Psychosocial, Physical, and Neurophysiological Risk Factors for Chronic Neck Pain: A Prospective Inception Cohort Study

  • Bahar Shahidi
    Physical Therapy and Rehabilitation Science Programs, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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  • Douglas Curran-Everett
    Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado
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  • Katrina S. Maluf
    Address reprint requests to Katrina S. Maluf, PT, PhD, School of Exercise and Nutritional Sciences, Doctor of Physical Therapy Program, College of Health & Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-7251.
    Physical Therapy and Rehabilitation Science Programs, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado

    Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California
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Published:September 20, 2015DOI:


      • Psychosocial, physical, and neurophysiological factors affected the risk for neck pain.
      • Depressed mood was the strongest predictor for development of chronic neck pain.
      • Diffuse noxious inhibitory control was impaired in those developing chronic neck pain.
      • Poor cervical extensor endurance increased the risk for developing chronic neck pain.


      The purpose of this investigation was to identify modifiable risk factors for the development of first-onset chronic neck pain among an inception cohort of healthy individuals working in a high-risk occupation. Candidate risk factors identified from previous studies were categorized into psychosocial, physical, and neurophysiological domains, which were assessed concurrently in a baseline evaluation of 171 office workers within the first 3 months of hire. Participants completed monthly online surveys over the subsequent year to identify the presence of chronic interfering neck pain, defined as a Neck Disability Index score ≥5 points for 3 or more months. Data were analyzed using backward logistic regression to identify significant predictors within each domain, which were then entered into a multivariate regression model adjusted for age, sex, and body mass index. Development of chronic interfering neck pain was predicted by depressed mood (odds ratio [OR] = 3.36, 95% confidence interval [CI] = 1.10–10.31, P = .03), cervical extensor endurance (OR = .92, 95% CI, .87–.97, P = .001), and diffuse noxious inhibitory control (OR = .90, 95% CI, .83–.98, P = .02) at baseline. These findings provide the first evidence that individuals with preexisting impairments in mood and descending pain modulation may be at greater risk for developing chronic neck pain when exposed to peripheral nociceptive stimuli such as that produced during muscle fatigue.


      Depressed mood, poor muscle endurance, and impaired endogenous pain inhibition are predisposing factors for the development of new-onset chronic neck pain of nonspecific origin in office workers. These findings may assist with primary prevention by allowing clinicians to screen for individuals at risk of developing chronic neck pain.

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