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Sensorimotor characteristics in chronic neck pain: possible pathophysiological mechanisms and implications for rehabilitation
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Pain from the musculoskeletal system is very common in the modern society. Chronic musculoskeletal pain syndromes causes not only individual suffering but also dysfunctions of movements and postural control, as large costs for the society. In spite of significant efforts, there is a shortage of knowledge on effective prevention, diagnoses and rehabilitation of different chronic musculoskeletal pain syndromes.

The general aims of this thesis was to investigate the predictive value of physical, sociodemographic, and psychosocial-behavioural variables for pain reduction after multimodal rehabilitation in patients with chronic low back or neck pain, and to develop and evaluate tests for objective and quantitative evaluation of characteristic sensorimotor disturbances in chronic neck pain.

Logistic regression models revealed that unchanged pain intensity could be predicted with good precision while reduced pain intensity after rehabilitation was poorly predicted by the baseline variables. Altered pain intensity in chronic low back pain was predicted by high pain intensity, low levels of pain severity and high affective distress, while reduced pain intensity for patients with chronic neck pain were predicted by high endurance, low age, high pain intensity, low need of being social along with optimistic attitudes on how the pain will interfere with daily life, and few vegetative symptoms. One of the conclusions was that objective measures of specific sensorimotor disturbances should improve the precision by which treatment-induced effects can be assessed and predicted.

A study was designed to objectively and quantitatively evaluate a large numbers of different sensorimotor characteristics in a small group of patients with chronic neck pain of different aetiology (whiplash-related and insidious). Kinematic data was recorded during different motor tasks, involving cervical rotations, arm movements and standing. In comparison to a group of asymptomatic control subjects, patients with chronic neck pain was characterised by slower movements, poor balance, reduced cervical stability during perturbations, altered smoothness of movement (jerk index), and reduced movement precision (variable error and variability in range of motion). The sensorimotor variables velocity of arm movements and cervical stability, could correctly classified nearly 90% of the subjects as having chronic neck pain or being asymptomatic.

There was a large diversity of sensorimotor disturbances among the individual patients. This was confirmed in a regression model that failed to separate the groups insidious neck pain (sensitivity 44%) and WAD (sensitivity 67%).

By investigating associations between the different sensorimotor variables, close relations was found between the repositioning acuity and variability in range of motion, and between standing balance and cervical stability/ standing balance during perturbation. These two groups of variables were only weakly related to each other and to smoothness of movement and movement velocity.

The results indicate that chronic neck pain is characterised by specific sensorimotor deficits, and that there are common pathophysiological mechanisms in chronic neck pain of different aetiology. However, the lack of associations between several sensorimotor disturbances indicates that different mechanisms are involved. The thesis indicates that objective sensorimotor tests should be used to improve the quality of functional assessments in chronic neck pain. Methods that objectively and quantitatively measure e.g. movement precision, balance and cervical stability are also needed in order to evaluate current treatment methods and to develop new rehabilitation programs for specific sensorimotor deficits.

Place, publisher, year, edition, pages
2004. , 58 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 924
Keyword [en]
Outcome prediction, Pain intensity, Neck Pain, WAD, Motor control, Proprioception, Balance, Cervical stability, Jerk, Neck kinematics
Research subject
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-368ISBN: 91-7305-744-4 (print)OAI: oai:DiVA.org:umu-368DiVA: diva2:143270
Public defence
2004-12-08, Stora salen, Arbetslivsinstitutionen, Umeå, 10:00
Opponent
Available from: 2004-11-17 Created: 2004-11-17 Last updated: 2010-08-09Bibliographically approved
List of papers
1. Factors predicting pain reduction in chronic back and neck pain after multimodal treatment.
Open this publication in new window or tab >>Factors predicting pain reduction in chronic back and neck pain after multimodal treatment.
2004 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 20, no 6, 447-454 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To determine whether treatment related pain reduction on the short- and long-term is predicted by different baseline variables, and with different accuracy, in patients with chronic low back pain as compared with those with chronic neck pain. DESIGN AND METHODS: A single blinded prospective cohort study based on patients with chronic musculoskeletal pain in the lower back (N = 167) or the neck (N = 136) who completed a 4-week multimodal rehabilitation program. At admission, each patient was evaluated on 17 potential predictors, including pain characteristics and physical, sociodemographic, and psychosocial-behavioral variables. Changes in self-reported pain intensity in the lower back or the neck between the pretreatment evaluation and those performed immediately after, and 12 months after the rehabilitation program, were assessed. RESULTS: Logistic regression models revealed that change in pain intensity could be predicted with good specificity but with poor sensitivity both for patients with chronic low back pain and chronic neck pain. Significant predictors among the neck pain patients were high endurance, low age, high pain intensity, few other symptoms, low need of being social, to do things with others, and to be helped, along with optimistic attitudes on how the pain will interfere with daily life. Among the low back pain patients, high pain intensity, low levels of pain severity, and high affective distress were important predictors. Variables such as sex, sick leave history, working status, accident, pain duration, and depressive symptoms demonstrated no predictive value. Short- and long-term pain outcome was equally predictable and predicted by almost the same variables. CONCLUSIONS: Patients who reported unchanged or increased pain after multimodal treatment could be predicted with good accuracy, whereas those who reported decreased pain were more difficult to identify. Treatment-related pain alteration in chronic low back pain seems to be predicted by partly different variables than in chronic neck pain.

Keyword
Adult, Back Pain/*rehabilitation, Case-Control Studies, Chronic Disease/rehabilitation, Cognitive Therapy/*methods, Combined Modality Therapy/methods, Female, Follow-Up Studies, Humans, Male, Neck Pain/*rehabilitation, Pain Measurement/methods, Patient Dropouts, Physical Therapy (Specialty)/*methods, Predictive Value of Tests, Prospective Studies, Regression Analysis, Sickness Impact Profile, Single-Blind Method, Socioeconomic Factors, Treatment Outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-16904 (URN)15502689 (PubMedID)
Available from: 2007-10-18 Created: 2007-10-18 Last updated: 2017-12-14Bibliographically approved
2. Vertical posture and head stability in patients with chronic neck pain.
Open this publication in new window or tab >>Vertical posture and head stability in patients with chronic neck pain.
Show others...
2003 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, no 5, 229-235 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate postural performance and head stabilization of patients with chronic neck pain. DESIGN: A single-blind comparative group study. SUBJECTS: Patients with work-related chronic neck pain (n = 9), with chronic whiplash associated disorders (n = 9) and healthy subjects (n = 16). METHODS: During quiet standing in different conditions (e.g. 1 and 2 feet standing, tandem standing, and open and closed eyes) the sway areas and the ability to maintain the postures were measured. The maximal peak-to-peak displacement of the centre of pressure and the head translation were analysed during predictable and unpredictable postural perturbations. RESULTS: Patients with chronic neck pain, in particular those with whiplash-associated disorders, showed larger sway areas and reduced ability to successfully execute more challenging balance tasks. They also displayed larger sway areas and reduced head stability during perturbations. CONCLUSION: The results show that disturbances of postural control in chronic neck pain are dependent on the aetiology, and that it is possible to quantify characteristic postural disturbances in different neck pain conditions. It is suggested that the dissimilarities in postural performance are a reflection of different degrees of disturbances of the proprioceptive input to the central nervous system and/or of the central processing of such input.

Keyword
neck pain, whiplash injury, work-related myalgia, single-blind method, posture, balance, head stabilization, proprioception
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4253 (URN)10.1080/16501970306093 (DOI)14582555 (PubMedID)
Note
Erratum in:* J Rehabil Med. 2007 Nov;39(9):744. Available from: 2004-11-17 Created: 2004-11-17 Last updated: 2017-12-14Bibliographically approved
3. Sensorimotor disturbances in chronic neck pain - range of motion, peak velocity, smoothness of movement, and repositioning acuity.
Open this publication in new window or tab >>Sensorimotor disturbances in chronic neck pain - range of motion, peak velocity, smoothness of movement, and repositioning acuity.
2008 (English)In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 13, no 2, 122-131 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this pilot study was to evaluate sensorimotor functions in patients with chronic neck pain with objective and quantitative methods. A group of 16 patients with chronic idiopathic neck pain of insidious onset or whiplash associated disorders (WAD) was compared to an equally sized group of healthy subjects. Kinematics were investigated during voluntary head rotations by measuring range of motion, variability of range of motion (ROM-Variability), peak velocity, and smoothness of movement (jerk index). Repositioning acuity after cervical rotations was evaluated by analysing constant and variable error (VE). In comparison to the healthy subjects, the patients showed significantly larger jerk index, ROM-Variability and VE. No statistically significant differences were found between insidious neck pain and WAD. It is concluded that jerky and irregular cervical movements and poor position sense acuity are characteristic sensorimotor symptoms in chronic neck pain. The observed individuality in sensorimotor disturbances emphasizes the importance of developing specific rehabilitation programs for specific dysfunctions, and of using objective and quantitative methods for evaluation of rehabilitation.

Keyword
Neck pain, Whiplash, Neck kinematics, Motor control, Proprioception, Jerk
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4254 (URN)10.1016/j.math.2006.10.002 (DOI)17197230 (PubMedID)
Available from: 2004-11-17 Created: 2004-11-17 Last updated: 2017-12-14Bibliographically approved
4. Objective evaluation of sen-sorimotor disturbances in chronic neck pain – implications for rehabilitation of specific dysfunctions
Open this publication in new window or tab >>Objective evaluation of sen-sorimotor disturbances in chronic neck pain – implications for rehabilitation of specific dysfunctions
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4255 (URN)
Available from: 2004-11-17 Created: 2004-11-17 Last updated: 2012-06-29Bibliographically approved

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