Exploring the definition of «acute» neck pain: a prospective cohort observational study comparing the outcomes of chiropractic patients with 0–2 weeks, 2–4 weeks and 4–12 weeks of symptoms

Nyirö, Luana; Peterson, Cynthia; Humphreys, B. Kim

doi:10.1186/s12998-017-0154-y

Cited by 11 publications

(9 citation statements)

References 67 publications

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“…The Episodic pattern used in our study allowed for patients to have only one episode during the follow-up, with pain lasting anything between 3 and 35 weeks. This is in contrast to results from other studies on the course of NP and LBP, where a new episode usually is much shorter and commonly lasts from 2 to 18 weeks [6,10,34]. In addition, the definitions used in our study distributed patients with mean pain intensity < 2 into a separate subgroup in each of the four patterns.…”

Section: Robustness Of the Definitionscontrasting

confidence: 90%

“…Our results show that, with the use of the LBP definitions, few NP patients qualified for distribution into the Single episode pattern. The usual curve of improvement from onset of an episode until a more stable pain situation is established, typically lasts 1-2 weeks [34]. For the Single episode pattern definition in our study, the pain could only last 1-2 consecutive weeks followed by completely pain-free weeks.…”

Section: Robustness Of the Definitionsmentioning

confidence: 94%

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Neck pain patterns and subgrouping based on weekly SMS-derived trajectories

Irgens

Kongsted

Myhrvold

et al. 2020

BMC Musculoskelet Disord

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Background Neck and low back pain represent dynamic conditions that change over time, often with an initial improvement after the onset of a new episode, followed by flare-ups or variations in intensity. Pain trajectories were previously defined based on longitudinal studies of temporal patterns and pain intensity of individuals with low back pain. In this study, we aimed to 1) investigate if the defined patterns and subgroups for low back pain were applicable to neck pain patients in chiropractic practice, 2) explore the robustness of the defined patterns, and 3) investigate if patients within the various patterns differ concerning characteristics and clinical findings. Methods Prospective cohort study including 1208 neck pain patients from chiropractic practice. Patients responded to weekly SMS-questions about pain intensity and frequency over 43 weeks. We categorized individual responses into four main patterns based on number of days with pain and variations in pain intensity, and subdivided each into four subgroups based on pain intensity, resulting in 16 trajectory subgroups. We compared baseline characteristics and clinical findings between patterns and between Persistent fluctuating and Episodic subgroups. Results 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. Conclusions 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.

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Section: Robustness Of the Definitionscontrasting

confidence: 90%

Section: Robustness Of the Definitionsmentioning

confidence: 94%

Neck pain patterns and subgrouping based on weekly SMS-derived trajectories

Irgens

Kongsted

Myhrvold

et al. 2020

BMC Musculoskelet Disord

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“…Data were collected between October 2009 and March 2015 in a standardized fashion, that remained unchanged over the duration of the study. Data of this cohort study have been published previously (Humphreys & Peterson, 2013;Langenfeld et al, 2015;Nyirö et al, 2017;Peterson et al, 2012;Thöni et al, 2017;Wirth et al, 2016).…”

Section: Methodsmentioning

confidence: 99%

Limited prognostic value of pain duration in non‐specific neck pain patients seeking chiropractic care

Guillén

Guekos

Graf

et al. 2022

European Journal of Pain

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Background: Pain chronicity is considered an important prognostic factor for outcome. Here, it was investigated whether pain duration influences outcome when only chronic patients (pain >3 months) are considered. Secondary aims were to determine, in patients of any pain duration, how much variance in outcome is explained by pain duration and whether pain duration truly predicts outcomes, that is out-of-sample prediction in independent data. Methods: Secondary analysis of a cohort study of neck pain patients. Patients were assessed before start of treatment and at 1-week, 1-, 3-, 6-and 12-month follow-up. Outcomes were patient global impression of change (PGIC) and percent change in patients' perceived pain intensity, rated on a numerical rating scale (NRS). Regression analyses (linear and logistic) and supervised machine learning were used to test the influence of pain duration on PGIC and percent NRS change at 1-week, 1-, 3-, 6-and 12-month follow-up within sample and out-of-sample.Separate analyses were performed for the full sample (n = 720) and for chronic patients (n = 238) only. Results:No relationship between pain duration and outcome was found for chronic patients only. For the full sample, statistical relationships between pain duration and outcomes were observed at all tested follow-up time points. However, the amount of variance in outcome explained by pain duration was low and no out-of-sample prediction was possible.Conclusions: Pain duration did not emerge as an important predictor of outcome in this database of 720 neck pain patients receiving chiropractic treatment. Significance statement:The relatively large dataset of neck pain patients challenges the widely accepted wisdom that pain duration is an important predictor of pain outcomes and that very chronic patients might only have a small likelihood of getting better. It is postulated that these results are important for the attitude of the first encounter between healthcare professionals and chronic patients.

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“…The obtained clusters were subsequently tested for association with baseline factors using univariable logistic regression analysis with cluster membership as the dependent variable. The independent variables were age, gender, pain duration (acute/subacute versus chronic; acute and subacute patients were summarized into one category because medium (1 month) and long-term (≥ 3 months) outcome was shown to be comparable for these groups in NP [21]), previous episodes (no previous episode versus ≥1 previous episodes), other painful areas (no concurrent versus concurrent LBP or NP or headache), whether the treating chiropractor diagnosed rib involvement (costo-vertebral syndrome yes/no), traumatic onset (yes/no), and smoking status (yes/no). To test the effects of these baseline factors on the patients' perception of outcome (PGIC) after twelve months, univariable binary logistic regression models with the dependent variable PGIC (dichotomized; 'improved' = better or much better, rest = 'not improved') were run.…”

Section: Data Analysis and Statisticsmentioning

confidence: 99%

A prospective observational study on trajectories and prognostic factors of mid back pain

Knecht¹,

Hartnack

Sick

et al. 2020

BMC Musculoskelet Disord

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Background: Although mid back pain (MBP) is a common condition that causes significant disability, it has received little attention in research and knowledge about trajectories and prognosis of MBP is limited. The purpose of this study was to identify trajectories of MBP and baseline risk factors for an unfavorable outcome in MBP patients undergoing chiropractic treatment. Methods: This prospective-observational study analyzes outcome data of 90 adult MBP patients (mean age = 37.0 ± 14.6 years; 49 females) during one year (at baseline, after 1 week, 1 month, 3, 6 and 12 months) after start of chiropractic treatment. Patients completed an 11-point (0 to 10) numeric pain rating scale (NRS) at baseline and one week, one month, three, six and twelve months after treatment start and the Patient's Global Impression of Change (PGIC) questionnaire at all time points except baseline. To determine trajectories, clustering with the package kml (software R), a variant of k-means clustering adapted for longitudinal data, was performed using the NRS-data. The identified NRS-clusters and PGIC data after three months were tested for association with baseline variables using univariable logistic regression analyses, conditional inference trees and random forest plots. Results: Two distinct NRS-clusters indicating a favourable (rapid improvement within one month from moderate pain to persistent minor pain or recovery after one year, 80% of patients) and an unfavourable trajectory (persistent moderate to severe pain, 20% of patients) were identified. Chronic (> 3 months) pain duration at baseline significantly predicted that a patient was less likely to follow a favourable trajectory [OR = 0.16, 95% CI = 0.05-0.50, p = 0.002] and to report subjective improvement after twelve months [OR = 0.19, 95% CI = 0.07-0.51, p = 0.001], which was confirmed by the conditional inference tree and the random forest analyses. Conclusions: This prospective exploratory study identified two distinct MBP trajectories, representing a favourable and an unfavourable outcome over the course of one year after chiropractic treatment. Pain chronicity was the factor that influenced outcome measures using NRS or PGIC.

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Exploring the definition of «acute» neck pain: a prospective cohort observational study comparing the outcomes of chiropractic patients with 0–2 weeks, 2–4 weeks and 4–12 weeks of symptoms

Cited by 11 publications

References 67 publications

Neck pain patterns and subgrouping based on weekly SMS-derived trajectories

Neck pain patterns and subgrouping based on weekly SMS-derived trajectories

Limited prognostic value of pain duration in non‐specific neck pain patients seeking chiropractic care

A prospective observational study on trajectories and prognostic factors of mid back pain

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