Pain severity and catastrophising modify treatment success in neck pain patients in primary care

doi:10.1016/j.math.2010.01.005

Manual Therapy

Volume 15, Issue 3, June 2010, Pages 267-272

https://doi.org/10.1016/j.math.2010.01.005 Get rights and content

Abstract

The objective of this study was to evaluate whether clinical factors at baseline in patients with non-specific neck pain are related to recovery after treatment with manual therapy versus physiotherapy. Participating physiotherapists recruited new consulters with complaints of the neck and/or upper extremity. For this study we selected patients from this cohort with non-specific neck complaints. Participants filled in questionnaires at baseline, 3 and 6 months. The main outcome measure was recovery at 6 months follow-up. Possible predictors like complaint-specific factors, physical factors, social and psychological factors were evaluated for interaction with treatment. Of the 396 participants in this study, 97 (24.5%) received manual therapy, all others received physiotherapy, consisting of exercises, massage or physical applications. In the multivariable model four variables were significantly related to recovery: duration of complaint, catastrophising, distress and somatisation. Severity of main complaint and catastrophising appeared to show interaction with treatment. It appeared that every point increase in severity or catastrophising resulted in a lower chance to recover from physiotherapy compared to manual therapy.

In conclusion, severity of main complaint and catastrophising seem to modify treatment success. Increased pain severity or catastrophising at baseline increased the chance of treatment success after manual therapy compared to physiotherapy.

Section snippets

What is already known

•
In primary care most neck pain patients are treated with a “wait and see” policy or referral for physiotherapy or manual therapy.
•
Physiotherapy or manual therapy are effective treatment strategies, but the effect sizes are rather small.
•
Increasing attention is being paid to factors that predict recovery with a specific treatment.

What this study adds

•
Treatment effect can be modified by targeting treatments to specific patients.
•
In patients with non-specific neck pain severity of main complaint and the catastrophising

Design

We used the data from a prospective cohort study carried out in physiotherapy practices in four provinces in the western part of the Netherlands (Karels et al., 2007). The population consisted of consecutive patients with arm, neck and/or shoulder complaints presenting in the participating physiotherapy practices (Karels et al., 2007).

Patient population

Included in the cohort study were new consulters between 18 and 65 years with pain and discomfort in neck and upper extremities (neck, upper back, shoulder, upper

Patient population

Between August 2001 and July 2002, 624 patients were recruited for the original cohort. In total 397 patients with non-specific neck pain were eligible for the present study (Karels et al., 2007). Patient characteristics and initial baseline variables from the total cohort and the eligible patients for this study are presented in Table 1.

No important differences were found between the original cohort and our study sample on all baseline characteristics. The mean age of the population was 42

Discussion

Severity of the complaint and catastrophising were the only variables that showed interaction with treatment, which means that all other variables are more generic. With a severity score of less than 2, which is the case in 3% of the participants, physiotherapy is significantly more beneficial than manual therapy in our study.

Our findings are slightly different from the clinical decision rule of Schellingerhout et al. (2008a), but differ greatly from the one developed by Cleland et al. (2005).

Acknowledgements

Contributions: APV, SMAB-Z designed the study; SW performed the analysis; CK was responsible for data collection; APV was responsible for writing the manuscript; SMAB-Z, APV, CK, JMS and BWK critically read and approved the manuscript; APV and SMAB-Z guaranteed the study.

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Chronic primary low back pain (CPLBP) refers to low back pain that persists over 3 months, that cannot be explained by another chronic condition, and that is associated with emotional distress and disability. Previous studies have shown that spinal manipulative therapy (SMT) is effective in relieving CPLBP, but the underlying mechanisms remain elusive. This randomized placebo-controlled dual-blind mixed experimental trial (NCT05162924) aimed to investigate the efficacy of SMT to improve CPLBP and its underlying mechanisms. Ninety-eight individuals with CPLBP and 49 controls were recruited. Individuals with CPLBP received SMT (n = 49) or a control intervention (n = 49), 12 times over 4 weeks. The primary outcomes were CPLBP intensity (0–100 on a numerical rating scale) and disability (Oswestry Disability Index). Secondary outcomes included pressure pain thresholds in 4 body regions, pain catastrophizing, Central Sensitization Inventory, depressive symptoms, and anxiety scores. Individuals with CPLBP showed widespread mechanical hyperalgesia (P < .001) and higher scores for all questionnaires (P < .001). SMT reduced pain intensity compared with the control intervention (mean difference: −11.7 [95% confidence interval, −11.0 to −12.5], P = .01), but not disability (P = .5). Similar mild to moderate adverse events were reported in both groups. Mechanical hyperalgesia at the manipulated segment was reduced after SMT compared with the control intervention (P < .05). Pain catastrophizing was reduced after SMT compared with the control intervention (P < .05), but this effect was not significant after accounting for changes in clinical pain. Although the reduction of segmental mechanical hyperalgesia likely contributes to the clinical benefits of SMT, the role of pain catastrophizing remains to be clarified.
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Citation Excerpt :
Hill et al., (2007) reported that catastrophizing and anxiety were independent predictors of longer term (6 months) treatment outcomes in patients with neck pain treated by physical therapy. Furthermore, Verhagen et al., (2010) recently found that increased catastrophizing at baseline increased the chance of recovery after treatment with manual therapy compared to exercise therapy in neck pain patients. In contrast, George et al., (2006), based on correlational analyses, did not find any association between level of fear of pain and anxiety and the immediate effects of spinal manipulation in healthy, asymptomatic subjects.
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Myofascial trigger point dry needling is frequently associated with postneedling soreness, which can generate patient dissatisfaction and reduced treatment adherence. Psychological factors may influence the perception of postneedling soreness and the effectiveness of postneedling soreness treatments.
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University community.
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Pain during needling and postneedling soreness were quantified using a visual analogue scale during needling, after treatment, and at 6, 12, 24, and 48 hours.
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Demographic, psychological, and functional self-reported parameters, derived from questionnaires and medical reports, were considered potential predictive parameters. These types of self-reported parameters have been reported to be strong predictors of treatment outcomes compared with clinical/physical signs and medication use.25-27 The demographic characteristics recorded included sex, age, body mass index (BMI), body fat percentage, and symptom duration.18
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Potential prognostic indicators were derived from the data of the medical examination, and questionnaires. Since evidence suggests that self-reported constructs are stronger predictors then clinical signs, no physical signs were included in this cohort study (Verhagen et al., 2010; Walton et al., 2013). Data retained from the medical examination were: age, sex, body mass index (BMI), comorbid pain (headache, lumbar pain, fibromyalgia, and thoracic pain), working status, level of physical activity, duration of symptoms, previous and present treatment and/or medication intake for neck pain, and self-reported information on whether or not the pain condition was related to an accident.
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Original articlePain severity and catastrophising modify treatment success in neck pain patients in primary care

Abstract

Section snippets

What is already known

What this study adds

Design

Patient population

Patient population

Discussion

Acknowledgements

Pain

Man Ther

Pain

J Clin Epidemiol

Pain

J Clin Epidemiol

J Clin Epidemiol

Pain

Man Ther

Pain

A clinical prediction rule to identify patients likely to benefit from spinal manipulation: a validation study

Ann Intern Med

Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and patient education

Phys Ther

Original article
Pain severity and catastrophising modify treatment success in neck pain patients in primary care