Doctoral Program in Health Sciences, University of Seville, Seville, Spain.
Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
Eur J Pain. 2024 Feb;28(2):322-334. doi: 10.1002/ejp.2184. Epub 2023 Sep 19.
A network analysis can be used to quantitatively assess and graphically describe multiple interactions. This study applied network analyses to determine the interaction between physical and pain-related factors and fear of movement in people with whiplash-associated disorders (WAD) during periods of acute and chronic pain.
Physical measurements, including pressure pain-thresholds (PPT) over neural structures, cervical range of motion, neck flexor and extensor endurance and the cranio-cervical flexion test (CCFT), in addition to subjective reports including the Tampa Scale of Kinesiophobia (TSK-11), Neck Disability Index (NDI) and neck pain and headache intensity, were assessed at baseline in 47 participants with acute WAD. TSK-11, NDI and pain intensity were assessed for the same participants 6 months later (n = 45). Two network analyses were conducted to estimate the associations between features at baseline and at 6 months and their centrality indices.
Both network analyses revealed that the greatest weight indices were found for NDI and CCFT at baseline and for neck pain and headache intensity and NDI and TSK-11 at both time points. Associations were also found betweeen cervical muscle endurance and neck pain intensity in the acute phase. Cervical muscle endurance assesssed during the acute phase was also associated with NDI after 6 months - whereas PPT measured at baseline was associsated with headache intensity after 6 months.
The strongest associations were found for headache and neck pain intensity and neck disability and fear of movement, both during acute pain and when mesured 6 months later. The extent of neck endurance and measures of PPT at baseline may be associated with neck disability and headache, respectively, 6 months after a whiplash injury.
Through two network analyses, we evaluated the interaction between pain-related factors, fear of movement, neck disability and physical factors in people who had experienced a whiplash injury. We demonstrated that physical factors may be involved in the maintenance and development of chronic pain after a whiplash injury. Nevertheless, the strongest associations were found for headache and neck pain intensity and neck disability and fear of movement, both during acute and chronic phases.
网络分析可用于定量评估和图形描述多种相互作用。本研究应用网络分析来确定在急性和慢性疼痛期间，与挥鞭样损伤相关障碍（WAD）相关的物理和疼痛相关因素与运动恐惧之间的相互作用。
在 47 名急性 WAD 患者的基线期，评估了包括神经结构的压力疼痛阈值（PPT）、颈椎活动范围、颈屈肌和伸肌耐力以及颅颈前屈试验（CCFT）在内的物理测量，以及包括 Tampa 运动恐惧量表（TSK-11）、颈痛残疾指数（NDI）和颈部疼痛及头痛强度在内的主观报告。6 个月后，对相同的 45 名患者进行了 TSK-11、NDI 和疼痛强度的评估。进行了两次网络分析，以评估基线和 6 个月时特征之间的关联及其中心性指数。
两项网络分析均显示，基线时最大的权重指数见于 NDI 和 CCFT，6 个月时见于颈部疼痛和头痛强度以及 NDI 和 TSK-11。在急性期还发现了颈椎肌肉耐力与颈部疼痛强度之间的关联。急性期颈椎肌肉耐力的评估与 6 个月后的 NDI 相关，而基线时测量的 PPT 与 6 个月后的头痛强度相关。
在急性疼痛和 6 个月后测量时，头痛和颈部疼痛强度以及颈部残疾和运动恐惧的关联最强。基线时颈部耐力的程度和 PPT 的测量值可能分别与 6 个月后颈部残疾和头痛有关。
通过两次网络分析，我们评估了经历过挥鞭样损伤的人疼痛相关因素、运动恐惧、颈部残疾和物理因素之间的相互作用。我们表明，物理因素可能参与了挥鞭样损伤后的慢性疼痛的维持和发展。然而，在急性和慢性阶段，头痛和颈部疼痛强度以及颈部残疾和运动恐惧的关联最强。
