Falla D.1, Peolsson A.2, Heneghan N.1, Rushton A.1, Soldini E.3, Löfgren H.4, Zsigmond P.5, Dedering Å.6, Barbero M.3
1University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom, 2Linköping University, Department of Medical and Health Sciences, Linköping, Sweden, 3University of Applied Sciences and Arts of Southern Switzerland, Department of Business Economics, Health and Social Care, Manno, Switzerland, 4Ryhov Hospital, Neuro-Orthopedic Center, Jönköping, Sweden, 5Linköping University Hospital, Neurosurgery Clinic, Linköping, Sweden, 6Karolinska Institutet, Division of Physiotherapy, Stockholm, Sweden
Background: People with cervical radiculopathy (CR) present with varying pain extent indicative of an interplay of differing pain mechanisms. A widespread distribution of perceived pain may reflect central sensitisation and could be associated with poorer psychological functioning as seen in other conditions such as individuals with whiplash associated disorders (WAD). No studies have evaluated the relation of pain extent to perceived pain and disability, general health and psychological status in individuals with CR.
Purpose: To analyse pain extent, extracted from pain drawings, in a cohort of individuals with MRI verified CR and evaluate the relation between pain extent and a number of variables including perceived pain and disability, general health, social factors and psychological status.
Methods: A novel method was applied to quantify pain extent from the pain drawings from a sample of 190 patients with CR recruited as part of a randomized controlled multi-center trial. Pain drawings were digitalised and pain extent was quantified as the sum of the pixels in the frontal and in the dorsal body chart, and expressed as the percentage of total body chart area. Pain extent was evaluated in relation to sex, age, employment status and physical activity levels. Multiple linear regression analysis was used to verify whether pain extent was associated with other health indicators including neck pain and arm pain intensity, perceived pain and disability (Neck Disability Index, NDI), health-related quality of life (EuroQol Five Dimension Scale), coping strategies (Coping Strategy Questionnaire), depression (Modified Self-rating Depression Scale), distress (Distress and Risk Assessment Method) and self-efficacy
(Self-Efficacy Scale).
Results: The sample consisted of 53% men, with a mean age of 50.0±8.3 years. Pain extent was significantly larger for those that did not work (pain extent: 6.7±0.9%) compared to those in part-time work (5.2±0.7%) or full time work (4.5±0.9%) (p 0.05). Pain extent was weakly related to neck pain (r=0.26, p 0.01) and arm pain intensity (r=0.31, p 0.01). When controlling for sex, age, employment status, physical exercise habits, neck pain and arm pain intensity, pain extent was only significantly associated to the NDI score (p 0.01), but not with any of the measured psychological features including depression, distress or self-efficacy.
Conclusion(s): Expanded pain distribution is associated with pain intensity and perceived disability in patients with CR, but not with psychological features. These findings contrast to those observed for patients with WAD supporting the need for condition specific tailored management.
Implications: Widespread pain is associated with higher pain intensity and perceived disability but it is not indicative of the need for more specific psychological screening in patients with CR.
Funding acknowledgements: N/A
Topic: Musculoskeletal: spine
Ethics approval: Approved by the Regional Ethics Committee of Linköping, Sweden
All authors, affiliations and abstracts have been published as submitted.
