Functional, Sleep-Related, and Pain-Related Emotional and Social Factors Associated With Health-Related Quality of Life in Chronic Nonspecific Neck Pain: A Cross-Sectional Study.

Abstract

Purpose: Chronic nonspecific neck pain (CNNP) is a multifactorial condition associated with pain-related emotional impact and sleep disturbance. Its impact on health-related quality of life (HRQoL) in non-Western populations remains understudied. This cross-sectional study examined associations between disability, pain, sleep, pain-related emotional and social factors, and HRQoL in Iranian adults with CNNP.

Methods: Adults with CNNP were recruited from tertiary rehabilitation centres in Tehran. Of 135 screened, 107 were analysed. Instruments included the NDI, NPDS, VAS, PSQI, and SF-36. Spearman's correlation, multivariable regression, and bootstrapped indirect-association analyses were used to identify factors associated with HRQoL.

Results: Participants exhibited moderate disability (NDI 17.2 ± 6.5; NPDS 48.1 ± 16.5) and poor sleep (PSQI 6.4 ± 3.7). Pain was correlated with disability (ρ = 0.44), sleep dysfunction (ρ = 0.55), and lower SF-36 scores (p < 0.05). Sleep disturbance was the primary independent factor associated with reduced Vitality, Mental Health, and Social Functioning, while sleep latency further contributed to lower Vitality; together, these variables explained 28%-49% of the variance across these domains (adjusted R² = 0.28-0.49). Lifting difficulty and pain with walking predicted poorer Physical Functioning, and lifting difficulty also predicted greater Bodily Pain. Difficulty working overhead uniquely contributed to lower General Health. Pain interference with work contributed to reduced Physical Functioning, while daytime dysfunction was associated with Bodily Pain. A BMI ≥ 25 kg/m² was associated with greater pain severity, poorer sleep, and lower HRQoL. A more negative Pain-Related Outlook on Life/Future was linked to lower Vitality, and pain-related emotional impact corresponded to reduced Mental Health. No severe multicollinearity or construct redundancy was detected.

Conclusions: CNNP was associated with disability, sleep disturbance, and pain-related emotional and social interference, each contributing independently to reduced HRQoL. Findings support the importance of individualised, multidisciplinary rehabilitation strategies incorporating biomechanical, sleep-focused, and psychological interventions.