Health characteristics and muscle strength in patients with severe pain in the neck versus low back : are they separate entities?

Abstract

Introduction Chronic low back pain (LBP) and chronic neck pain (NP) are common musculoskeletal disorders with big socioeconomic consequences worldwide. Recent evidence shows that patients with LBP and NP report similarities in terms of the comprehensive biopsychosocial symptom picture. However, it is unclear if chronic NP and chronic pain LBP constitute separate entities in terms of muscle strength and health characteristics. Multidisciplinary treatment (MDT) has in recent years become a common rehabilitation method and has been used in treatment to target the multifactorial cause of pain. The objective of this study was to investigate differences between patients with LBP versus NP in muscle strength and health characteristics. A second objective was to investigate acute effects of a three-week MDT on self-rated health, fear avoidance beliefs and numerical pain rating scale.

Methods Eighty-seven patients (56 with severe chronic LBP and 31 with severe chronic NP) referred to a three-week MDT at the Department of Physical Medicine and Rehabilitation, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway volunteered to participate in the study. Data collection included objective measurements in grip strength and cervical strength, and subjective measurements which was obtained with a questionnaire.

Results The comparison of the two patient groups showed that the patients with LBP had a significantly higher body mass index (BMI) than the patients with NP. Although there was no difference in cervical strength between the groups, patients with NP reported significantly higher pain levels during maximal voluntary isometric contraction in neck flexion and neck extension. The NP group also tended to have a higher comorbidity in terms of number of pain sites than the LBP group. Analysis of acute MDT effects showed no differences between groups in terms of self-rated health, fear avoidance beliefs and numerical pain rating scale.

Conclusion The results from the current study indicate no major differences in health characteristics between patients with severe chronic LBP and NP. A short-term MDT program seems to have similar effects in these patient groups.