Abstract
BackgroundNeck and low back pain represent dynamic conditions that change over time, often with an initial improvement after the onset of a new episode, followed by flare-ups or variations in intensity. Pain trajectories were previously defined based on longitudinal studies of temporal patterns and pain intensity of individuals with low back pain. In this study, we aimed to 1) investigate if the defined patterns and subgroups for low back pain were applicable to neck pain patients in chiropractic practice, 2) explore the robustness of the defined patterns, and 3) investigate if patients within the various patterns differ concerning characteristics and clinical findings.MethodsProspective cohort study including 1208 neck pain patients from chiropractic practice. Patients responded to weekly SMS-questions about pain intensity and frequency over 43 weeks. We categorized individual responses into four main patterns based on number of days with pain and variations in pain intensity, and subdivided each into four subgroups based on pain intensity, resulting in 16 trajectory subgroups. We compared baseline characteristics and clinical findings between patterns and between Persistent fluctuating and Episodic subgroups.ResultsAll but two patients could be classified into one of the 16 subgroups, with 94% in the Persistent fluctuating or Episodic patterns. In the largest subgroup, “Mild Persistent fluctuating” (25%), mean (SD) pain intensity was 3.4 (0.6) and mean days with pain 130. Patients grouped as “Moderate Episodic” (24%) reported a mean pain intensity of 2.7 (0.6) and 39 days with pain. Eight of the 16 subgroups each contained less than 1% of the cohort. Patients in the Persistent fluctuating pattern scored higher than the other patterns in terms of reduced function and psychosocial factors.ConclusionsThe same subgroups seem to fit neck and low back pain patients, with pain that typically persists and varies in intensity or is episodic. Patients in a Persistent fluctuating pattern are more bothered by their pain than those in other patterns. The low back pain definitions can be used on patients with neck pain, but with the majority of patients classified into 8 subgroups, there seems to be a redundancy in the original model.
Highlights
Neck and low back pain represent dynamic conditions that change over time, often with an initial improvement after the onset of a new episode, followed by flare-ups or variations in intensity
The objectives of this study were to 1) investigate if the defined patterns and subgroups for low back pain (LBP) are applicable to Neck pain (NP) patients in chiropractic practice, 2) explore the robustness of the defined subgroups, and 3) investigate if the patients in the defined patterns or subgroups differ with respect to baseline characteristics and clinical findings
Our study was the first to use defined, standardized definitions of subgroups based on LBP patients in a cohort with NP
Summary
Neck and low back pain represent dynamic conditions that change over time, often with an initial improvement after the onset of a new episode, followed by flare-ups or variations in intensity. Pain trajectories were previously defined based on longitudinal studies of temporal patterns and pain intensity of individuals with low back pain. The clinical course is mostly characterized by an initial improvement after the onset of a new episode, followed by flare-ups or more persistent patterns of variations in intensity or episodes [5,6,7,8]. The collaborative group advised that focus should be on subgroups constructed on a combination of pain variation patterns, pain intensity, and speed of improvement based on previously identified trajectories [2]. To further investigate the usefulness of these variation patterns, it was recommended to test whether the findings on LBP are similar across cohorts and conditions
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