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Review
. 2025 Jun 18:23:100308.
doi: 10.1016/j.cpnec.2025.100308. eCollection 2025 Aug.

Frequencies of persistence, activity pacing, fear avoidance and general stress in acute neck pain

Morf Rita  1 , Reicherzer Leah  1 , Degenfellner Jürgen  1 , Hasenbring Monika  2 , Erat Anna  3 , Hotz-Boendermaker Sabina  1   4
Affiliations
Review

Frequencies of persistence, activity pacing, fear avoidance and general stress in acute neck pain

Morf Rita et al. Compr Psychoneuroendocrinol. .

Abstract

Background: Neck pain (NP) is a common musculoskeletal health problem, persisting in 47 % of cases. A person's engagement in daily activities is defined as activity patterns (eustress persistence, distress persistence, activity pacing, and fear avoidance) that influence the development and continuation of pain. These behaviors may be linked to heightened stress levels, further negatively impacting pain perception. Understanding these relationships is vital, given the intricate interplay between stress, pain, and activity patterns. This study aims to assess the frequency of activity patterns and identify their impact on stress levels in participants with acute NP.

Methods: 125 individuals aged 18-65 with acute NP were recruited. Activity patterns were identified using the Avoidance-Endurance Fast Screen, which calculated the frequencies of activity patterns. Furthermore, subjective stress was evaluated using the Stress and Coping Inventory and objective stress using hair cortisol concentration to determine which activity pattern group experienced the highest stress.

Results: Most participants were classified in the eustress persistence group (52 %), followed by activity pacing (22.8 %), distress persistence (19.5 %), and fear avoidance (5.7 %). Subjective and objective stress levels consistently remained below established reference values. Analysis of activity pattern groups showed that distress persistence had the highest subjective stress levels, followed by fear avoidance, while activity pacing had the lowest. No relevant differences between the activity pattern groups were observed in the objective stress measurements.

Discussion: To the best of our knowledge, this study represents the first investigation of frequencies of activity patterns and subjective and objective stress in acute NP.

Keywords: Activity patterns; Hair cortisol concentration; Neck pain; Objective stress; Subjective stress.

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Conflict of interest statement

The authors declare that they have no conflicts of interest related to this work. There are no financial, personal, or professional relationships that could be perceived as influencing the research, analysis, or conclusions presented in this manuscript.

Figures

Fig. 1
Fig. 1
Frequencies of activity patterns in comparison with other study results LBP, low back pain; NP, neck pain.
Fig. 2
Fig. 2
Comparison of objective stress levels (Cortisol 1 month) with the reference values Objective stress levels were measured with the Hair Cortisol Concentration and were separated by gender (female and male).
Fig. 3
Fig. 3
Comparison of objective stress levels (Cortisol 3 months) with the reference values Objective stress levels were measured with the Hair Cortisol Concentration and were separated by gender (female and male).
See this image and copyright information in PMC

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