Designing effective treatment protocols for neck-related disability has proven difficult. Disability has been examined from structural, emotional, and cognitive perspectives, with evidence supporting a multidimensional nature. The patient’s perspective of their condition has found increasing value for patient-centred, evidence-informed care. This cross-sectional study utilized descriptive thematic analysis to examine perceptions of causation in 118 people with neck pain. The Brief Illness Perceptions Questionnaire was used to capture perceptions of causation for neck pain symptoms. The Neck Disability Index, the Pain Catastrophizing Scale, the Hospital Anxiety and Depression Scale, and the P4 pain intensity numeric rating scale were also collected. Eight main themes were found for the cause(s) of neck pain: posture and movement, structure and mechanism, emotions, predisposition and lifestyle, symptoms, fatigue and insomnia, treatment, and environment. A series of regression models stratified by perceived cause suggested that disability could be explained by different constructs across the larger of the main themes. The findings are discussed in terms of the false view that mechanical neck pain should be considered a homogenous condition and potential application to treatment decision making based on patient perspectives. 1. Introduction Neck pain is a common occurrence in the general population, with a 1-year incidence of 11–18% [1, 2]. The intensity of symptoms can range from mild to extreme, with interference ranging from low to very high. The Neck Pain Task Force [3] has proposed a classification system for neck pain that incorporates both the intensity and resultant interference of neck pain to be used as a treatment decision aide. This classification system encourages separate consideration of symptom intensity and symptom interference, recognizing the two are not always directly linked. The occasionally ambiguous relationship between pain intensity and disability leads to difficulty in treatment decisions. The mechanisms of neck pain and disability are clearly not well understood. Disability, in particular, has been examined from a variety of perspectives, including structural [4, 5], psychological [6–8], and social [9–11] determinants. One of the primary barriers to develop effective treatment paradigms for neck-related disability is the weak, or at best, inconsistent association often seen between findings of structural pathology on diagnostic imaging and presenting signs or symptoms [12]. It has also been suggested that cognitive or emotional
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