A cohort study on chronic neck pain classification and management

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A cohort study on chronic neck pain classification and management

Neck pain is the fourth leading cause of disability as it exerts a steep personal and socioeconomic toll. The primary determinant in the treatment decisions is to identify whether it is neuropathic or nonneuropathic pain, as this influence treatment at all stages. Till now, no study has sought to classify the neck pain in this aspect.

A six months follow-up of 100 participants referred to an urban, academic, military treatment facility with a primary diagnosis of neck pain were enrolled in the study. The pain was categorized as a neuropathic, possible neuropathic or nonneuropathic using painDETECT and as neuropathic, mixed, or nociceptive by self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale (s-LANSS) and physician‘s  judgment. As per available evidences, the intermediate possible neuropathic pain category was considered to be a mixed condition. As for the final classification, a metric combining all 3 systems, slightly weighted towards physician's judgment was regarded as the reference standard.

The results revealed that 50%  of participants were classified having possible neuropathic pain, 43%  with nonneuropathic pain and 7% with primarily neuropathic pain. Concordance was high between the different classification schemes, ranging from a low of 62% between painDETECT and physician designation for the possible neuropathic pain to 83% concordance between s-LANSS and the 2 other systems for neuropathic pain. After 6 months, the individuals with neuropathic pain disclosed higher levels of baseline disability and were more likely to have a coexisting psychiatric illness.  Moreover, these patients also underwent surgery more frequently than other pain categories but were also more likely to report greater reductions in disability.

It has culminated that although pure neuropathic pain comprised a small percentage of the cohort, 50% of the population inculcated mixed pain conditions containing a possible neuropathic component. Also, significant overlap between the various classification schemes was observed.

Source:

Reg Anesth Pain Med.

Link to the source:

http://journals.lww.com/rapm/pages/articleviewer.aspx?year=2017&issue=01000&article=00008&type=abstract

The original title of the article:

Classification and Treatment of Chronic Neck Pain: A Longitudinal Cohort Study

Authors

Liu, Richard et al.

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