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Classification and Treatment of Chronic Neck Pain: A Longitudinal Cohort Study
  1. Richard Liu, MD*,
  2. Connie Kurihara, RN*,
  3. Hue-ting Tsai, PhD,
  4. Peter J. Silvestri, DO*,
  5. Michael I. Bennett, MD,
  6. Paul F. Pasquina, MD§ and
  7. Steven P. Cohen, MD*,,
  1. *Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD
  2. Department of Oncology, Georgetown University School of Medicine, Washington, DC
  3. Department of Palliative Medicine, Leeds Institute of Health Sciences School of Medicine, Leeds, United Kingdom
  4. §Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD
  5. Departments of Anesthesiology & Critical Care Medicine and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
  6. Uniformed Services University of the Health Sciences, Bethesda, MD
  1. correspondence: Steven P. Cohen, MD, 550 North Broadway, Suite 301, Baltimore, MD 21205 (e-mail: scohen40{at}


Background and Objectives Neck pain exerts a steep personal and socioeconomic toll, ranking as the fourth leading cause of disability. The principal determinant in treatment decisions is whether pain is neuropathic or nonneuropathic, as this affects treatment at all levels. Yet, no study has sought to classify neck pain in this manner.

Methods One hundred participants referred to an urban, academic military treatment facility with a primary diagnosis of neck pain were enrolled and followed up for 6 months. Pain was classified as neuropathic, possible neuropathic, or nonneuropathic using painDETECT and as neuropathic, mixed, or nociceptive by s-LANSS (self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale) and physician designation. Based on previous studies, the intermediate possible neuropathic pain category was considered to be a mixed condition. The final classification was based on a metric combining all 3 systems, slightly weighted toward physician's judgment, which is considered the reference standard.

Results Fifty percent of participants were classified as having possible neuropathic pain, 43% as having nonneuropathic pain, and 7% with primarily neuropathic pain. Concordance was high between the various classification schemes, ranging from a low of 62% between painDETECT and physician designation for possible neuropathic pain, to 83% concordance between s-LANSS and the 2 other systems for neuropathic pain. Individuals with neuropathic pain reported higher levels of baseline disability, were more likely to have a coexisting psychiatric illness, and underwent surgery more frequently than other pain categories, but were also more likely to report greater reductions in disability after 6 months.

Conclusions Although pure neuropathic pain comprised a small percentage of our cohort, 50% of our population consisted of mixed pain conditions containing a possible neuropathic component. There was significant overlap between the various classification schemes.

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  • R.L. and C.K. contributed equally to the study.

    This study was funded in part by the Centers for Rehabilitation Sciences Research, Bethesda, MD. The role of the funding sources was to provide support for research personnel.

    M.I.B. is the developer of the s-LANSS (self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale) instrument. S.P.C. has served on the Advisory Boards of Semnur Pharmaceuticals, Halyard, Regenesis, Zynerba, SPR, and St Jude Medical in the past 2 years. The other authors declare no conflict of interest.

    The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Department of the Army or the Department of Defense.