Motor Imagery and Action Observation of Specific Neck Therapeutic Exercises Induced Hypoalgesia in Patients with Chronic Neck Pain: A Randomized Single-Blind Placebo Trial.

Luis Suso-Martí,Roy La Touche,Ferran Cuenca-Martínez,Jose Vicente León-Hernández,Alba Paris-Alemany

doi:10.3390/jcm8071019

Abstract

The aim of the present study was to explore the pain modulation effects of motor imagery (MI) and action observation (AO) of specific neck therapeutic exercises both locally, in the cervical region, and remotely. A single-blind, placebo clinical trial was designed. A total of 30 patients with chronic neck pain (CNP) were randomly assigned to an AO group, MI group, or placebo observation (PO) group. Pain pressure thresholds (PPTs) of C2/C3, trapezius muscles, and epicondyle were the main outcome variables. Secondary outcomes included heart rate measurement. Statistically significant differences were observed in PPTs of the cervical region in the AO and MI groups between the preintervention and first postintervention assessment. Significant differences were found in the AO group in the epicondyle between the preintervention, first and second post-intervention assessments. Regarding heart rate response, differences were found in the AO and MI groups between the preintervention and average intervention measurements. AO and MI induce immediate pain modulation in the cervical region and AO also induces remote hypoalgesia. OA appears to lead to greater pain modulation as well as a greater heart rate response, however, both should be clinically considered in patients with CNP.

Highlights

Chronic neck pain (CNP) is a common musculoskeletal disorder with a high prevalence, and is the fourth leading condition that generates significant disability [1,2]
No statistically significant differences were found between groups for any of the primary variables, demographic data, or self-report variables at baseline between
Our results show that both motor imagery (MI) and action observation (AO) induced an immediate pain modulation response in the cervical region, it was not sustained in the second measurement after the intervention

Summary

Introduction

Chronic neck pain (CNP) is a common musculoskeletal disorder with a high prevalence, and is the fourth leading condition that generates significant disability [1,2]. Specific neck therapeutic exercise (SNTE) training of the deep neck musculature is widely used and might reduce pain and disability in patients with CNP compared with other types of conservative treatment [5]. The mental practice paradigms of motor simulation, such as action observation (AO) and motor imagery (MI), have recently been developed as a neurocognitive treatment tool for chronic pain [9,10]. AO evokes an internal, real-time motor simulation of the movements that the observer perceives visually [12] Both mental practice paradigms trigger the activation of the neurocognitive mechanisms that underlie the planning and execution of voluntary movements in a manner that resembles how the action is performed in real life [13,14,15]. It has been shown that both MI and AO lead to changes in the ANS that cause sympathetic responses, and the neurophysiological base appears to be centrally controlled [16,17,18]

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