Biopsychosocial model predicts disability in neck pain patients

Self-reported disability in patients with chronic mechanical neck pain can be predicted by previous episodes of neck pain, pain intensity, pain-related fear, and cervical extension range of motion, say researchers.

They found that these factors, when combined, explained 37.2% of the variability in the self-reported disability of 97 patients with neck pain.

"The results of the current study provide preliminary support that the biopsychosocial model, which recognizes that individuals exhibit a combination of somatic and psychologic factors influences by social context, may be beneficial in the management of patients with neck-related disability," say Manuel Arroyo-Morales (Universidad de Granada, Spain) and colleagues.

Among the 28 men and 69 women, aged an average of 40 years, participating in the cross-sectional study, all had suffered with mechanical neck pain for more than 3 months and 74.2% presented with three to five previous episodes of neck pain.

The results, published in the American Journal of Physical Medicine and Rehabilitation, showed significant low to moderate positive associations between disability and presence of previous episodes of neck pain, intensity of current neck pain, and also kinesiophobia. There was also a negative association between disability and cervical extension.

Regression analyses confirmed that these factors were significant predictors of disability, with the presence of previous episodes of neck pain contributing approximately 20.0% of the variance in lower disability scores, while pain intensity contributed an additional 11.4%. Kinesiophobia, as measured on the 17-item Tampa Scale of Kinesiophobia, contributed an additional 3.5% and extension cervical range of motion, 2.3%, after taking into account the presence of previous episodes of neck pain.

Arroyo-Morales and colleagues stress the need for clinicians to understand the importance of psychosocial issues when treating patients with neck pain.

"The fear of movement model suggests that pain could be perceived as threatening after several previous episodes and could potentially promote psychologic distress and give rise to pain-related fear of movement," they explain.

This fear can lead to avoidance behaviors and "disuse," the team adds, which is associated with deconditioning and a subsequent increase in avoidance behaviors, thereby perpetuating the pain process.

"It is possible that if fear-avoidance attitudes are identified in the acute stage and managed accordingly, it could prevent the development of chronic symptoms," they conclude.

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  1. Ian Ian United Kingdom says:

    The biopsychosocial seems to be struggling to show itself capable of anything of value, and these poor results continue this disappointing history.  These associations are weak and unsurprising, and should doing nothing to legitimise the medicalisation of the psychosocial aspects of the lives of those patients with neck pain.

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