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Peer-reviewedCC BY-NC-ND 4.0Global Spine Journal

Association of Arm Pain, Neck Pain, and Numbness Improvement with Patient Satisfaction During Pharmacological Treatment for Cervical Spine Disorders: A Prospective Multicenter Cohort Study

  • Hiroaki Nakashima1
  • Norimitsu Wakao2
  • Sadayuki Ito1
  • Takeo Furuya3
  • Toshitaka Yoshii4
  • Hideyuki Arima5
  • Yu Yamato5
  • Shiro Imagama1
  • Yasuaki Imajo6
  • Hiroshi Miyamoto7
  • Gen Inoue8
  • Masayuki Miyagi8
25 more authors
  • Shunsuke Kanbara9
  • Yoichi Iizuka10
  • Hirotaka Chikuda10
  • Kei Watanabe11
  • Kazuyoshi Kobayashi12
  • Mikito Tsushima13
  • Masashi Miyazaki14
  • Mitsuru Yagi15
  • Satoshi Suzuki16
  • Masahiko Takahata17
  • Michio Hongo18
  • Masao Koda19
  • Keiji Nagata20
  • Kanji Mori21
  • Akinobu Suzuki22
  • Takashi Kaito23
  • Naohisa Miyakoshi18
  • Hiroshi Hashizume20
  • Yukihiro Matsuyama5
  • Mamoru Kawakami24
  • Hirotaka Haro25
  • Masaya Nakamura16
  • Masahiko Watanabe26
  • The Project Committee of the Japanese Society for Spine Surgery
  • Related Research (JSSR)
26 affiliations
  1. 1Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
  2. 2Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan
  3. 3Department of Orthopaedic Surgery, Chiba University, School of Medicine, Chiba, Japan
  4. 4Department of Orthopaedic Surgery, Institute of Science Tokyo, Tokyo, Japan
  5. 5Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
  6. 6Department of Orthopaedic Surgery, Tokuyama Central Hospital, Shunan, Japan
  7. 7Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan
  8. 8Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Sagamihara, Japan
  9. 9Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
  10. 10Department of Orthopaedic Surgery, Gunma University, School of Medicine, Maebashi, Japan
  11. 11Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
  12. 12Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
  13. 13Department of Orthopaedic Surgery, Konan Kosei Hospital, Konan, Japan
  14. 14Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
  15. 15Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan
  16. 16Department of Orthopaedic Surgery, Keio University, School of Medicine, Tokyo, Japan
  17. 17Department of Orthopaedic Surgery, Hokkaido University, School of Medicine, Sapporo, Japan
  18. 18Department of Orthopaedic Surgery, Akita University, School of Medicine, Akita, Japan
  19. 19Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
  20. 20Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
  21. 21Department of Spine and Joint Reconstruction, Shiga University of Medical Science, Otsu, Japan
  22. 22Department of Orthopaedic Surgery, Osaka Metropolitan University, School of Medicine, Osaka, Japan
  23. 23Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
  24. 24Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
  25. 25Department of Orthopaedic Surgery, University of Yamanashi Interdisciplinary Graduate School, Chuo, Japan
  26. 26Department of Orthopaedic Surgery, Tokai University, School of Medicine, Isehara, Japan
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Abstract

Study Design: Prospective multicenter cohort study.

Objectives: To examine associations between improvements in arm pain, neck pain, numbness, and patient satisfaction during pharmacological treatment of cervical spine disorders.

Methods: Of 256 patients with cervical spine disorders and upper extremity symptoms enrolled at 28 institutions, 220 patients (830 observations) were included. A generalized estimating equation with cluster-robust variance regressed satisfaction (5-point Likert; satisfied ≥4) on improvement in arm pain, neck pain, and numbness (NRS 0–10), adjusting for psychosocial burden (BS-POP), age, sex, and time point. An ordinal model was used as an alternative outcome specification, and sensitivity analyses were interpreted descriptively.

Results: Arm pain improvement was associated with satisfaction under both binary (OR 1.095 per point, P=.022; Holm-adjusted P=.044) and ordinal (OR 1.143, P=.019) coding. Neck pain improvement was associated with satisfaction under binary coding only (OR 1.121, P=.003; Holm-adjusted P=.009; ordinal P=.447). Numbness improvement showed the same direction but was not significant in either specification (OR 1.068, P=.106; ordinal P=.377). Confidence intervals overlapped across domains, and the arm pain estimate was attenuated under inverse-probability weighting and in diagnostic subsets. Approximately one-third of observations with persistent numbness had satisfaction scores ≥4.

Conclusions: Arm pain improvement was consistently associated with greater satisfaction, whereas the association with numbness improvement was less consistent. Residual numbness alone should not be considered treatment failure and should be interpreted alongside pain relief, neurological findings, and overall clinical condition. These findings support multidimensional assessment of treatment response rather than reliance on residual numbness alone in clinical practice.

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Cite

BibTeXRIS
BibTeX
@article{nakashima2026association,
  title = {{Association of Arm Pain, Neck Pain, and Numbness Improvement with Patient Satisfaction During Pharmacological Treatment for Cervical Spine Disorders: A Prospective Multicenter Cohort Study}},
  author = {Hiroaki Nakashima and Norimitsu Wakao and Sadayuki Ito and Takeo Furuya and Toshitaka Yoshii and Hideyuki Arima and Yu Yamato and Shiro Imagama and Yasuaki Imajo and Hiroshi Miyamoto and Gen Inoue and Masayuki Miyagi and Shunsuke Kanbara and Yoichi Iizuka and Hirotaka Chikuda and Kei Watanabe and Kazuyoshi Kobayashi and Mikito Tsushima and Masashi Miyazaki and Mitsuru Yagi and Satoshi Suzuki and Masahiko Takahata and Michio Hongo and Masao Koda and Keiji Nagata and Kanji Mori and Akinobu Suzuki and Takashi Kaito and Naohisa Miyakoshi and Hiroshi Hashizume and Yukihiro Matsuyama and Mamoru Kawakami and Hirotaka Haro and Masaya Nakamura and Masahiko Watanabe and The Project Committee of the Japanese Society for Spine Surgery and Related Research (JSSR)},
  journal = {Global Spine Journal},
  year = {2026},
  month = oct,
  doi = {10.1177/21925682261493432},
  url = {https://doi.org/10.1177/21925682261493432},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Association of Arm Pain, Neck Pain, and Numbness Improvement with Patient Satisfaction During Pharmacological Treatment for Cervical Spine Disorders: A Prospective Multicenter Cohort Study
AU  - Hiroaki Nakashima
AU  - Norimitsu Wakao
AU  - Sadayuki Ito
AU  - Takeo Furuya
AU  - Toshitaka Yoshii
AU  - Hideyuki Arima
AU  - Yu Yamato
AU  - Shiro Imagama
AU  - Yasuaki Imajo
AU  - Hiroshi Miyamoto
AU  - Gen Inoue
AU  - Masayuki Miyagi
AU  - Shunsuke Kanbara
AU  - Yoichi Iizuka
AU  - Hirotaka Chikuda
AU  - Kei Watanabe
AU  - Kazuyoshi Kobayashi
AU  - Mikito Tsushima
AU  - Masashi Miyazaki
AU  - Mitsuru Yagi
AU  - Satoshi Suzuki
AU  - Masahiko Takahata
AU  - Michio Hongo
AU  - Masao Koda
AU  - Keiji Nagata
AU  - Kanji Mori
AU  - Akinobu Suzuki
AU  - Takashi Kaito
AU  - Naohisa Miyakoshi
AU  - Hiroshi Hashizume
AU  - Yukihiro Matsuyama
AU  - Mamoru Kawakami
AU  - Hirotaka Haro
AU  - Masaya Nakamura
AU  - Masahiko Watanabe
AU  - The Project Committee of the Japanese Society for Spine Surgery
AU  - Related Research (JSSR)
PY  - 2026
DA  - 2026/10/30
JO  - Global Spine Journal
DO  - 10.1177/21925682261493432
UR  - https://doi.org/10.1177/21925682261493432
AB  - Study Design: Prospective multicenter cohort study.  Objectives: To examine associations between improvements in arm pain, neck pain, numbness, and patient satisfaction during pharmacological treatment of cervical spine disorders.  Methods: Of 256 patients with cervical spine disorders and upper extremity symptoms enrolled at 28 institutions, 220 patients (830 observations) were included. A generalized estimating equation with cluster-robust variance regressed satisfaction (5-point Likert; satisfied ≥4) on improvement in arm pain, neck pain, and numbness (NRS 0–10), adjusting for psychosocial burden (BS-POP), age, sex, and time point. An ordinal model was used as an alternative outcome specification, and sensitivity analyses were interpreted descriptively.  Results: Arm pain improvement was associated with satisfaction under both binary (OR 1.095 per point, P=.022; Holm-adjusted P=.044) and ordinal (OR 1.143, P=.019) coding. Neck pain improvement was associated with satisfaction under binary coding only (OR 1.121, P=.003; Holm-adjusted P=.009; ordinal P=.447). Numbness improvement showed the same direction but was not significant in either specification (OR 1.068, P=.106; ordinal P=.377). Confidence intervals overlapped across domains, and the arm pain estimate was attenuated under inverse-probability weighting and in diagnostic subsets. Approximately one-third of observations with persistent numbness had satisfaction scores ≥4.  Conclusions: Arm pain improvement was consistently associated with greater satisfaction, whereas the association with numbness improvement was less consistent. Residual numbness alone should not be considered treatment failure and should be interpreted alongside pain relief, neurological findings, and overall clinical condition. These findings support multidimensional assessment of treatment response rather than reliance on residual numbness alone in clinical practice.
SN  - 2192-5682
SN  - 2192-5690
ER  -