Physical and Psychological Predictors for Persistent and Recurrent Non-Specific Neck Pain: A Systematic Review.

BACKGROUND: Patients with non-specific neck pain often develop persistent or recurrent pain and associated disability. This review investigated which physical and psychological factors predict persistent and recurrent neck pain and disability. DATABASES AND DATA TREATMENT: Five databases were searched from inception to January 31, 2025. After data extraction, the Quality in Prognosis Studies tool (QUIPS) was used for risk of bias assessment and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to assess the certainty of evidence for each factor's predictive capability for neck disability, pain intensity and incidence. RESULTS: Six prospective cohort studies were selected. Three studies were rated with high overall risk of bias and three with moderate overall risk of bias. Consistent findings supported that high pain catastrophizing and psychological distress predict persistent and recurrent pain, disability and incidence with low to moderate certainty of evidence. There was inconsistency of results or limited studies reporting association between neck flexion strength, cold pain threshold tested over the tibialis anterior, pressure pain threshold tested over the neck or tibialis anterior, conditioned pain modulation, neck extensor endurance, and temporal summation with disability. In addition, there was low certainty of evidence which showed no relationship between cervical range of motion, cold pain threshold tested over the neck and neck extensor strength with disability. CONCLUSIONS: Pain catastrophizing and psychological distress were identified as predictors of persistent and recurrent neck pain, disability and incidence. Further studies are needed to confirm findings of an association between physical factors with future neck pain and disability. SIGNIFICANCE STATEMENT: This review provides evidence to support the addition of early assessment of pain catastrophizing and psychological distress to identify patients that are more susceptible to persistent and recurrent neck pain. When warranted, psychological interventions targeting maladaptive beliefs, pain-related anxiety and catastrophizing may be required to minimize persistent and recurrent neck pain and disability.