Cervicobrachial Pain Syndrome Research Articles

In search of the pathogenesis of refractory cervicobrachial pain syndrome. A deconstruction of the RSI phenomenon.

To discuss the clinical and social phenomenon of refractory cervicobrachial pain, more popularly known as repetitive strain injury (RSI), from the standpoint of medical knowledge and to present the phenomenon as a problem of chronic musculoskeletal pain in which clinical clues suggest a neuropathic pathogenesis. Published articles from both medical and non-medical literature, primarily since 1980, were integrated with our clinical experience and observations. Three sets of formal responses to the issue--medical, psychiatric and sociological--were identified and analysed with respect to the validity of their conclusions, which formed the conventional wisdom. Clinical observation revealed clues to disturbed nociception in a carefully defined set of subjects with chronic cervicobrachial pain. Theoretical pathophysiological correlations of these led to the formulation of an hypothesis. We doubt that clinical method and diagnostic logic were rigorously applied to the RSI phenomenon, which helped to produce an unresolved controversy with widespread ramifications. Our hypothesis is that there is a central disturbance of nociception in this syndrome, induced by continual afferent barrage from nociceptors in anatomically relevant sites in the neck and upper limbs. Initial and proposed testing of this hypothesis are discussed.

Stretch-induced cervicobrachial pain syndrome

The case records of 22 patients who presented with severe and persistent cervicobrachial pain were reviewed. The onset of their pain followed the performance of a forceful activity (lifting, pulling or pushing) using one or both arms in the outstretched position. Their symptoms and the findings on physical examination were both consistent with stretch-induced damage to neural tissues related to the painful upper limb. The predominant site of painful neural pathology appeared to be within the cervical spine.

The Cervico-Brachial Pain Syndrome: Muscle Activity and Pain Relief

The investigators explored whether electromyographic (EMG) mediated biofeedback would help patients with cervico-brachial pain syndrome (CBPS) reduce muscle contraction and aid in pain relief. Twenty seven volunteer subjects with medically diagnosed CBPS were randomly assigned to two groups. The experimental group received EMG biofeedback mediated muscle relaxation of the neck for five, 40 minute sessions. The participants in the other group acted as "wait list" controls, and in turn, received treatment at the end of the study. Pre and post intervention measures consisted of EMG recordings of neck muscle activity; self-report measures of neck and general body relaxation, level of pain intensity, depression, anxiety and functional impairment. The results indicated that neck muscle activity, as measured by EMG, was significantly lower at the end of training. Associated with this reduction were a significant increase in self-reported neck and body relaxation and a significant reduction in the average intensity level of pain experienced by subjects over the pre to post intervention period. No changes were reported for the other measures.