Skip to main content

Advertisement

Log in

Predictors of pain persistence and disability in high-school students with chronic neck pain at 6-month follow-up

  • Published:
Quality of Life Research Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. Mikkelsson, M., Salminen, J. J., & Kautiainen, H. (1997). Non-specific musculoskeletal pain in preadolescents. Prevalence and 1-year persistence. Pain, 73(1), 29–35.

    Article  CAS  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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

    Article  Google Scholar 

  20. 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.

    Article  Google Scholar 

  21. 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.

    Article  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 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.

    Google Scholar 

  26. 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.

    Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

  29. 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.

    Article  PubMed  Google Scholar 

  30. 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

    Article  Google Scholar 

  31. 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

    Article  PubMed  Google Scholar 

  32. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. 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

    Article  PubMed  Google Scholar 

  35. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Marôco, J. (2014) Análise estatística com o SPSS statistics (6a edição). ReportNumber

  37. Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(Supplement), S2-15.

    Article  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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

    Article  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. 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.

    Article  Google Scholar 

  42. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Graven-Nielsen, T., & Arendt-Nielsen, L. (2002). Peripheral and central sensitization in musculoskeletal pain disorders: An experimental approach. Current Rheumatology Reports, 4, 313–321.

    Article  PubMed  Google Scholar 

  44. 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.

    Article  CAS  PubMed  Google Scholar 

  45. Palermo, T. M., & Chambers, C. T. (2005). Parent and family factors in pediatric chronic pain and disability: An integrative approach. Pain, 119, 1–4.

    Article  PubMed  Google Scholar 

  46. 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.

    Article  Google Scholar 

  47. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  48. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  49. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  50. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  51. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  52. 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

    Article  PubMed  Google Scholar 

  53. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  54. 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.

    Article  Google Scholar 

  55. 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.

    Article  CAS  PubMed  Google Scholar 

  56. 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

    Article  PubMed  Google Scholar 

  57. 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.

    Article  PubMed  Google Scholar 

  58. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  59. 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.

    Article  PubMed  Google Scholar 

  60. 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.

    Article  PubMed  Google Scholar 

  61. 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

    Article  CAS  Google Scholar 

  62. 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.

    Article  PubMed  Google Scholar 

  63. 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.

    Article  PubMed  Google Scholar 

  64. 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.

    Article  Google Scholar 

Download references

Funding

Funding was provided by Fundação para a Ciência e a Tecnologia (Grant No. SFRH/BD/119528/2016), Portugal.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rosa Andias.

Ethics declarations

Conflict of interest

Although there are no conflicts of interest to declare, the authors would like to inform that they are authors of 5 articles referenced in this study.

Ethical approval

Ethical approval was obtained from the Ethics and Deontology Council of the University of Aveiro.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-021-02969-0

Keywords

Navigation