Predictors of pain persistence and disability in high-school students with chronic neck pain at 6-month follow-up

Central sensitization-related symptoms and their relationship to disability in prevalent chronic musculoskeletal pain: A cross-sectional study

BACKGROUND

Central sensitization (CS) has an important role in chronic musculoskeletal (MSK) pain, which is one of the leading causes of disability worldwide.

OBJECTIVES

To investigate the relationship between CS-related symptoms and disability in chronic MSK pain.

DESIGN

Multi-center cross-sectional survey.

METHODS

Demographic and clinical variables including location, duration, and severity of pain were recorded. In the examination of disability, Istanbul Low Back Pain Disability Index for low back pain, Neck Pain and Disability Scale for neck pain, Quick Disability of the Arm, Shoulder, and Hand for shoulder/upper extremity pain, and Knee Injury and Osteoarthritis Outcome Score for knee pain were used. CS-related symptoms were investigated via the central sensitization inventory (CSI). Based on CSI scores, patient data were compared using the T test and an ANOVA. The association between CSI and selected variables was investigated using Pearson correlation and multivariate regression analysis.

RESULTS

The mean CSI score of five hundred participants was 40.46 (SD: 15.87). Patients with CSI≥40 were found to have higher levels of pain and disability and a poorer quality of life (p < 0.05). In ANOVA, significant differences between groups were observed in CS severity levels for VAS, symptom duration, and all clinical scores (p < 0.01). In the multivariate regression analysis, CSI and VAS scores were found to be related to disability in all pain groups, while pain duration was effective only in the change of knee disability.

CONCLUSION

CS-related symptoms, which are related to increased pain and disability, should be closely monitored in patients with chronic MSK pain.

Systemic Inflammation, Sleep, and Psychological Factors Determine Recovery Trajectories for People With Neck Pain: An Exploratory Study

We conducted an explorative prospective cohort study with 6 months follow-up to 1) identify different pain and disability trajectories following an episode of acute neck pain, and 2) assess whether neuroimmune/endocrine, psychological, behavioral, nociceptive processing, clinical outcome, demographic and management-related factors differ between these trajectories. Fifty people with acute neck pain (ie, within 2 weeks of onset) were included. At baseline, and at 2, 4, 6, 12, and 26 weeks follow-up, various neuroimmune/endocrine (eg, inflammatory cytokines and endocrine factors), psychological (eg, stress symptoms), behavioral (eg, sleep disturbances), nociceptive processing (eg, condition pain modulation), clinical outcome (eg, trauma), demographic factors (eg, age), and management-related factors (eg, treatment received) were assessed. Latent class models were performed to identify outcome trajectories for neck pain and disability. Linear mixed models or the Pearson chi-square test were used to evaluate differences in these factors between the trajectories at baseline and at each follow-up assessment and over the entire 6 months period. For pain, 3 trajectories were identified. The majority of patients were assigned to the "Moderate pain - Favourable recovery" trajectory (n = 25; 50%) with smaller proportions assigned to the "Severe pain - Favourable recovery" (n = 16; 32%) and the "Severe pain - Unfavourable recovery" (n = 9; 18%) trajectories. For disability, 2 trajectories were identified: "Mild disability - Favourable recovery" (n = 43; 82%) and "Severe disability - Unfavourable recovery" (n = 7; 18%). Ongoing systemic inflammation (increased high-sensitive C-reactive protein), sleep disturbances, and elevated psychological factors (such as depression, stress and anxiety symptoms) were mainly present in the unfavorable outcome trajectories compared to the favorable outcome trajectories. PERSPECTIVE: Using exploratory analyses, different recovery trajectories for acute neck pain were identified based on disability and pain intensity. These trajectories were influenced by systemic inflammation, sleep disturbances, and psychological factors.

Mechanism-Based Pharmacological Treatment for Chronic Non-cancer Pain in Adolescents: Current Approaches and Future Directions

Chronic non-cancer pain in pediatrics is a widespread phenomenon that affects about 20% of adolescents (10-19 years old). Although interdisciplinary pain treatment programs, which often include pharmacological treatment, have emerged as the standard of care in management of this patient population, evidence regarding an optimal treatment is lacking. The efficacy and safety profiles of pharmacological treatments used to help adolescents suffering from chronic non-cancer pain remain understudied. This lack of evidence may increase polypharmacy and the risk of drug interactions and adverse events. This review examines evidence for the use of pharmacological treatments prescribed to treat chronic pain in adolescents (10-19 years old), with a focus on mechanism-based pharmacology. The objectives of this review are to: (a) review the evidence for mechanism-based pharmacological treatments for chronic non-cancer pain in adolescents and (b) describe the pharmacological agents that are commonly prescribed to manage chronic pain in adolescents, including dosage information, mechanism, and potential adverse effects. Pharmacological treatments should be used carefully with adolescents, ideally within an interdisciplinary treatment program that will incorporate physical rehabilitation, integrative medicine/active mind-body techniques, psychology, and global efforts to normalize daily activities.

Constitutional psychic human qualities influence on the emotional and psychic state at the patients with neurological spine disorders

Objective - to study the emotional and psychic state at the patients with neurological cervical spine disorders (NCSD) and determine of the constitutional psychic human qualities influence at the it. Methods and subjects. 87 patients (18-44 years old), who suffered from subacute and chronic NCSD, were examined by clinical-anamnestic, clinical-functional (vertebral neurological), clinical-neurological methods. Emotional and psychic state was examined by Spielberger-Hanin test and Hamilton Depression Rating Scale. Psychic functions of human constitution were studied by temperament type determining with using Eysenck’s EPQ questionnaire. Results and discussion. The course of subacute and chronic cervicalgia, cervicocranialgia, cervicobrachialgia (neck and shoulder pain) was characterized depression symptoms at the melancholic temperament type (at 76% patients, р< 0,05). At the choleric temperament type depression symptoms was present meeted very often too (at 68% patients). At the sanguine temperament type depression symptoms was very rarely (at 29% patients). The peculiarities from reactive and personality anxiety were found too. It were at the melancholic and choleric patient highter significantly, than at the sanguine patients (p <0,05, p <0,01, p < 0,001). Temperament influence on the depression symptoms and anxiety confirmed by reliable correlations. Conclusions. The emotional and psychic state at the patients with NCSD characterize as anxiety on the background of neurological symptoms of cervicalgia, cervicocranialgia, cervicobrachialgia (neck and shoulder pain). It this symptoms add with decreased performance, mood and sleep disturbances and all these complaints in the aggregate are summed up as depressive disorders, mainly of mild severity. Constitutional psychic human qualities, which included in temperament, influence on the it formation. The models of influence different temperament types on the emotional and psychic states at the patients with NCSD were represented. It points pathogenic significance of melancholic and choleric temperament types and sanogenetic qualities of sanguine type. Constitutional psychic human qualities and emotional and psychic state should be considere at the diagnostic and treatment patients with NCSD. Significance of the human constitution, emotional and psychic state for NCSD confirm by study results. It is background for following studies.