Related Experiment Video
Updated: May 5, 2026
Dynamic Quantitative Sensory Testing to Characterize Central Pain Processing
Published on: February 16, 2017
Association between centralization and directional preference and functional and pain outcomes in patients with neck
Susan L Edmond1, Guillermo Cutrone, Mark Werneke
1Rutgers, The State University of New Jersey, Newark, NJ.
Study Design:
Retrospective cohort.
Objectives:
In subjects with neck pain, the present study aimed (1) to describe the prevalence of centralization (CEN), noncentralization (non-CEN), directional preference (DP), and no directional preference (no DP); (2) to determine if age, sex, fear-avoidance beliefs about physical activity, number of comorbid conditions, or symptom duration varies among subjects who demonstrate CEN versus non-CEN and DP versus no DP; and (3) to determine if CEN and/or DP are associated with changes in function and pain.
Background:
CEN and DP are prevalent among patients with low back pain and should be considered when determining treatment strategies and predicting outcomes; however, these findings are not well investigated in patients with neck pain.
Methods:
Three hundred four subjects contributed data. CEN and DP prevalence were calculated, as was the association between CEN and DP, and age, sex, number of comorbid conditions, fear-avoidance beliefs, and symptom duration. Multivariate models assessed whether CEN and DP predicted change in function and pain.
Results:
CEN and DP prevalence were 0.4 and 0.7, respectively. Younger subjects and those with fewer comorbid conditions were more likely to centralize; however, subjects who demonstrated DP were more likely to have acute symptoms. Subjects who centralized experienced, on average, a 3.6-point (95% confidence interval: -0.3, 7.4) improvement in function scores, whereas subjects with a DP averaged a 5.4-point (95% confidence interval: 0.8, 10.0) improvement. Neither CEN nor DP was associated with pain outcomes.
Conclusion:
DP and, to a lesser extent, CEN represent evaluation categories that are associated with improvements in functional outcomes.
