Central sensitization in adults with chronic neck pain: cross-cross study exploring differences by gender

Abdon, Ana Paula Vasconcellos; Aleixo, Leonardo Lima; Toledo, Amanda de Oliveira; Rela, Maíra de Oliveira Viana; Rodrigues, Carlos Ewerton Maia; Fontenele, Ticiana Mesquita de Oliveira

doi:10.5935/2595-0118.20240032-en

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • BrJP 7 • 2024 • https://doi.org/10.5935/2595-0118.20240032-en copy

Central sensitization in adults with chronic neck pain: cross-cross study exploring differences by gender

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

The presence of central sensitization (CS) in people with chronic neck pain requires clarification, as does the possible disparities between genders. Therefore, this study aimed to evaluate the presence of CS in chronic neck pain according to gender.

METHODS:

Cross-sectional study with the participation of 260 adults (18-59 years old) with chronic neck pain, carried out between September 2022 and September 2023. Instruments were applied to collect sociodemographic profile, pain characteristics, cervical functional disability and presence of SC. The software SPSS 23.0 was used for comparative analyzes.

RESULTS:

Regarding disparities between genders, there were no differences in the intensity of pain and cervical functional disability (p=0.134 and p=0.277, respectively). However, SC was higher in women (43.5 ± 14.0; p=0.003). In females, CS was related to "pain interference" in the aspects of walking (r=0.311; p=0.001), relationships with people (r=0.309; p=0.001), appreciation of life (r=0.321; p= 0.001) and with cervical functional disability (r=0.570; p=0.001). In males, CS was related to "pain interference" in aspects such as general activity (r=0.311; p=0.008), mood (r=0.376; p=0.001), walking (r=0.313; p= 0.007), relationships with people (r=0.477; p=0.001), sleep (r=0.321; p=0.006), appreciation of life (r=0.427 p=0.001) and functional disability (r=0.667; p<0.001).

CONCLUSION:

Women with chronic neck pain showed a greater presence of CS, while CS in men was related to a variety of aspects that negatively affect life. Given this, differences between genders could be considered in the management of patients with chronic neck pain.

Keywords:
Adult; Central nervous system sensitization; Chronic pain; Gender; Neck pain

HIGHLIGHTS

Women have higher levels of central sensitization compared to men.

Central sensitization is associated with several aspects that negatively affect life, such as pain interference (general activity, mood, interpersonal relationships, sleep and enjoyment of life) and functional disability of the cervical spine, but with greater involvement in males.

Although there were no significant differences in pain intensity and functional disability between genders, both groups had moderate pain intensity and high functional disability associated with chronic neck pain.

The differences found between men and women in central sensitization and factors associated with chronic neck pain highlight the need to consider these disparities in the clinical management of patients.

Sociodemographic variables	Gender						p-value	OR^a IC95%
	Male			Female
	n	%	Mean (SD) Median (p25-75)	n	%	Mean (SD) Median (p25-75)
Age			30.1 (10.6) 27.0 (22.0-34.7)			30.5 (11.7) 25.0(21.0-39.0)	0.900
Marital status							0.619
Married	18	25		40	21.3
Single	51	70.8		134	71.3
Divorced	3	4.2		13	6.9
Separated#	0.0	0.0		1	0.5
Race/color							0.973
White	30	41.7		82	43.6
Brown	35	48.6		88	46.8
Black	4	5.6		11	5.9
Indigenous#	0.0	0.0		1	0.5
Yellow	3	4.2		6	3.2
Schooling							0.103
Incomplete elementary school	1	1.4		8	4.3
Complete elementary school #	0.0	0.0		1	0.5
High school incomplete	2	2.8		2	1.1
High school complete	12	16.7		21	11.2
Higher education incomplete	28	38.9		101	53.7
Higher education incomplete	29	40.3		55	29.3
Gainful employment							0.001*	0.36 0.20-0.65
No	21	29.2		99	52.7
Yes	51	70.8		88	46.8
Not declared#	0.0	0.0		1	0.5
Social class							0.454	1.26 0.68-2.34
A/B	20	27.8		44	23.4
C/D/E	51	70.8		142	75.5
Not declared#	1	1.4		2	1.1

Variables	Gender						p-value^a	OR^a IC95%
	Male			Female
	n	%	Mean (SD) Median (p25-75)	n	%	Mean (SD) Median (p25-75)
Lifestyle
Hours of sleep			6.1 (1.5) 6.0 (5.0-7.0)			6.1 (1.2) 6.0 (5.0-7.0)	0.947
Screen time			7.3 (3.6) 6.5(4.3-10.0)			7.2 (3.8) 7.0(4.0-10.0)	0.641
Smoking							0.310
Non-smoker	61	84.7		145	77.1			1
Smoker	6	8.3		29	15.4			2.03 0.80-5.41
Ex-smoker	5	6.9		14	7.4			1.178 0.40-3.41
Alcohol consumption							0.293
No	30	41.7		92	48.9			1
Yes	42	58.3		96	51.1			0.741 0.43-1.29
Physical activity							0.002*
Yes	56	77.8		107	56.9			1
No	16	22.2		81	43.1			2.650 1.41-4.95

Variables	Gender						p-value^a
	Male			Female
	n	%	Mean (SD) Median (p25-75)	n	%	Mean (SD) Median (p25-75)
Pain intensity			6.1 (1.5) 6.0 (5.0-7.0)			6.4 (1.8) 7.0 (5.0-8.0)	0.277
Pain intensity classification
Mild	2	2.8		11	5.9
Moderate	54	75.0		123	65.4
Severe	16	22.2		54	28.7
Worst pain you've felt in the last 24 hours			5.1 (2.6) 5 (3.2-7.0)			5.5 (2.7) 6.0 (4.0-8.0)	0.221
Weakest pain you've felt in the last 24 hours			2.0(1.8) 2.0 (0.2-3.0)			2.2 (2.0) 2.0(1.0-3.7)	0.506
Timing of pain
Constant	44	62.0		94	50.3
Recurrent	22	31		67	35.8
Constant with worsening period	5	7.0		26	13.9
Days of pain in the month			12.2(10.0) 8.0(4.0-19.0)			13.14(10.4) 10.0(3.5-20.0)	0.777
Time of neck pain			3.0 (3.3) 2.0(1.0-5.0)			3.4 (4.0) 2.0(1.0-5.0)	0.628
≥ 1 year	43	59.7		118	72.8
< 1 year	29	40.3		70	37.2
Interference of pain on different aspects
General activities			3.9 (2.9) 4.0(1.0-7.0)			4.25 (3.3) 4.0(1.0-6.0)	0.755
Mild	35	48.6		86	45.7
Moderate	27	37.5		76	40.4
Severe	10	13.9		26	13.8
Mood			4.2 (3.3) 4.5(1.0-7.0)			5.0 (3.5) 5.0 (2.0-8.0)	0.106
Mild	34	47.2		72	38.3
Moderate	21	29.2		55	29.3
Severe	17	23.6		61	32.4
Walking			2.6 (3.2) 1.0 (0.0-4.7)			2.6(3.1) 0.0 (0.0-5.0)	0.819
Mild	47	65.3		127	67.6
Moderate	16	22.2		42	22.3
Severe	9	12.5		19	10.1
Work			3.1 (3.3) 2.0 (0.0-6.0)			4.0 (3.4) 4.0 (0.0-7.0)	0.040*
Mild	47	65.3		91	48.3
Moderate	14	19.4		56	29.8
Severe	11	15.3		41	21.8
Interpersonal relationships			2.6 (2.8) 2.0 (0.0-5.0)			3.3 (3.4) 2.0 (0.0-6.0)	0.120
Mild	48	66.7		111	59
Moderate	19	26.4		42	22.3
Severe	5	6.9		35	18.6
Sleep			4.8 (3.5) 5.5(1.0-8.0)			4.9 (3.5) 5.0 (2.0-8.0)	0.886
Mild	28	38.9		71	37.8
Moderate	22	30.6		61	32.4
Severe	22	30.6		46	37.7
Appreciation of life			3.1 (3.2) 2.0 (0.0-6.0)			3.6 (3.5) 3.0 (0.0-7.0)	0.464
Mild	44	61.1		99	52.7
Moderate	18	25		52	27.7
Severe	10	13.9		37	19.7

Variables	Gender						p-value^a
	Male			Female
	n	%	Mean (SD) Median (p25-75)	n	%	Mean (SD) Median (p25-75)
Functional disability of the cervical region			12.3(5.3) 11.0(9.0-15.0)			13.5(5.9) 13(10.0-17.0)	0.134
Classification of functional disability of the cervical region
No disability	2	2.8		4	2.1
Mild	50	69.4		112	59.6
Moderate	19	26.4		63	33.5
Severe	1	1.4		9	4.8
Involvement of central sensitization			37.4(13.9) 35.5 (26.2-49.0)			43.5(14.0) 42.0 (33.0-54.0)	0.003*
Classification of central sensitization
Subclinical	23	31.9		30	16.0
Mild	20	27.8		50	26.6
Moderate	11	15.3		48	25.5
Severe	13	18.1		35	18.6
Extreme	5	6.9		25	13.3

Variables	Central Sensitization
	Male		Female
	r	P value^a	r	p-value^a
Age	-0.105	0.379	0.630	0.387
Hours of sleep	-0.144	0.227	-0.340	<0.001*
Screen time	0.105	0.380	0.057	0.442
Pain intensity	0.108	0.364	0.184	0.012*
Time of pain	-0.198	0.097	-0.081	0.276
Interference of pain in various aspects
General activity	0.311	0.008*	0.283	<0.001*
Mood	0.376	0.001*	0.261	<0.001*
Walking	0.313	0.007*	0.311	<0.001*
Work	0.108	0.367	0.026	0.724
Interpersonal relationships	0.477	<0.001*	0.309	<0.001*
Sleep	0.321	0.006*	0.277	<0.001*
Appreciation of life	0.427	<0.001*	0.321	<0.001*
Functional disability of the cervical region	0.671	<0.001*	0.570	<0.001*

Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
E-mail: dor@dor.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence to: Ana Paula Vasconcellos Abdon E-mail: paulaabdon@unifor.br