Initial Evaluation of the Operational Neck Pain Index.

Introduction: Neck pain during military flight is well documented. Characterizing operationally relevant, specific pain location(s), severity, character, and exacerbating or relieving conditions is needed to develop musculoskeletal neck pain prediction models.

Methods: An anonymous, web-based questionnaire and weighted numerical response index was developed with the help of an expert clinical panel. The questionnaire was reviewed, approved, and disseminated to military pilots. Respondents reported their current neck and upper back musculogenic and neurogenic pain with a 5-level severity at 14 locations, pain onset time, duration, and relief measures, and three-axis neck mobility.

Results: Of 222 fixed and rotary wing pilot respondents, 117 completed questionnaires were used for index calculation. Bilateral moderate musculogenic and neurogenic pain in the 10 posterior muscle areas was most common. Flexor muscles were infrequently indicated. Typically, neck pain started within 30 min of flight or pilots were already in pain, pain duration was less than 7 d, and pain was relieved by rest with over-the-counter medications or by a chiropractor or physical therapist. Neck motion limitations were equally rated as very limited, slight, or no restriction. The normalized index was divided into five ranges where 78% were very mild to mild severity.

Discussion: This new approach differentiates between musculogenic and neurogenic pain by discrete location and severity, addressing pain pattern, structural involvement, and neck mobility changes beyond pain absence or presence. This information can help define necessary model complexity to simulate neck pain biomechanics. The index has potential medical use in tracking pain progression and treatment progress. Whitley PE, Shender BS, Shivers BL. Initial evaluation of the Operational Neck Pain Index. Aerosp Med Hum Perform. 2025; 96(5):367-377.