My doctor tells me they can now predict which patients with neck pain are likely to get better with physical therapy and who won't improve. Since I was referred to PT, I assume I'm one who is likely to benefit. What is this decision based on?

With the increasing costs of all aspects of medical treatment, patient referral to physical therapy (PT) and other health services must be based on evidence of positive results. Predicting which patients can benefit from PT is the focus of numerous studies.

There are several factors that have been consistently identified by many researchers as predictors of results. Patients with one or more of these predictive factors are at increased risk for treatment failure. These include manual labor, severe pain intensity, and neck pain lasting more than three months.

A new study from England has added two more factors that may be even more reliable than these items already listed. Low expectations of treatment and catastrophizing most of the time have now been placed at the top of the list of predictive factors for poor outcome.

Patients who catastrophize describe their pain in emotional terms. They use words like torturing, dreadful, or terrible to describe their symptoms. They are more likely to report that the pain is killing me. Or they declare they will never get better--ever.