Background & Aims

Neck pain ranks third among musculoskeletal conditions causing disability. With high public health expenditures and elevated work absenteeism rates, this population may experience persistent pain due to alterations in endogenous pain processing. Anti- and pro-nociceptive profiles, categorized as efficient or deficient pain modulation, respectively, may play a role in pain persistence and predict intervention outcomes. However, it is yet unknown whether clinical outcomes such as pain intensity and disability differ between the predominant profiles of patients. Therefore, the aim of this study was to compare pain intensity and neck disability levels between anti-nociceptive and pro-nociceptive profiles in individuals with chronic, non-specific neck pain.

Methods

A cross-sectional study included individuals aged 18 to 65 with chronic, non-specific neck pain. During a single face-to-face visit, pain intensity (Numeric Pain Rating Scale, NPRS) and disability (Neck Disability Index, NDI) were assessed. After, conditioned pain modulation (CPM) with immersion of the right ankle in 4°C water for 1 minute was also assessed. Pressure pain threshold (PPT) using the Algomed digital pressure algometer (Computerized Pressure Algometer, Medoc, Israel) served as the conditioning stimulus. PPT was measured before and immediately after ankle immersion at the midpoint of the right quadriceps, and the result was calculated as follows: PPT after = PPT before. Individuals with deficient CPM were classified as having a pro-nociceptive profile (negative values), and those with efficient CPM had an anti-nociceptive profile (positive values). Independent t-tests were used for the parametric variable NPRS and the Mann-Whitney test for the non-parametric variable NDI.

Results

The study included 33 participants (age of 37.2 ± 14), with 60.5% of the sample composed of women. Fourteen individuals were categorized with a pro-nociceptive profile (NPRS 3.9 ± 1.9; NDI median 24 and interquartile range 11) and 19 with an anti-nociceptive profile (NPRS 4.6 ± 2.4; NDI median 28 and interquartile range 14). There was no significant difference between profiles for NPRS (p = 0.28) and NDI (p = 0.12).

Conclusions

There is no difference in pain intensity and neck disability levels regardless of the predominant pain mechanism profile (anti-nociceptive or pro-nociceptive) in individuals with chronic, non-specific neck pain. However, in this study, the population reported moderate pain and mild disability on average, limiting the generalization of these results to populations without these characteristics. Ultimately, we can conclude that the presented results have the potential to enhance patient assessment for pain clinicians and researchers alike, as deficient conditioned pain modulation may interfere with the patient’s ability to positively respond to therapeutic interventions.

References

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Presenting Author

Luiz Fernando Approbato Selistre

Poster Authors

Luiz Fernando Approbato Selistre

PhD

Department of Physiotherapy , Federal University of São Carlos, São Paulo, Brazil

Lead Author

Giovanna Laura Neves Antonio Gaban PT

Federal University of São Carlos

Lead Author

Maria Ramela Schalch Vivaldini PT

Federal University of São Carlos

Lead Author

Camila Nepomuceno Broisler

Federal University of São Carlos

Lead Author

Giovanna Silva Nunes

Federal University of São Carlos

Lead Author

Henrik Bjarke Vaegter

University of Southern Denmark and University Hospital Odense, Denmark

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Neck Pain