Can people with chronic neck pain recognise their own pain?

Abichandani, Deepa and Barbero, Marco and Cescon, Corrado and Gallace, Alberto and Sanchis-Sánchez, Enrique and Falla, Deborah (2019) Can people with chronic neck pain recognise their own pain? UNSPECIFIED. In: WCPT2019 Proceedings World Confederation for Physical Therapy Congress, 2019, May 10th-13th, Geneva, Switzerland.

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Background: Approximately 50%-85% of people with neck pain fail to achieve complete resolution of their symptoms and many develop chronic neck pain (CNP). Some people with chronic pain display altered cortical body representation and distortions in body image, describing their painful region/limb as reduced or enlarged. No study has examined perception of the painful area or self-awareness to recognise one's own pain in people with CNP. Purpose: In this study we uniquely investigate whether people with CNP can recognise their own pain drawing (PD) when presented randomly amongst other PD with distortions of the original drawing. Furthermore, we examined the association between their ability to recognize their own pain with their levels of pain intensity, disability, psychosocial and somatic features. Methods: A convenience sample of 20 individuals with CNP firstly completed a series of questionnaires including the Numerical Rating Scale (NRS), The Neck Disability Index (NDI), The Pain Catastrophizing Scale (PCS), The Depression, Anxiety and Stress Scale (DASS-42), and the Modified Somatic Perceptions Questionnaire (MSPQ). They then completed their PD on a digital body chart with the instruction to “draw where you felt pain over the last week and try to be as precise as possible”. Their original PD was then digitally modified by a vertical translation, horizontal translation or by downscaling or upscaling the size of the painful area. Following a 10 min break listening to music, a series of 20 PD were presented in a random order with two of these being their original PD. For each PD, the participant rated the likeness to their own PD on a Likert scale from 0 to 100 with 0 defined as 'not at all like my pain' and 100 defined as 'this is my pain'. Results: The participants rated their original PD with median score of 92% similarity. Overall, this was the highest score with patients reporting 91.8% similarity when presented with a PD which was scaled down to 75% of the original size, although this was not a significantly different score compared to their original PD. The similarity median score was 89.5% when presented with images of their PD scaled up by 150%. The drawings which the patients found to be most dissimilar to their original PD were a horizontal translation by 40 pixels (8%), vertical translation by 70 pixels (12.8%) and vertical translation by 30 pixels (28.5%), which were all significantly different to the rating of their original PD. Spearman's correlation coefficient revealed a significant negative association between the ability of the individuals with CNP to recognize their original PD and their MSPQ scores. Conclusion(s): People with CNP were not able to perfectly identify their own PD and rated an upscaled and downscaled version of their painful area in a similar way. Their ability to recognise their own original PD was negatively correlated with the extent of somatic awareness. Implications: This novel study has provided new insights into pain perception in people with CNP. This further prompts the need for strategies to address heightened somatic awareness in the management of patients with CNP.

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