Network and cluster analyses reveal the central role of disability and the presence of nociplastic pain features in cervical radiculopathy

Valter Devecchi; Åsa Dedering; Anneli Peolsson; Deborah Falla

doi:10.1016/j.jpain.2026.106282

Network and cluster analyses reveal the central role of disability and the presence of nociplastic pain features in cervical radiculopathy

J Pain. 2026 Mar 31:44:106282. doi: 10.1016/j.jpain.2026.106282. Online ahead of print.

Authors

Valter Devecchi¹, Åsa Dedering², Anneli Peolsson³, Deborah Falla⁴

Affiliations

¹ Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom.
² Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden; The Health and Medical Care Administration, Region Dalarna, Falun, Sweden.
³ Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Campus US, Linköping, Sweden; Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, Campus US, Linköping, Sweden.
⁴ Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom. Electronic address: d.falla@bham.ac.uk.

PMID: 41933814
DOI: 10.1016/j.jpain.2026.106282

Abstract

Cervical radiculopathy (CR) is a neuropathic condition characterized by heterogeneous clinical presentations affecting musculoskeletal, neurological, and psychological domains. The variable success of CR management may result from a limited consideration of this complexity and a mismatch between treatment strategies and the predominant pain mechanisms, often overlooking the presence of nociplastic pain features. This cross-sectional study aimed to examine the relationships among clinical, musculoskeletal, neurological, and psychological features in patients with CR using a network analysis, and to identify patient subgroups with distinct clinical profiles, specifically testing for the presence of features characteristic of nociplastic pain. A cohort of patients with CR was assessed using validated measures across the musculoskeletal, neurological, clinical, and psychological domains. Network analysis was performed to determine the most influential variables and their interconnections. Cluster analysis was conducted to identify subgroups based on symptom profiles. Network analysis revealed that disability was the most central variable, directly associated with self-efficacy, fear avoidance, pain severity, and cervical mobility. Cluster analysis identified three clusters along a continuum of severity. The most severe cluster, representing ∼25% of the cohort, exhibited a complex and mixed profile with the highest disability, pain, psychological distress, multisite pain, sleep disturbances, musculoskeletal impairments, and widespread sensorimotor alterations; all features characteristic of nociplastic pain. Disability is a key factor in the experience of CR, and the existence of a patient subgroup with a complex presentation and nociplastic features highlights that effective management of CR requires a personalised, multimodal approach that directly targets the main drivers of disability. PERSPECTIVE: This study integrates network and cluster analyses to understand the relationships between clinical, musculoskeletal, neurological, and psychological factors in cervical radiculopathy. Disability was the central, bridging variable across domains. The presence of a cluster with features characteristic of nociplastic pain supports the need for multimodal, mechanism-based management of cervical radiculopathy.

Keywords: Cervical radiculopathy; Cluster analysis; Network analysis; Nociplastic pain; Pain phenotypes.