Abstract
Background
Neck pain tends to persist for periods of 1 to 4 years of follow-up in adolescents, and a high percentage of them report disability. However, studies assessing the factors associated with persistent neck pain and disability in this age group are scarce. This study aimed to explore the association between psychosocial factors, sleep, and symptoms of central sensitization at baseline and the persistence of neck pain and disability at 6-month follow-up.
Methods
A total of 710 adolescents with chronic neck pain were assessed at baseline with an online questionnaire that collected information on sociodemographic data, presence of musculoskeletal pain, pain intensity, physical activity, functional disability, depression, anxiety, stress, quality of sleep, catastrophizing, kinesiophobia, self-efficacy, and symptoms of central sensitization. At 6-month follow-up, adolescents were reassessed for disability and pain intensity and categorized as recovered or reporting persistent neck pain.
Results
Of the 710 participants with neck pain at baseline, 334 were classified as having persistent neck pain and 375 adolescents as being recovered at 6-month follow-up. Multivariable analysis showed that female gender (OR 1.47; p = 0.04) and symptoms of central sensitization (OR 1.02; p = 0.001) at baseline were positively associated with the persistence of neck pain at 6-month follow-up. Similarly, higher levels of disability (β = 0.41; p < 0.001) and symptoms of central sensitization (β = 0.28; p < 0.001) at the baseline were positively associated with disability.
Conclusions
Symptoms of central sensitization and disability at baseline should be considered in the assessment and design of interventions for adolescents with chronic neck pain as an attempt to minimize its future impact on pain persistence and disability.
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References
King, S., Chambers, C. T., Huguet, A., MacNevin, R. C., McGrath, P. J., Parker, L., & MacDonald, A. J. (2011). The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain, 152(12), 2729–2738.
Hoftun, G. B., Romundstad, P. R., Zwart, J.-A., & Rygg, M. (2011). Chronic idiopathic pain in adolescence—high prevalence and disability: The young HUNT study 2008. Pain, 152(10), 2259–2266.
Mikkelsson, M., Salminen, J. J., Sourander, A., & Kautiainen, H. (1998). Contributing factors to the persistence of musculoskeletal pain in preadolescents: A prospective 1-year follow-up study. Pain, 77(1), 67–72.
Paananen, M. V., Taimela, S. P., Auvinen, J. P., Tammelin, T. H., Kantomaa, M. T., Ebeling, H. E., Taanila, A. M., Zitting, P. J., & Karppinen, J. I. (2010). Risk factors for persistence of multiple musculoskeletal pains in adolescence: A 2-year follow-up study. European Journal of Pain, 14(10), 1026–1032.
Mikkelsson, M., Salminen, J. J., & Kautiainen, H. (1997). Non-specific musculoskeletal pain in preadolescents. Prevalence and 1-year persistence. Pain, 73(1), 29–35.
Ståhl, M., Kautiainen, H., El-Metwally, A., Häkkinen, A., Ylinen, J., Salminen, J. J., & Mikkelsson, M. (2008). Non-specific neck pain in schoolchildren: Prognosis and risk factors for occurrence and persistence. A 4-year follow-up study. Pain, 137(2), 316–22.
Auvinen, J. P., Tammelin, T. H., Taimela, S. P., Zitting, P. J., Järvelin, M. R., Taanila, A. M., & Karppinen, J. I. (2010). Is insufficient quantity and quality of sleep a risk factor for neck, shoulder and low back pain? A longitudinal study among adolescents. European Spine Journal, 19(4), 641–649.
Huguet, A., Tougas, M. E., Hayden, J., McGrath, P. J., Stinson, J. N., & Chambers, C. T. (2016). Systematic review with meta-analysis of childhood and adolescent risk and prognostic factors for musculoskeletal pain. Pain, 157, 2640–2656.
Pourbordbari, N., Riis, A., Jensen, M. B., Olesen, J. L., & Rathleff, M. S. (2019). Poor prognosis of child and adolescent musculoskeletal pain: A systematic literature review. BMJ, 9, 1–10.
Edwards, R. R., Dworkin, R. H., Sullivan, M. D., Turk, D. C., & Wasan, A. D. (2016). The role of psychosocial processes in the development and maintenance of chronic pain. The Journal of Pain, 17(9 Suppl), T70-92.
Asmundson, G. J., Noel, M., Petter, M., & Parkerson, H. A. (2012). Pediatric fear-avoidance model of chronic pain: Foundation, application and future directions. Pain Research and Management, 17, 1–9.
Nijs, J., Van Houdenhove, B., & Oostendorp, R. A. B. (2010). Recognition of central sensitization in patients with musculoskeletal pain: Application of pain neurophysiology in manual therapy practice. Manual Therapy, 15(2), 135–141.
van Wilgen, C. P., Vuijk, P. J., Kregel, J., Voogt, L., Meeus, M., Descheemaeker, F., Keizer, D., & Nijs, J. (2018). Psychological distress and widespread pain contribute to the variance of the central sensitization inventory: A cross-sectional study in patients with chronic pain. Pain Practice, 18(2), 239–246.
Oliveira, A. C., & Silva, A. G. (2016). Neck muscle endurance and head posture: A comparison between adolescents with and without neck pain. Manual Therapy, 22, 62–67.
Sá, S., & Silva, A. G. (2017). Repositioning error, pressure pain threshold, catastrophizing and anxiety in adolescents with chronic idiopathic neck pain. Musculoskeletal Science and Practice, 30, 18–24.
Pate, J. W., Hancock, M. J., Hush, J. M., Gray, K., Pounder, M., & Pacey, V. (2020). Prognostic factors for pain and functional disability in children and adolescents with persisting pain: A systematic review and meta-analysis. European Journal of Pain, 24(4), 722–741. https://doi.org/10.1002/ejp.1539
Misailidou, V., Malliou, P., Beneka, A., Karagiannidis, A., & Godolias, G. (2010). Assessment of patients with neck pain: A review of definitions, selection criteria, and measurement tools. Journal of Chiropractic Medicine, 9(2), 49–59.
Elgar, F. J., Roberts, C., Tudor-Smith, C., & Moore, L. (2005). Validity of self-reported height and weight and predictors of bias in adolescents. Journal of Adolescent Health, 37(5), 371–375.
Mesquita, C. C., Ribeiro, J. C., & Moreira, P. (2010). Portuguese version of the standardized Nordic musculoskeletal questionnaire: Cross cultural and reliability. Journal of Public Health (Bangkok), 18(5), 461–466. https://doi.org/10.1007/s10389-010-0331-0
Castarlenas, E., Jensen, M. P., von Baeyer, C. L., & Miró, J. (2017). Psychometric properties of the numerical rating scale to assess self-reported pain intensity in children and adolescents. Clinical Journal of Pain, 33(4), 376–383.
Ferro-Lebres, V., Silva, G., Moreira, P., & Ribeiro, J. C. (2018). Validation of the Portuguese version of the international physical activity questionnaire for adolescents (IPAQA). The Open Sports Sciences Journal, 10(1), 239–250.
De Cocker, K., Ottevaere, C., Sjöström, M., Moreno, L. A., Wärnberg, J., Valtueña, J., Manios, Y., Dietrich, S., Mauro, B., Artero, E. G., Molnár, D., Hagströmer, M., Ruiz, J. R., Sarri, K., Kafatos, A., Gottrand, F., De Henauw, S., Maes, L., De Bourdeaudhuij, I., & HELENA Study Group. (2011). Self-reported physical activity in European adolescents: Results from the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Public Health Nutrition, 14(2), 246–54.
Andias, R., & Silva, A. G. (2019). European Portuguese version of the functional disability inventory: Translation and cultural adaptation, validity and reliability in adolescents with chronic spinal pain. Disability and Rehabilitation, 43(12), 1742–1749.
Claar, R. L., & Walker, L. S. (2006). Functional assessment of pediatric pain patients: Psychometric properties of the functional disability inventory. Pain, 121(1), 77–84.
Leal, I. P., Antunes, R., Passos, T., Pais-Ribeiro, J., & Maroco, J. (2009). Estudo da escala de Depressão, Ansiedade e Stress para Crianças (EADS- C). Psicol Saúde Doenças, 10(2), 277–284.
Pais-Ribeiro, J. L., Honrado, A., & Leal, I. (2004). Contribuição para o estudo da adaptação portuguesa das escalas de Ansiedade, Depressão e Stress (EADS) de 21 items de Lovibond. Psicol Saúde Doenças, 5(2), 229–239.
Allen Gomes, A., Ruivo Marques, D., Meia-Via, A. M., Meia-Via, M., Tavares, J., Fernandes da Silva, C., & Pinto de Azevedo, M. H. (2015). Basic scale on insomnia complaints and quality of sleep (BaSIQS): Reliability, initial validity and normative scores in higher education students. Chronobiology International, 32(3), 428–40.
Jacome, C., & Cruz, E. (2004). Adaptação Cultural e contributo para a Validação da Pain Catastrophizing Scale (PCS). Unpublished, 1-11. Escola Superior de Saúde - Instituto Politécnico de Setúbal.
Fisher, E., Heathcote, L. C., Eccleston, C., Simons, L. E., & Palermo, T. M. (2018). Assessment of pain anxiety, pain catastrophizing, and fear of pain in children and adolescents with chronic pain: A systematic review and meta-analysis. Journal of Pediatric Psychology, 43(3), 314–325.
Cordeiro, N., Pezarat-Correia, P., Gil, J., & Cabri, J. (2013). Portuguese language version of the Tampa Scale for Kinesiophobia [13 Items]. Journal of Musculoskeletal Pain, 21(1), 58–63. https://doi.org/10.3109/10582452.2012.762966
Andias, R., & Silva, A. G. (2020). European Portuguese version of the Child Self-Efficacy Scale: A contribution to cultural adaptation, validity and reliability testing in adolescents with chronic musculoskeletal pain. Musculoskeletal Science and Practice. https://doi.org/10.1016/j.msksp.2020.102176
Bursch, B., Tsao, J. C. I., Meldrum, M., & Zeltzer, L. K. (2006). Preliminary validation of a self-efficacy scale for child functioning despite chronic pain (child and parent versions). Pain, 125(1–2), 35–42.
Andias, R., & Silva, A. G. (2020). Cross-cultural adaptation and psychometric properties of the European Portuguese version of the central sensitization inventory in adolescents with musculoskeletal chronic pain. Pain Practice, 20(5), 480–490.
Mayer, T. G., Neblett, R., Cohen, H., Howard, K. J., Choi, Y. H., Williams, M. J., Perez, Y., & Gatchel, R. J. (2012). The development and psychometric validation of the central sensitization inventory. Pain Practice, 12(4), 276–285. https://doi.org/10.1111/j.1533-2500.2011.00493.x
Holley, A. L., Wilson, A. C., & Palermo, T. M. (2017). Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: A prospective study. Pain, 158(5), 794–801.
Marôco, J. (2014) Análise estatística com o SPSS statistics (6a edição). ReportNumber
Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(Supplement), S2-15.
Smart, K. M., Blake, C., Staines, A., Thacker, M., & Doody, C. (2012). Mechanisms-based classifications of musculoskeletal pain: Part 1 of 3: Symptoms and signs of central sensitisation in patients with low back (±leg) pain. Manual Therapy, 17(4), 336–344.
Neblett, R. (2018). The central sensitization inventory: A user’s manual. Journal of Applied Biobehavioral Research, 23(2), e12123. https://doi.org/10.1111/jabr.12123
Nijs, J., Paul van Wilgen, C., Van Oosterwijck, J., van Ittersum, M., & Meeus, M. (2011). How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: Practice guidelines. Manual Therapy, 16(5), 413–8.
Nijs, J., Goubert, D., & Ickmans, K. (2016). Recognition and treatment of central sensitization in chronic pain patients: Not limited to specialized care. Journal of Orthopaedic and Sports Physical Therapy, 46, 1024–1028.
Chimenti, R. L., Frey-Law, L. A., & Sluka, K. A. (2018). A mechanism-based approach to physical therapist management of pain. Physical Therapy, 98(5), 302–314.
Graven-Nielsen, T., & Arendt-Nielsen, L. (2002). Peripheral and central sensitization in musculoskeletal pain disorders: An experimental approach. Current Rheumatology Reports, 4, 313–321.
Karels, C. H., Bierma-Zeinstra, S. M. A., Burdorf, A., Verhagen, A. P., Nauta, A. P., & Koes, B. W. (2007). Social and psychological factors influenced the course of arm, neck and shoulder complaints. Journal of Clinical Epidemiology, 60(8), 839–848.
Palermo, T. M., & Chambers, C. T. (2005). Parent and family factors in pediatric chronic pain and disability: An integrative approach. Pain, 119, 1–4.
Harrison, L., Wilson, S., & Munafò, M. R. (2014). Exploring the associations between sleep problems and chronic musculoskeletal pain in adolescents: A prospective cohort study. Pain Research & Management, 19(5), e139–e145.
Silva, A. G., Sa-Couto, P., Queirós, A., Neto, M., & Rocha, N. P. (2017). Pain, pain intensity and pain disability in high school students are differently associated with physical activity, screening hours and sleep. BMC Musculoskeletal Disorders, 18(1), 194.
Andreucci, A., Campbell, P., Mundy, L. K., Sawyer, S. M., Kosola, S., Patton, G. C., & Dunn, K. M. (2020). Sleep problems increase the risk of musculoskeletal pain in boys but not girls: A prospective cohort study. European Journal of Pediatrics, 179, 1711–1719.
Badawy, S. M., Law, E. F., & Palermo, T. M. (2019). The interrelationship between sleep and chronic pain in adolescents. Current Opinion in Physiology, 11, 25–8.
Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: An update and a path forward. The Journal of Pain, 14(12), 1539–1552.
Andreucci, A., Groenewald, C. B., Rathleff, M. S., & Palermo, T. M. (2021). The role of sleep in the transition from acute to chronic musculoskeletal pain in youth—a narrative review. Children, 8(3), 241.
Silva, A. G., Couto, P. S., Queiros, A., Neto, M., & Rocha, N. P. (2018). Musculoskeletal multisite pain and patterns of association after adjusting for sleep, physical activity, and screen time in adolescents. Spine, 43, 1432–1437. https://doi.org/10.1097/BRS.0000000000002646
Kashikar-Zuck, S., Flowers, S. R., Claar, R. L., Guite, J. W., Logan, D. E., Lynch-Jordan, A. M., Palermo, T. M., & Wilson, A. C. (2011). Clinical utility and validity of the functional disability inventory among a multicenter sample of youth with chronic pain. Pain, 152(7), 1600–1607.
Guite, J. W., McCue, R. L., Sherker, J. L., Sherry, D. D., & Rose, J. B. (2011). Relationships among pain, protective parental responses, and disability for adolescents with chronic musculoskeletal pain. Clinical Journal of Pain, 27(9), 775–781.
Basch, M. C., Chow, E. T., Logan, D. E., Borsook, D., Schechter, N. L., & Simons, L. E. (2018). Cumulative effects of multiple pain sites in youth with chronic pain. European Journal of Pain, 22(6), 1134–1141.
Tanaka, K., Murata, S., Nishigami, T., Mibu, A., Manfuku, M., Shinohara, Y., Tanabe, A., & Ono, R. (2019). The central sensitization inventory predict pain-related disability for musculoskeletal disorders in the primary care setting. European Journal of Pain, 23(9), 1640–1648. https://doi.org/10.1002/ejp.1443
Tran, S. T., Jastrowski Mano, K. E., Hainsworth, K. R., Medrano, G. R., Anderson Khan, K., Weisman, S. J., & Davies, W. H. (2015). Distinct influences of anxiety and pain catastrophizing on functional outcomes in children and adolescents with chronic pain. Journal of Pediatric Psychology, 40(8), 744–755.
Evans, S., Djilas, V., Seidman, L. C., Zeltzer, L. K., & Tsao, J. C. I. (2017). Sleep quality, affect, pain, and disability in children with chronic pain: Is affect a mediator or moderator? The Journal of Pain, 18(9), 1087–1095.
Kalapurakkel, S., Carpino, E. A., Lebel, A., & Simons, L. E. (2015). “Pain can’t stop me”: Examining pain self-efficacy and acceptance as resilience processes among youth with chronic headache. Journal of Pediatric Psychology, 40(9), 926–33.
Gauntlett-Gilbert, J., & Eccleston, C. (2007). Disability in adolescents with chronic pain: Patterns and predictors across different domains of functioning. Pain, 131(1), 132–141.
Malmborg, J. S., Bremander, A., Olsson, M. C., Bergman, A.-C., Brorsson, A. S., & Bergman, S. (2019). Worse health status, sleeping problems, and anxiety in 16-year-old students are associated with chronic musculoskeletal pain at three-year follow-up. BMC Public Health, 19(1565), 1–11. https://doi.org/10.1186/s12889-019-7955-y
Auvinen, J. P., Paananen, M. V., Tammelin, T. H., Taimela, S. P., Mutanen, P. O., Zitting, P. J., & Karppinen, J. I. (2009). Musculoskeletal pain combinations in adolescents. Spine, 34(11), 1192–1197.
Paananen, M. V., Auvinen, J. P., Taimela, S. P., Tammelin, T. H., Kantomaa, M. T., Ebeling, H. E., Taanila, A. M., Zitting, P. J., & Karppinen, J. I. (2010). Psychosocial, mechanical, and metabolic factors in adolescents’ musculoskeletal pain in multiple locations: A cross-sectional study. European Journal of Pain, 14(4), 395–401.
Mikkelsson, M., Sourander, A., Salminen, J. J., Kautiainen, H., & Piha, J. (1998). Widespread pain and neck pain in schoolchildren. A prospective one-year follow-up study. Acta Paediatrica, 88(10), 1119–1124.
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Funding was provided by Fundação para a Ciência e a Tecnologia (Grant No. SFRH/BD/119528/2016), Portugal.
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Andias, R., Silva, A.G. Predictors of pain persistence and disability in high-school students with chronic neck pain at 6-month follow-up. Qual Life Res 31, 803–816 (2022). https://doi.org/10.1007/s11136-021-02969-0
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DOI: https://doi.org/10.1007/s11136-021-02969-0