Neck pain and emotional state in cervical spondylosis: A dual trajectory model analysis

Abstract

BACKGROUND

Neck pain, a primary symptom of cervical spondylosis, affects patients’ physical and mental health, reducing their quality of life. Pain and emotional state interact; however, their longitudinal interrelationship remains unclear. In this study, we applied a dual-trajectory model to assess how neck pain and emotional state evolve together over time and how clinical interventions, particularly acupuncture, influence these trajectories.

AIM

To investigate the longitudinal relationship between neck pain and emotional state in patients with cervical spondylosis.

METHODS

This prospective cohort study included 472 patients with cervical spondylosis from eight Chinese hospitals. Participants received acupuncture or medication and were followed up at baseline, and at 1, 2, 4, 6, and 8 weeks. Neck pain and emotional distress were assessed using the Northwick Park Neck Pain Questionnaire (NPQ) and the affective subscale of the Short-Form McGill Pain Questionnaire (SF-MPQ), respectively. Group-based trajectory models and dual trajectory analysis were used to identify and correlate pain-emotion trajectories. Multivariate logistic regression identified predictors of group membership.

RESULTS

Three trajectory groups were identified for NPQ and SF-MPQ scores (low, medium, and high). Higher NPQ trajectory was associated with older age (OR = 1.058, P < 0.001) and was significantly reduced by acupuncture (OR = 0.382, P < 0.001). Similarly, acupuncture lowered the odds of high SF-MPQ trajectory membership (OR = 0.336, P < 0.001), while age increased it (OR = 1.037, P < 0.001). Dual-trajectory analysis revealed bidirectional associations: 69.1% of patients with low NPQ had low SF-MPQ scores, and 42.6% of patients with high SF-MPQ also had high NPQ scores. Gender was a predictor for medium SF-MPQ trajectory (OR = 1.629, P = 0.094). Occupation and education levels differed significantly across the trajectory groups (P < 0.05).

CONCLUSION

Over time, neck pain and emotional distress are closely associated in patients with cervical spondylosis. Acupuncture alleviates both outcomes significantly, while age is a risk factor. Integrated approaches to pain and emotional management are encouraged.

Keywords: Cervical spondylosis; Neck pain; Emotional state; Group-based trajectory model; Dual trajectory analysis

Core Tip: This study employed group-based dual trajectory modeling to analyze longitudinal correlations between neck pain (Neck Pain Questionnaire scores) and emotional state (Short-Form McGill Pain Questionnaire affective scores) in patients with cervical spondylosis. Key findings indicate that acupuncture significantly reduces high pain and emotional distress trajectories, whereas aging increases the risk. Dual trajectory analysis revealed bidirectional associations: 69.1% of patients with low pain had emotional distress, whereas 42.6% of patients with high distress had pain. Integrated pain-emotion management strategies are recommended.