Change search
ReferencesLink to record
Permanent link

Direct link
Factors predicting pain reduction in chronic back and neck pain after multimodal treatment.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
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.

Place, publisher, year, edition, pages
2004. Vol. 20, no 6, 447-454 p.
Keyword [en]
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
URN: urn:nbn:se:umu:diva-16904PubMedID: 15502689OAI: diva2:156577
Available from: 2007-10-18 Created: 2007-10-18 Last updated: 2010-08-09Bibliographically approved
In thesis
1. Sensorimotor characteristics in chronic neck pain: possible pathophysiological mechanisms and implications for rehabilitation
Open this publication in new window or tab >>Sensorimotor characteristics in chronic neck pain: possible pathophysiological mechanisms and implications for rehabilitation
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.

58 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 924
Outcome prediction, Pain intensity, Neck Pain, WAD, Motor control, Proprioception, Balance, Cervical stability, Jerk, Neck kinematics
Research subject
urn:nbn:se:umu:diva-368 (URN)91-7305-744-4 (ISBN)
Public defence
2004-12-08, Stora salen, Arbetslivsinstitutionen, Umeå, 10:00
Available from: 2004-11-17 Created: 2004-11-17 Last updated: 2010-08-09Bibliographically approved

Open Access in DiVA

No full text

Other links


Search in DiVA

By author/editor
Michaelson, Peter
By organisation
Sports Medicine
In the same journal
The Clinical Journal of Pain
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 76 hits
ReferencesLink to record
Permanent link

Direct link