17/11/2025
It’s interesting that this research shows that addressing the psychological aspect of pain was more effective than standard physiotherapy in dealing with neck pain.(click on see more section and look at the conclusion) This begs the question… why are doctors referring people with neck pain to physios when chiropractic has way better results?
Just published 🔥
Physical and Psychological Predictors for Persistent and Recurrent Non‐Specific Neck Pain: A Systematic Review
▶️ Non‐specific neck pain (NSNP) is a highly prevalent musculoskeletal disorder, with up to 57% of patients developing persistent disability one year after onset (https://pubmed.ncbi.nlm.nih.gov/23664654/) and 23–48% experiencing recurrent episodes within a year (https://pubmed.ncbi.nlm.nih.gov/15284511/, https://pubmed.ncbi.nlm.nih.gov/15561381/).
▶️ Persistent pain is typically defined as lasting ≥3 months (https://pubmed.ncbi.nlm.nih.gov/30586067/), whereas recurrent pain refers to episodic pain with ≥24-hour duration, separated by at least one month of remission (https://pubmed.ncbi.nlm.nih.gov/19531986/).
▶️ Previous reviews have focused predominantly on psychological and demographic predictors of chronic neck pain (https://pubmed.ncbi.nlm.nih.gov/20466711/, https://pubmed.ncbi.nlm.nih.gov/31026716, ) https://pubmed.ncbi.nlm.nih.gov/32517732/, with limited attention to physical factors such as neuromuscular function, sensory changes, and motor control impairments (https://pubmed.ncbi.nlm.nih.gov/30690409/, https://doi.org/10.1038/s41598-022-14696-8, https://pubmed.ncbi.nlm.nih.gov/23849933/).
▶️ Identifying modifiable predictors of persistence and recurrence is crucial for developing targeted interventions (https://pubmed.ncbi.nlm.nih.gov/25659245/)
📘 In a brand-new systematic review, published in the “European Journal of Pain”, Yu et al. (2025) conducted a systematic review to evaluate both physical (e.g., cervical strength, range of motion, sensory thresholds) and psychological (e.g., catastrophizing, distress) predictors of persistent or recurrent NSNP.
📊 Results
🧠 Psychological predictors:
✅ Pain catastrophizing and psychological distress (e.g., depression, anxiety, perceived stress) were consistently associated with persistent and recurrent neck pain and disability, supported by low-to-moderate certainty of evidence.
✅ Catastrophizing predicted higher Neck Disability Index (NDI) scores and greater pain intensity
💪 Physical predictors:
❓ Findings for neck flexion strength, pain inducing pressure threshold (PPT), pain inducing cold threshold (CPT), conditioned pain modulation (CPM), temporal summation (TS), and neck endurance were inconsistent or limited.
❎ Cervical range of motion, cold pain threshold at the neck, and neck extensor strength showed no predictive value.
Certainty of evidence: Overall, evidence for psychological predictors was stronger than for physical measures, though all were limited by study design heterogeneity and small sample sizes.
💡 Conclusions
High pain catastrophizing and psychological distress are consistent predictors of persistent and recurrent NSNP and related disability. Evidence for physical predictors remains inconclusive due to methodological variability and limited longitudinal data.
The authors recommend incorporating early assessment of maladaptive psychological traits into clinical screening and exploring targeted cognitive-behavioral or multimodal rehabilitation strategies to prevent chronicity. In this context, Farrell and colleagues confirmed that psychological interventions provided by physiotherapists were more effective than standard physiotherapy for treating chronic, non-traumatic neck pain. The effect size was low to moderate (https://pubmed.ncbi.nlm.nih.gov/37731474/).
