Trajectories of Neck Pain

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:     Frankp@chiro.org

	The Clinical Course of Neck Pain: Are Trajectory Patterns Stable Over a 1-year Period? European Journal of Pain 2021 (Oct 26) [EPUB] We found an overall stability of the Persistent pattern, and that Episodic patterns have more potential for shifts. Shifts mostly occurred between patterns closest in pain variation. The deviation in pattern distribution compared with previous studies suggests that the duration of measurement periods has an impact on the results of the classification.
	Neck Pain Patterns and Subgrouping Based on Weekly SMS-derived Trajectories BMC Musculoskelet Disord 2020 (Oct 14); 21 (1): 678 ~ FULL TEXT All but two patients could be classified into one of the 16 subgroups, with 94% in the Persistent fluctuating or Episodic patterns. In the largest subgroup, "Mild Persistent fluctuating" (25%), mean (SD) pain intensity was 3.4 (0.6) and mean days with pain 130. Patients grouped as "Moderate Episodic" (24%) reported a mean pain intensity of 2.7 (0.6) and 39 days with pain. Eight of the 16 subgroups each contained less than 1% of the cohort. Patients in the Persistent fluctuating pattern scored higher than the other patterns in terms of reduced function and psychosocial factors.   The same subgroups seem to fit neck and low back pain patients, with pain that typically persists and varies in intensity or is episodic. Patients in a Persistent fluctuating pattern are more bothered by their pain than those in other patterns. The low back pain definitions can be used on patients with neck pain, but with the majority of patients classified into 8 subgroups, there seems to be a redundancy in the original model.
	Broad External Validation and Update of a Prediction Model for Persistent Neck Pain After 12 Weeks Spine (Phila Pa 1976). 2019 (Nov 15); 44 (22): E1298–E1310 ~ FULL TEXT This study is one of few to independently externally validate a prediction model for neck pain. [11] We did not find that the original model was predictive in this sample of patients managed by chiropractors. The between population-heterogeneity might be a limitation when transferring prediction models to different settings. An attempt to update the model resulted in a new prediction model that was able to predict patients with a favorable outcome. It is, however still pre-mature to be used in clinical decision guidance and would need further evaluation and perhaps updating before implementation is considered.

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