A population-based survey of beliefs about neck pain and its associated disorders: a cross-sectional study

Neck pain and whiplash are prevalent disorders with high socio-economic burden. Beliefs and expectations influence their prognosis, causing chronicisation. We aimed to investigate the perspective of the Italian population.

We conducted an online survey among Italian adults recruited through social media. The main outcomes were the Whiplash Beliefs Questionnaire (WBQ) total score and its subscales, recovery expectations, and anxiety/stress items. Independent variables were history of neck pain, whiplash, and associated symptoms, with adjustment for age, gender, marital status, employment, and type of job. Associations were assessed using linear regression for WBQ outcomes and proportional odds logistic regression for recovery expectations and anxiety/stress.

One thousand thirty-four participants were included. Most responders were women (65%, n = 673) between 35 and 50 years of age (37.6%, n = 389) and reported working more than 6 h as a white-collar worker (39.7%, n = 411). Most responders reported negative thoughts about the impact on quality of life (61.9%) and work (31.8%-30.2%). Many distrusted surgery (70.3%) medications (69.7%), and painkillers (51.2%). 23%-36% were not sure about the benefit of conservative strategies like exercise or rest (30.1%). The total score for the Whiplash Beliefs Questionnaire was significantly lower (mean difference = -1.82; p = 0.002; 95% CI -2.98 to -0.66) among those with recent pain compared to laypersons (i.e., asymptomatic healthy individuals); additionally, significantly higher scores were found for recovery pessimism among those with associated symptoms compared to laypersons (mean difference = 0.45; p = 0.01; 95% CI 0.09 to 0.79). Overall, laypersons exhibited different beliefs compared to those with recent or chronic neck pain. However, coping strategies, treatment pessimism, recovery expectations and anxiety/depression showed no significant differences (p > 0.05).

This study highlights Italians' perspectives on neck pain and whiplash, showcasing a nuanced relationship between pain and beliefs. Italian responders reported negative beliefs regarding the impact of neck pain/whiplash and agreed that anxiety and stress influence the perception of pain. Recovery pessimism seems to be perceived more by individuals with symptoms. Future research should integrate individual's experience from qualitative research into quantitative research.