Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, Amsterdam, Noord Holland, The Netherlands; Department of Clinical Chemistry, Laboratory Medical Immunology, Amsterdam University Medical Centre, Location Vrije Universiteit, Amsterdam, Noord Holland, The Netherlands.
Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, Amsterdam, Noord Holland, The Netherlands; School of Health Sciences and Social Work, and Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Queensland, Australia.
J Pain. 2024 Aug;25(8):104496. doi: 10.1016/j.jpain.2024.02.010. Epub 2024 Feb 9.
We conducted an explorative prospective cohort study with 6 months follow-up to 1) identify different pain and disability trajectories following an episode of acute neck pain, and 2) assess whether neuroimmune/endocrine, psychological, behavioral, nociceptive processing, clinical outcome, demographic and management-related factors differ between these trajectories. Fifty people with acute neck pain (ie, within 2 weeks of onset) were included. At baseline, and at 2, 4, 6, 12, and 26 weeks follow-up, various neuroimmune/endocrine (eg, inflammatory cytokines and endocrine factors), psychological (eg, stress symptoms), behavioral (eg, sleep disturbances), nociceptive processing (eg, condition pain modulation), clinical outcome (eg, trauma), demographic factors (eg, age), and management-related factors (eg, treatment received) were assessed. Latent class models were performed to identify outcome trajectories for neck pain and disability. Linear mixed models or the Pearson chi-square test were used to evaluate differences in these factors between the trajectories at baseline and at each follow-up assessment and over the entire 6 months period. For pain, 3 trajectories were identified. The majority of patients were assigned to the "Moderate pain - Favourable recovery" trajectory (n = 25; 50%) with smaller proportions assigned to the "Severe pain - Favourable recovery" (n = 16; 32%) and the "Severe pain - Unfavourable recovery" (n = 9; 18%) trajectories. For disability, 2 trajectories were identified: "Mild disability - Favourable recovery" (n = 43; 82%) and "Severe disability - Unfavourable recovery" (n = 7; 18%). Ongoing systemic inflammation (increased high-sensitive C-reactive protein), sleep disturbances, and elevated psychological factors (such as depression, stress and anxiety symptoms) were mainly present in the unfavorable outcome trajectories compared to the favorable outcome trajectories. PERSPECTIVE: Using exploratory analyses, different recovery trajectories for acute neck pain were identified based on disability and pain intensity. These trajectories were influenced by systemic inflammation, sleep disturbances, and psychological factors.
我们进行了一项探索性前瞻性队列研究，随访时间为 6 个月，目的是：1）确定急性颈痛发作后不同的疼痛和残疾轨迹，2）评估神经免疫/内分泌、心理、行为、伤害感受处理、临床结局、人口统计学和管理相关因素在这些轨迹之间是否存在差异。共纳入 50 名急性颈痛患者（即发病后 2 周内）。在基线、2 周、4 周、6 周、12 周和 26 周随访时，评估了各种神经免疫/内分泌（如炎症细胞因子和内分泌因素）、心理（如压力症状）、行为（如睡眠障碍）、伤害感受处理（如条件疼痛调制）、临床结局（如创伤）、人口统计学因素（如年龄）和管理相关因素（如接受的治疗）。采用潜在类别模型确定颈痛和残疾的结局轨迹。线性混合模型或 Pearson 卡方检验用于评估基线和每个随访评估以及整个 6 个月期间轨迹之间这些因素的差异。对于疼痛，确定了 3 种轨迹。大多数患者被分配到“中度疼痛-有利恢复”轨迹（n=25；50%），较小比例的患者被分配到“严重疼痛-有利恢复”（n=16；32%）和“严重疼痛-不利恢复”（n=9；18%）轨迹。对于残疾，确定了 2 种轨迹：“轻度残疾-有利恢复”（n=43；82%）和“严重残疾-不利恢复”（n=7；18%）。与有利结局轨迹相比，持续的全身炎症（高敏 C 反应蛋白升高）、睡眠障碍和升高的心理因素（如抑郁、压力和焦虑症状）主要存在于不利结局轨迹中。观点：使用探索性分析，根据残疾和疼痛强度确定了急性颈痛的不同恢复轨迹。这些轨迹受到全身炎症、睡眠障碍和心理因素的影响。
