An Exploratory Study Of The Combined Effect Of Yogic Practices and Physiotherapy On Reducing Neck Pain Among Working Women of Punjab

Background: Tai Chi is emerging as a promising treatment for a variety of pain conditions, including chronic nonspecific neck pain. Given this trend, it is important to better understand the dose-response relationship and how pain, anxiety, and depression impact this relationship. Method: This secondary analysis used data from the Tai Chi arm (age = 52.03 ± 10.92 years; 73.68% female; n = 38) of a randomized controlled trial for chronic nonspecific neck pain. The authors tested whether (1) greater home practice time or cumulative practice time during the intervention predicted greater post-treatment reductions in neck pain intensity and (2) reporting greater neck pain intensity during the current week relative to other weeks was associated with lower home practice time during the current week. Post hoc analyses were conducted to evaluate whether baseline anxiety and depression levels moderated the association between weekly pain intensity and weekly home practice time. Results: While cumulative Tai Chi practice time (i.e., home practice + class time) was associated with post-treatment reductions in neck pain intensity, home practice time alone was not associated with post-treatment reductions in neck pain. Participants with low and moderate baseline anxiety were found to practice less than usual on weeks when pain intensity was worse, while participants with high baseline anxiety were found to practice more than usual on weeks when pain intensity was worse. Baseline depression levels did not moderate the effect of weekly pain intensity on weekly home practice time. Conclusions: Combined class and at-home exposure to Tai Chi appears to be critical to reductions in chronic nonspecific neck pain. In addition, anxiety may be an important characteristic that partially governs the dose-response relationship in participants with chronic nonspecific neck pain. Clinical Trial Registration: NCT02222051.

Chronic neck pain is a common problem with a poorly understood pathophysiology. Often no underlying structural pathology can be found and radiological imaging findings are more related to age than to a patient's symptoms. Besides its common occurrence, chronic idiopathic neck pain is also very disabling with almost 50% of all neck pain patients showing moderate disability at long-term follow-up. Central sensitization (CS) is defined as "an amplification of neural signaling within the central nervous system that elicits pain hypersensitivity," "increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input," or "an augmentation of responsiveness of central neurons to input from unimodal and polymodal receptors." There is increasing evidence for involvement of CS in many chronic pain conditions. Within the area of chronic idiopathic neck pain, there is consistent evidence for the presence and clinical importance of CS in patients with traumatic neck pain, or whiplash-associated disorders. However, the majority of chronic idiopathic neck pain patients are unrelated to a traumatic injury, and hence are termed chronic idiopathic non-traumatic neck pain. When comparing whiplash with idiopathic non-traumatic neck pain, indications for different underlying mechanisms are found. The goal of this article was to review the existing scientific literature on the role of CS in patients with chronic idiopathic non-traumatic neck pain. Systematic review. All selected studies were case control studies. A systematic search of existing, relevant literature was performed via the electronic databases Medline, Embase, Web of Science, Cinahl, PubMed, and Google Scholar. All titles and abstracts were checked to identify relevant articles. An article was considered eligible if it met following inclusion criteria: (1) participants had to be human adults (> 18 years) diagnosed with idiopathic non-traumatic chronic (present for at least 3 months) neck pain; (2) papers had to report outcomes related to CS; and (3) articles had to be full-text reports or original research (no abstracts, case-reports, reviews, meta-analysis, letters, or editorials). Six articles were found eligible after screening the title, abstract and - when necessary - the full text for in- and exclusion criteria. All selected studies were case-control studies. Overall, results regarding the presence of CS were divergent. While the majority of patients with chronic traumatic neck pain (i.e. whiplash) are characterized by CS, this is not the case for patients with chronic idiopathic neck pain. The available evidence suggests that CS is not a major feature of chronic idiopathic neck pain. Individual cases might have CS pain, but further work should reveal how they can be characterized. Very few studies available. Literature about CS in patients with chronic idiopathic non-traumatic neck pain is rare and results from the available studies provide an inconclusive message. CS is not a characteristic feature of chronic idiopathic and non-traumatic neck pain, but can be present in some individuals of the population. In the future a subgroup with CS might be defined, but based on current knowledge it is not possible to characterize this subgroup. Such information is important in order to provide targeted treatment.

Office workers with chronic neck pain demonstrates signs of widespread hyperalgesia, less efficient descending pain modulation, which could indicate sensitization of central pain pathways. No studies have assessed a wide variety of office workers with different chronic neck pain disorders and assessed the impact of pain intensity on assessments of central pain pathways. This study aimed to assessed pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM) and to associate these with pain intensity and disability in subgroups of office workers. One hundred-and-seventy-one office workers were distributed into groups of asymptomatic and chronic neck pain subjects. Chronic neck pain was categorized as chronic trapezius myalgia and chronic non-specific neck pain and as 'mild-pain' (Visual Analog Scale [VAS]≤3) and 'moderate-pain' (VAS>3) groups. PPTs, TSP, CPM, and Copenhagen Psychosocial Questionnaire II were assessed in all subjects. Neck Disability Index and Pain Catastrophizing Scale were assessed in all the symptomatic office workers. PPTs were lower in moderate pain (n=49) and chronic trapezius myalgia (n=56) compared with asymptomatic subjects (n=62, p<0.05). TSP was facilitated in moderate pain group compared with mild pain (n=60, p<0.0001) group and asymptomatic subjects (p<0.0001). No differences were found in CPM comparing the different groups (p<0.05). Multiple regression analysis identified Neck Disability Index and TSP as independent factors forprediction of pain intensity in chronic trapezius myalgia(R2=0.319) and chronic non-specific neck pain (R2=0.208). Somatic stress, stress and sleep as independent factors in chronic non-specific neck pain (R2=0.525), and stress in moderate pain group (R2=0.494) for the prediction of disability. Office workers with chronic trapezius myalgia and moderate pain intensity showed significant signs of widespread pressure hyperalgesia. Moreover, the moderate pain group demonstrated facilitated TSP indicating sensitization of central pain pathways. Neck Disability Index and TSP were independent predictors for pain intensity in pain groups. Sleep and stress were independent predictors for disability.

Abstract- Neck pain is one of the most common musculoskeletal condition on a global scale in India, 67% of population experience neck pain and out of that 20% develop chronic type neck pain. In health care students neck pain is caused due to lower mobility in daily life, sleep disturbance and poor ability to perform activity of daily living due to neck pain. MFR is a manual therapy technique used to improve range of motion, decrease pain and enhance tissue recovery. Aerobic exercise promote anti-inflammatory cytokines. Aim &amp; Objectives: To evaluate the effect of aerobic exercise in terms of pain, endurance and functional activity. To estimate the effect of aerobic exercise and MFR with foam roller in improving pain among health care students in term of functional outcome, reducing pain, muscles relaxation and enhancing Lymphatic drainage and posture correction. Methodology: An observational study conducted among healthcare student with 60 participant. Inclusion criteria- No history of fracture, no neurological, chronic neck pain without medication Age group 18-30 years with both male and female participants, chronic neck pain without administration of medications. Exclusion criteria -underwent any recent therapeutic intervention, any associated psychological illness, neck instability and other degenerative disorder, acute neck pain with/without radiculopathy, vertigo, and headache. Result: There is beneficial effect of using MRF technique with foam roller and aerobic exercise among healthcare students with chronic pain. Conclusion: This study helps us to conclude that aerobic exercise using MFR with foam roller has more positive effect in terms of reducing neck pain and increasing functional function activity. Clinical Relevance: There is reduction in pain and it will improved mobility. Prolong sitting and improper ergonomics can contribute to poor posture. Combination of MFR and aerobic exercise can enhance all over functional performance. Key words: Myofascial Release, NDI, Aerobic Exercise, Foam Roller, Neck Pain

Neck pain is a common and recurrent condition affecting between 30 to 50% of adults in any given year. People experiencing neck pain commonly report difficulties in performing activities involving the upper extremity. Furthermore, clinical trials that have included exercises that target the shoulder girdle have shown beneficial effects in reducing neck pain. These observations are feasible based on the biomechanical dependence of the cervical spine and shoulder girdle, which includes common muscle attachments. However, to date there has been a paucity of studies investigating underlying movement disorders of the shoulder girdle in people with neck pain. This is in part due to the challenges of kinematic measurement in this region. The aim of this thesis is to contribute to the literature concerning the role of the shoulder girdle and thorax complex in neck pain from three perspectives. First, the thesis has further refined and informed measurement methods of shoulder girdle and thoracic kinematics (Studies 1-3). Secondly, the thesis further defined normative kinematics of the region with a focus on upright resting posture (Study 4). Thirdly, the thesis explored differences in shoulder girdle and thoracic resting posture in upright standing in those with and without neck pain (Study 5).Advancement in knowledge concerning normal and impaired function of the shoulder girdle has been hindered by challenges related to 3D motion capture of the shoulder girdle and thorax due to skin movement and the complexity of measuring multiple joints and axes of rotation. Therefore, Study1 focused on refining and validating an acromion marker cluster (AMC) method to track scapular movement with the intent of minimising skin movement error. Although the findings of Study 1 indicated that the refined AMC design did not appear to lessen skin movement error compared to previous designs, it was found to be of comparable accuracy (max RMSE 4.45°) and reliability to previous designs (within- ession test-retest ICC 0.79-0.99) and appropriate for use in the subsequent thesis studies. In Study 2 the reliability and validity of the AMC method was further evaluated in its capacity to track the scapula at end range clavicular movements (protraction/retraction, elevation/depression). Establishing its measurement accuracy and reliability (max RMSE 6.6°) in these common directions of scapula motion was necessary as it had been previously unstudied. While Studies 1 and 2 focused on optimising the measurement of scapulothoracic kinematics by ensuring the scapula could be tracked accurately, Study 3 focused on refining the measurement of the relationship between the shoulder girdle and the underlying thorax. This study compared thoracic and shoulder girdle postural relationships expressed in the external reference frame to that expressed in the traditionally used ISB recommended thorax reference frame. Using these different frames of reference Study 3 also compared measures of thoracic inclination and thoracic curvature. The findings showed that measurements of thoracic inclination expressed in the external reference frame provided additional insight into scapulothoracic relationship compared to traditional measurements in the thorax reference frame. Study 4 then utilized the refined measurements of the scapula and thorax to more accurately describe normative shoulder girdle parameters, and to identify individual characteristics underpinning variations in these parameters, in a large cohort of asymptomatic individuals. This study demonstrated that scapular resting posture is strongly associated with thoracic inclination (scapular anterior/posterior tilt) and clavicular posture (scapular internal and upward rotation). Based on the results of Study 4, shoulder girdle resting posture and thoracic spine parameters were compared in individuals with (n=53) and without (n=100) chronic neck pain. The results presented in Study 5 show that mild differences in shoulder girdle and thoracic posture may exist between people with and without chronic non-specific neck pain. In summary, this thesis explores and improves upon the current methodology of investigating relationships between the thorax and shoulder girdle. It further defines normative characteristics of shoulder girdle kinematics and thus enabled comparison to a neck pain population. Understanding these relationships and the association between shoulder girdle function and neck pain will facilitate future development of patient-centred management approaches for those suffering with neck pain.

Background: Chronic neck pain is a common problem in the adult population with a typical 12- month prevalence of 30% to 50%. Cervical disc herniation and radiculitis is one of the common conditions described responsible for chronic neck and upper extremity pain. Cervical epidural injections for managing chronic neck pain with disc herniation are one of the commonly performed non-surgical interventions in the United States. However, the literature supporting cervical interlaminar epidural steroids in managing chronic neck pain is scant. Study Design: A randomized, double-blind, controlled trial. Setting: A private interventional pain management practice and specialty referral center in the United States. Objectives: To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in providing effective and long-lasting relief in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis, and to evaluate the differences between local anesthetic with or without steroids. Methods: Patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received cervical interlaminar epidural injections with 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone. Outcomes Assessment: Multiple outcome measures were utilized. They included the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake. Assessments were done at baseline and 3, 6, and 12 months post-treatment. Significant pain relief was defined as 50% or more; significant improvement in disability score was defined as a reduction of 50% or more. Results: Significant pain relief (≥ 50%) was demonstrated in 77% of patients in both groups. Functional status improvement was demonstrated by a reduction (&gt; 50%) in the NDI scores in 74% of Group I and 71% of Group II at 12 months. The overall average procedures per year were 3.7 ± 1.1 in Group I and 4.0 ± 0.91 in Group II; the average total relief per year was 39.45 ± 11.59 weeks in Group I and 41.06 ± 11.56 weeks in Group II over the 52 week study period in the patients defined as successful. The initial therapy was considered to be successful if a patient obtained consistent relief with 2 initial injections lasting at least 4 weeks. All others were considered failures. Limitations: The study results are limited by the lack of a placebo group and a preliminary report of 70 patients, 35 in each group. Conclusion: Cervical interlaminar epidural injections with local anesthetic with or without steroids might be effective in 77% of patients with chronic function-limiting neck pain and upper extremity pain secondary to cervical disc herniation and radiculitis. Key words: Chronic neck pain, cervical disc herniation, upper extremity pain, cervical epidural injections, epidural steroids, local anesthetics

Background: Neck pain is a key public health issue that affects the human beings with reduction productivity and quality of life and produced significant socioeconomic burden on society. It is necessary to raise public awareness about risk factors and preventive treatments of chronic neck pain. Neck pain is fairly common and has a significant impact on a person's quality of life. According to Statistics, neck issues also contribute significantly to occupational illness and disability. This study aims to assess the frequency of neck pain, decreased range of motion, and disability among chronic neck pain with the goal of raising awareness about the risks and promoting preventative measures, such as ergonomic design, postural re- education, and regular exercise. Objective: The aim of this study is to Comparison of McKenzie Exercise Program Versus Routine Physical Therapy Management on Pain, Range of Motion and Function with Chronic Mechanical Neck Pain. Methods: A randomized clinical trial study was conducted on 50 patients with chronic neck pain. Subjects were randomly divided into two interventional groups where group A received Routine physical therapy (joint mobilization, Hot pack and home exercise program) and McKenzie exercise group B received Routine physical therapy for total duration 12 week. Outcome measure such as pain, function and range of motion will be assessed by NPRS, NDI and Goniometer respectively. Assessment will be done at 4th, 6th and 12th week. Results: 50 participants with mean age 46.2±5.9 years while BMI of participant with standard deviation was 21.4±2.6. Normality of data which was analyzed by Shapiro-Walk test comparing variables such as NPRS, NDI and ROM. For NPRS p value was &lt;0.05 which showed that data was not normally distributed and non-parametric test were used for this variable to show difference like Fried Man test for within group analysis and Man Whitney test for between group analysis. But for NDI and ROM p value was &gt;0.05 which showed that data was normally distributed and parametric tests such as Repeated measure ANOVA for within group analysis and Mixed Model ANOVA for between group analysis were used. Conclusion: It is concluded that both groups are equally effective in management of chronic neck pain based on P &gt; 0.05 between group analysis and within group analysis But McKenzie exercises have a great effect on pain relief, Improvement in range of motion and Disability.

Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are perceptions of benefit. Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. This update replaces our 2006 Cochrane review update on this topic. To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015. We searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005. We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasi-randomised controlled trials (RCTs). Two review authors made independent decisions for each step of the review: article inclusion, data abstraction and assessment of quality of trial methods. We assessed study quality by using the Cochrane Back Review Group 'Risk of bias' tool. We used consensus to resolve disagreements, and when clinical heterogeneity was absent, we combined studies by using random-effects meta-analysis models. Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants).For mechanical neck pain, we found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement.Statistical pooling was appropriate for acupuncture compared with sham for short-term outcomes due to statistical homogeneity (P value = 0.83; I(2) = 20%).Results of the meta-analysis favoured acupuncture (standardised mean difference (SMD) -0.23, 95% confidence interval (CI) -0.20 to -0.07; P value = 0.0006). This effect does not seem sustainable over the long term.Whether subsequent repeated sessions would be successfulwas not examined by investigators in our primary studies.Acupuncture appears to be a safe treatment modality, as adverse effects are minor. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncture treatments were cost-effective.Since the time of our previous review, the quality of RCTs has improved, and we have assessed many of them as having low risk of bias. However, few large trials have provided high-quality evidence. Moderate-quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short-term follow-up, and that those who received acupuncture report less pain and disability at short-term follow-up than those on a wait-list. Moderate-quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short-term follow-up.

Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are perceptions of benefit. Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. This update replaces our 2006 Cochrane review update on this topic. To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015. We searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005. We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasi-randomised controlled trials (RCTs). Two review authors made independent decisions for each step of the review: article inclusion, data abstraction and assessment of quality of trial methods. We assessed study quality by using the Cochrane Back Review Group 'Risk of bias' tool. We used consensus to resolve disagreements, and when clinical heterogeneity was absent, we combined studies by using random-effects meta-analysis models. Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants).For mechanical neck pain, we found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement.Statistical pooling was appropriate for acupuncture compared with sham for short-term outcomes due to statistical homogeneity (P value = 0.83; I2 = 20%).Results of the meta-analysis favoured acupuncture (standardised mean difference (SMD) -0.23, 95% confidence interval (CI) -0.20 to -0.07; P value = 0.0006). This effect does not seem sustainable over the long term.Whether subsequent repeated sessions would be successfulwas not examined by investigators in our primary studies.Acupuncture appears to be a safe treatment modality, as adverse effects are minor. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncture treatments were cost-effective.Since the time of our previous review, the quality of RCTs has improved, and we have assessed many of them as having low risk of bias. However, few large trials have provided high-quality evidence. Moderate-quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short-term follow-up, and that those who received acupuncture report less pain and disability at short-term follow-up than those on a wait-list. Moderate-quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short-term follow-up.

Acupuncture for neck disorders

Background: Non-specific neck pain (NNP) affects 30–50% of the general population, and it often leads to severe disability. Several manual therapy techniques are available to reduce pain and disability and to improve cervical range of motion and functional activities. Muscle Energy Technique (MET) showed more evidence for treating such a disorder. The aim of this current scientific literature analysis was to compare the clinical effects of MET with the other manual or rehabilitative treatments for non-specific acute and chronic neck pain. Methods: The literature search was conducted using the following databases: PubMed, Medline, PEDro, Cochrane Database, and Google Scholar from 2010 to January 2020. Clinical trials about MET were included. The quality of the trials was assessed according to the PEDro scale. Results: Twenty-one papers according to inclusion and exclusion criteria were selected: 15 studies about non-specific acute neck pain and 6 studies about non-specific chronic neck pain. Conclusions: This analysis suggests that the MET approach has a good clinical effect on reducing neck pain in patients with acute neck pain and improves cervical range of motion in patients with chronic neck pain, and is better if combined with a traditional rehabilitative approach. This review’s findings should be considered with caution for physiotherapy practice because of the studies’ methodologic limitations. On the basis of the current available and limited evidence, clinicians could combine MET with traditional physiotherapy and other manual techniques when treating people with non-specific neck pain.

The comorbidity of mental and physical disorders with self-reported chronic back or neck pain: Results from the China Mental Health Survey

Background: Chronic neck pain is a common problem in the adult population with a typical 12-month prevalence of 30% to 50%, and 14% of the patients reporting grade II to IV neck pain with high pain intensity and disability that has a substantial impact on health care and society. Cervical epidural injections for managing chronic neck pain are one of the commonly performed interventions in the United States. However, the literature supporting cervical epidural steroids in managing chronic pain problems has been scant and no systematic review dedicated to the evaluation of cervical interlaminar epidurals has been performed in the past. Study Design: A systematic review of cervical interlaminar epidural injections. Objective: To evaluate the effect of cervical interlaminar epidural injections in managing various types of chronic neck and upper extremity pain emanating as a result of cervical spine pathology. Methods: The available literature of cervical interlaminar epidural injections in managing chronic neck and upper extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF) for therapeutic interventions. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to November 2008, and manual searches of bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term &gt; 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: The indicated evidence is Level II-1 in managing chronic neck and upper extremity pain. Limitations: The limitations of this systematic review include the paucity of literature and lack of randomized trials performed under fluoroscopy. Conclusion: The results of this systematic evaluation of cervical interlaminar epidural injection showed significant effect in relieving chronic intractable pain of cervical origin and also providing long-term relief with an indicated evidence level of Level II-1. Key words: Cervical disc herniation, cervical post surgery syndrome, cervical spinal stenosis, cervical radiculitis, cervical interlaminar epidural injections, local anesthetic steroids, chronic discogenic pain

Editorial

Background It is unclear whether the prevalence of chronic low back pain is higher in chronic whiplash patients than in the general population. In a population-based study, we evaluated the prevalence of chronic low back pain in individuals with chronic neck pain of traumatic and non-traumatic origin, with special emphasis on whiplash injury.Subjects and methods Additional questions concerning the patient's experience of neck and low back pain were added to the questionnaire of the MONICA health survey. 4,415 subjects aged 25–64 years were randomly selected from a geographically well-defined area in northern Sweden.Results The prevalences of chronic low back pain and chronic neck pain were 16% and 17%, respectively. 51% of subjects had both back and neck pain. Of the patients with neck pain, one quarter had a history of neck injury, which was related to whiplash injury in almost one-half of the cases. The prevalence of chronic low back pain in individuals with chronic non-traumatic neck pain was 53%, and it was 48% in those with chronic neck pain and a history of neck trauma. There was no difference in the prevalence of chronic low back pain between whiplash injury and other types of neck trauma. Confounding factors such as sex, age, marital status, BMI, smoking status and level of education were not significantly different between traumatic and non-traumatic groups.Interpretation Independently of traumatic or non-traumatic origin of the symptoms, the prevalence of chronic low back pain is 3 times higher in individuals with chronic neck pain than in the general population. Causes other than a history of neck trauma, such as chronic muskuloskeletal pain syndromes, may be important in evaluation of these cases. ▪