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Half of people with neck pain improve quickly

updated

Tags: neck, stats, good news, bad news, head/neck, spine, scientific medicine

One article on PainSci cites Leaver 2013: The Complete Guide to Neck Pain & Cricks

PainSci summary of Leaver 2013: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

This good-and-bad-news study showed that about half of 180 patients who sought treatment for a new case of neck pain “recovered completely within three months” … and the other half mostly recovered. That’s quite good!

The bad news is that there were certainly exceptions. Predictably, worse cases fared worse, as did people with a history of neck pain, and older patients, or if they didn’t just have neck pain but back pain as well.

But most people recovered completely or mostly, and the authors believe that “physiotherapists should reassure people with a new episode of neck pain that rapid improvement in symptoms is common, modifying this advice where applicable based on risk factors.”

Here’s an odd thing: faster recovery was associated with… smoking?! That may be the first time in almost a quarter century of reading about health science that I have seen the slightest hint of smoking being anything other than a problem.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

QUESTION: What is the clinical course of a new episode of non-specific neck pain in people who are treated with multimodal physical therapies in a primary care setting?

DESIGN: Observational study with 3-month follow-up, run in conjunction with a randomised trial.

PARTICIPANTS: 181 adults who consulted a physiotherapist or chiropractor for a new episode of nonspecific neck pain.

OUTCOME MEASURES: Time to recover from the episode of neck pain, time to recover normal activity, and pain and neck-related disability at three months. Clinical and demographic characteristics were investigated as potential predictors of recovery.

RESULTS: Within 3 months, 53% of participants reported complete recovery from the episode of neck pain. On a scale from 0 (none) to 10 (worst), pain improved from 6.1 (SD 2.0) at baseline to 2.5 (SD 2.1) at 2 weeks and to 1.5 (SD 1.8) at 3 months. On a scale from 0 (none) to 50 (worst), disability improved from 15.5 (SD 7.4) at baseline to 5.4 (SD 6.4) at 3 months. Faster recovery was independently associated with better self-rated general health, shorter duration of symptoms, being a smoker «Er, what?!», and absence of concomitant upper back pain or headache. Higher disability at 3 months was independently associated with higher disability at baseline, concomitant upper or lower back pain, older age, and previous sick leave for neck pain.

CONCLUSION: People who seek physical treatments for a new episode of neck pain in this primary care setting typically have high pain scores that improve rapidly after commencing treatment. Although almost half of those who seek treatment do not recover completely within three months, residual pain and disability in this group is relatively low. Physiotherapists should reassure people with a new episode of neck pain that rapid improvement in symptoms is common, modifying this advice where applicable based on risk factors.

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