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Trajectories of Pain Intensity Over One Year in Adults with Disabling Subacute or Chronic Neck Pain

Pico-Espinosa, Oscar Javier MD, MSc*; Côté, Pierre DC; PhD; Hogg-Johnson, Sheilah PhD; Jensen, Irene PhD; Axen, Iben DC; PhD; Holm, Lena W. PhD*; Skillgate, Eva DN; PhD*,§

doi: 10.1097/AJP.0000000000000727
Original Article: PDF Only

Objectives: To describe the one-year trajectories of disabling subacute or persistent neck pain and to investigate whether baseline age, sex, pain characteristics and depressive symptoms are associated with such trajectories.

Study design and setting: Participants (n=617) included in a randomized controlled trial provided weekly pain intensity ratings by responding to text messages over one year. We used latent class mixed model analyses to identify clusters of individual trajectories. Thereafter, we used logistic regression to determine the association between baseline age, sex, pain characteristics, depressive symptoms and treatment, and trajectories of neck pain.

Results: Six different clusters of trajectories were identified. Most participants (73%) followed a trajectory of decreasing pain throughout follow-up. The remaining experienced unfavorable trajectories; persistent pain of high intensity (22%), slightly (3%) or highly (2%) fluctuating levels of pain reaching high levels of pain intensity. Pain intensity at baseline OR 3.76 (95%CI: 2.49-5.68), depressive symptoms OR 3.46 (95%CI: 2.01-5.95), younger age OR 2.29 (95%CI: 1.48-3.54), female sex OR 1.51 (95%CI 1.01-2.26) and sudden onset of pain 1.74 (95%CI: 1.13-2.69) were associated with unfavorable trajectories.

Conclusions: Most individuals with disabling subacute or chronic neck pain show improvement in pain intensity over a year. However, a quarter present unfavorable trajectories. High pain intensity at baseline, depressive symptoms, younger age, female sex and sudden onset of pain are factors associated with unfavorable trajectories.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Musculoskeletal and Sports Injury Epidemiology Center. Institute of Environmental Medicine. Karolinska Institutet. Stockholm, Sweden

Faculty of Health Sciences and UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation. University of Ontario Institute of Technology. Toronto. Canada

Unit of intervention and implementation research for worker health. Institute for Environmental Medicine. Karolinska Institutet. Stockholm, Sweden

§Naprapathögskolan – Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden

Funding: The Swedish Research Council (VR), Swedish Research Council for Health, Working Life and Welfare (FORTE) and The Swedish Naprapathic Association funded this study.

Author contribution: ES, LH and PC conceptualized the STONE trial. ES supervised the data collection. All authors contributed to the planning of the analyses. OJPE prepared the dataset and performed the analysis together with SHJ. OJPE wrote the manuscript and all authors contributed with analytical input along the project.

Authors extend special thanks to Anna Peterson, for the coordination of the data collection.

Funding/Support: Swedish Research Council (VR), Swedish Research Council for Health, Working Life and Welfare (FORTE) and The Swedish Naprapathic Association funded this study.

Role of the funder/sponsor: The funding organizations did not influence the conduction of the study or the presentation of the results. The main investigator ensured that all the procedures followed the pre-established protocols.

Compliance with ethical standards: Informed consent was obtained from all individual participants included in the study and all procedures performed were in accordance with the ethical standards of the Regional Ethic Committee in Stockholm (Dnr: 2014/755-31/3) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

ARTICLE INFORMATION: Conflict of interest: None.

Reprints: Oscar Javier Pico-Espinosa, MD, MSc, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden (e-mail:

Received January 29, 2019

Received in revised form April 18, 2019

Accepted May 13, 2019

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