Psychosocial, Physical, and Neurophysiological Risk Factors for Chronic Neck Pain: A Prospective Inception Cohort Study

Abstract

The purpose of this investigation was to identify modifiable risk factors for the development of first-onset chronic neck pain among an inception cohort of healthy individuals working in a high-risk occupation. Candidate risk factors identified from previous studies were categorized into psychosocial, physical, and neurophysiological domains, which were assessed concurrently in a baseline evaluation of 171 office workers within the first 3 months of hire. Participants completed monthly online surveys over the subsequent year to identify the presence of chronic interfering neck pain, defined as a Neck Disability Index score ≥5 points for 3 or more months. Data were analyzed using backward logistic regression to identify significant predictors within each domain, which were then entered into a multivariate regression model adjusted for age, sex, and body mass index. Development of chronic interfering neck pain was predicted by depressed mood (odds ratio [OR] = 3.36, 95% confidence interval [CI] = 1.10-10.31, P = .03), cervical extensor endurance (OR = .92, 95% CI, .87-.97, P = .001), and diffuse noxious inhibitory control (OR = .90, 95% CI, .83-.98, P = .02) at baseline. These findings provide the first evidence that individuals with preexisting impairments in mood and descending pain modulation may be at greater risk for developing chronic neck pain when exposed to peripheral nociceptive stimuli such as that produced during muscle fatigue.

Perspective: Depressed mood, poor muscle endurance, and impaired endogenous pain inhibition are predisposing factors for the development of new-onset chronic neck pain of nonspecific origin in office workers. These findings may assist with primary prevention by allowing clinicians to screen for individuals at risk of developing chronic neck pain.

Keywords: Neck pain; chronic; prospective; risk factors.

Figure 1

Candidate risk factors were categorized into psychosocial, physical, and neurophysiological measurement domains, which were assessed concurrently in the same cohort using a combined risk model (*) to investigate their combined contribution (*) to chronic interfering neck pain.

Figure 2

Flow diagram of participant enrollment, follow up, and analysis.

Figure 3

Group differences in significant risk factors identified from unadjusted risk models for individuals who did (+Chronic NP) and did not (−Chronic NP) develop chronic interfering neck pain during the 12 month follow up. Values are group mean (SD). BDI = Beck Depression Inventory, DNIC = Diffuse noxious inhibitory control, BPA-L = Leisure subscale of the Baecke Physical Activity Questionnaire