The relationship between neck and body awareness, pain, and proprioception with central sensitization in patients with chronic nonspecific neck pain

Central sensitization (CS) is a significant cause of chronic pain, causing increased sensitivity at the central nervous system level. However, the effects of CS in patients with chronic nonspecific neck pain (CNSNP) are poorly understood. This study aimed to compare pain severity, pressure pain threshold, disability, proprioception, neck and body awareness in patients with CNSNP with and without CS, and to investigate the relationship between them. Eighty-three patients were included in this cross-sectional study and were divided into two groups, CS and non-CS, according to the Central Sensitization Inventory (CSI). Pain severity (Numeric Pain Rating Scale (NPRS)), pressure pain threshold (PPT), neck disability (Neck Disability Index (NDI)), proprioception (Cervical range of motion device (CROM)), and neck (Fremantle Neck Awareness Questionnaire (FreNAQ)) and body awareness (Body Awareness Questionnaire (BAQ)) were measured. Data analysis was performed using an Independent Samples T-test and the Mann-Whitney U test. Spearman correlation coefficients and multivariate logistic regression were applied to analyze potential predictors of having CS. The NPRS, NDI, flexion and extension joint position error, FreNaQ, and BAQ scores of the CNSNP with the CS group were statistically significantly higher than those of the non-CS group (p < 0.05), and the PPT value was lower (p = 0.013). Increased pain intensity (OR = 1.722, p = 0.005) and neck extension joint position error (OR = 1.517, p = 0.006) significantly increased the likelihood of CS (p < 0.001). Patients with CNSNP who had CS had increased pain intensity and functional disability, decreased pressure pain threshold, and worsened proprioceptive sensory feedback, neck, and body awareness. These results suggest that CS may be associated with worsening symptoms. Therefore, CS should not be overlooked in the clinical follow-up of patients with CNSNP. Submitted to ClinicalTrials (number: NCT06976398, date: 05/02/2025).