is a prevalent musculoskeletal condition among workers in the United States. This study explores a set of workplace psychosocial and organization-related factors for neck pain.

METHODS

Data used for this study come from the 2010 National Health Interview Survey which provides a representative sample of the US population. To account for the complex sampling design, the Taylor linearized variance estimation method was used. Logistic regression models were constructed to measure the associations.

RESULTS

This study demonstrated significant associations between neck pain and a set of workplace risk factors, including work-family imbalance, exposure to a hostile work environment and job insecurity, non-standard work arrangements, multiple jobs, and long work hours.

CONCLUSION

Workers with neck pain may benefit from intervention programs that address issues related to these workplace risk factors. Future studies exploring both psychosocial risk factors and physical risk factors with a longitudinal design will be important. Am. J. Ind. Med. 59:549-560, 2016. © 2016 Wiley Periodicals, Inc.