313: Pain Inequities: QST and Health Metrics to Inform Precision Rehabilitation in Chronic Neck Pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Quantitative Sensory testing (static and dynamic, e.g., HPT, PPT, CPM, TSP, offset analgesia)

Background and Aims: Pain is a distinctly personal yet universal experience influenced by numerous factors beyond the correlate of sensory input and pathoanatomic tissue damage.1,2 On a global scale, chronic pain constitutes a prevalent and persistent global health issue, affecting approximately one in five adults worldwide.3 Pain is ubiquitous and imposes major global health burden from limitations in function and mobility, decreased quality of life, increased health care cost and lost productivity.1,2,3,4 This study explores the relationship between psychosocial factors and pain processing mechanisms, assessed through Quantitative Sensory Testing (QST), in individuals with Chronic Neck Pain (CNP).

Methods: Prospective cohort study of adults between 18-65 years old (n=41) conducted at a hospital-based comprehensive outpatient rehabilitation center.
Forty-one adults diagnosed with nonspecific CNP who presented to physical therapy for initial examination were recruited. Consent form approved by the RWJ Barnabas Health system. Primary predictors were anxiety and pain catastrophizing; secondary predictors included demographics and self-reported pain and disability. Primary outcomes were central pain processing assessed via Quantitative Sensory Tests (QST) through measures of mechanical Pressure Pain Threshold (PPT) and Conditioned Pain Modulation (CPM).

Results: Generalized Additive Modelling (GAM) was used to examine the nonlinear associations between NDI, PCS, and age on CPM. The model explained a small portion of the variance (adjusted R² = 0.083; deviance explained = 24.6%), indicating a limited fit. None of the predictors demonstrated statistically significant effects: NDI (edf = 1.97, p = 0.200) and PCS (edf = 1.81, p = 0.572) both showed nonlinear trends, but these did not reach significance. Similarly, age showed no significant association with CPM (edf = 1.00, p = 0.840).

Conclusions: Across our models, anxiety levels (STAI) emerged as the most consistent psychological correlate of pain processing, particularly for mechanical PPT and CPM. , neither NDI nor PCS showed significant associations with PPT in our sample, despite prior studies linking both factors to altered pain thresholds.28,43,44,46.

References: 1. Hansen GR, Streltzer J. The psychology of pain. Emergency Medical Clinic of North America. 2005;23(2):339-348
2. Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises.Pain. 2020;161(9):1976-1982.doi:10.1097/j.pain.0000000000001939
3. Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11:770. Published 2011 Oct 6. doi:10.1186/1471-2458-11-770
4. Nahin RL, Feinberg T, Kapos FP, Terman GWEstimated Rates of Incident and Persistent Chronic Pain Among US Adults, 2019-2020. JAMA Netw Open. 2023. doi:10.1001/jamanetworkopen.2023.13563

Presenting Author: Carla S. Enriquez
Submitting Author: Carla Enriquez

Senior Author: Carla S. Enriquez

IASP 2026 Global Year theme of Neuropathic Pain: No

• Musola N. Oniyide: PT, DPT - 4Overlook Medical Center, Atlantic Health Rehabilitation, Atlantic Health System
• Alka Bishnoi: PhD - Kean University
• Roger Luo: MD - Rutgers Medical School
• Katherine Jennings: SPT - Kean University