Patients with chronic neck-pain after trauma do not differ in type of symptoms and signs, but suffer more than patients with chronic neck pain without a traumatic onset
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Harald Breivik
In this issue of the Scandinavian Journal of Pain Inge Ris and co-workers publish an interesting study comparing chronic neck pain patients whose pain condition started after a traumatic event (n = 120)– with chronic neck pain patients without an obvious traumatic event (n = 80), their hypothesis being that these two groups of patients could have differing symptoms and signs so that the traumatic neck pain patients more easily could be recognized as such [1].
Patients with at least 6 months pain and at least a moderate disability (Neck Disability Index) had a thorough physical examination and they reported on several self-evaluation questionnaires covering physical and psychological symptoms. The traumatic onset neck pain patients had duration of pain of 88 months, compared with 138 months in the non-trauma-group, still the patients with a traumatic onset of neck pain had worse signs and symptoms than the non-trauma group of neck pain patients: Neck muscles performed worse, they reported poorer quality of life, more depressive symptoms, and had a worse score on the Neck Disability Index. Pressure pain thresholds were lower in the neck area.
In spite of these statistically highly significant group differences, they concluded that they could not find any specific symptoms or signs in individual trauma-onset neck pain patients that were clinically different from the no-trauma-onset neck pain patients. The group differences were in degrees of symptoms, the traumatic onset neck pain patients clearly suffering more and having more severe disabilities from their neck pain.
Clearly, 120 patients with chronic neck pain after trauma, in the literature and in clinical jargon also called patients with WAD – Whiplash Associated Disorders [2], or patients with NAD – Neck and Associated Disorders [1,3], did not differ in type, but in degrees, of symptoms and impairments from 80 patients with chronic neck pain without traumatic onset.
Thus, their main conclusion with important implications for patients with neck pain and those trying to treat and help them is that you cannot from the symptoms-presentation and the degree of physical impairments and psychological sequelae determine that the neck pain is caused by trauma or not.
DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.08.008.
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Conflict of interest: None declared.
References
[1] Ris I, Juul-Kristensen B, Boyle E, Kongsted A, Manniche C, Søgaard K. Chronic neck pain patients with traumatic or non-traumatic onset: differences in characteristics. A cross-sectional study. Scand J pain 2017;14:1–8.Suche in Google Scholar
[2] Westergren H, Freeman MD, Malmström E-M. The whiplash enigma: still searching for answers. Scand J Pain 2014;5:226–8.Suche in Google Scholar
[3] Côté PSH, Ameis A, Carroll L, Mior M, Nordin M, the OPTIMa Collaboration. Enabling recovery from common traffic injuries: a focus on the injured person. Ontario: Rehabilitation, U-CCftSoDPa; 2015.Suche in Google Scholar
© 2016 Scandinavian Association for the Study of Pain
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Artikel in diesem Heft
- Scandinavian Journal of Pain
- Editorial comment
- Patients with chronic neck-pain after trauma do not differ in type of symptoms and signs, but suffer more than patients with chronic neck pain without a traumatic onset
- Observational study
- Chronic neck pain patients with traumatic or non-traumatic onset: Differences in characteristics. A cross-sectional study
- Editorial Comment
- Re-enforcing therapeutic effect by positive expectations of pain-relief from our interventions
- Original experimental
- Effect of expectation on pain assessment of lower- and higher-intensity stimuli
- Editorial comment
- Objective methods for the assessment of the spinal and supraspinal effects of opioids
- Topical review
- Objective methods for the assessment of the spinal and supraspinal effects of opioids
- Editorial Comment
- Multi-target treatment of bone cancer pain using synergistic combinations of pharmacological compounds in experimental animals
- Original experimental
- Synergistic combinations of the dual enkephalinase inhibitor PL265 given orally with various analgesic compounds acting on different targets, in a murine model of cancer-induced bone pain
- Editorial comment
- Terminal cancer pain intractable by conventional pain management can be effectively relieved by intrathecal administration of a local anaesthetic plus an opioid and an alfa2-agonist into the cerebro-spinal-fluid
- Observational study
- Multimodal intrathecal analgesia in refractory cancer pain
- Editorial comment
- Treatment success in neck pain: The added predictive value of psychosocial variables in addition to clinical variables
- Observational study
- Treatment success in neck pain: The added predictive value of psychosocial variables in addition to clinical variables
- Editorial comment
- Why are some patients with chronic pain from anterior abdominal nerve entrapment syndrome (ACNES) refractory to peripheral treatment with neurectomy?
- Clinical pain research
- Treatment response and central pain processing in Anterior Cutaneous Nerve Entrapment Syndrome: An explorative study
- Editorial comment
- Gain in functions before pain reduction during intensive multidisciplinary paediatric pain rehabilitation programme
- Clinical pain research
- Physical and occupational therapy outcomes: Adolescents’ change in functional abilities using objective measures and self-report
- Editorial comment
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- Clinical pain research
- The risk of pain syndrome affecting a previously non-painful limb following trauma or surgery in patients with a history of complex regional pain syndrome
- Editorial Comment
- Positive affect could reduce the impact of pain
- Original experimental
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- Editorial comment
- The meaning and consequences of amputation and mastectomy from the perspective of pain and suffering – Lessons to be learned and relearned
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- Editorial comment
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- Educational case report
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- Observational study
- Item response theory analysis of the Pain Self-Efficacy Questionnaire
- Announcement
- Scandinavian Association for the Study of Pain (SASP): Annual Meeting 2017
