Chronic Neck Pain Group Research Articles

Movement behaviour in patients with chronic neck pain

The present study evaluated whether patients with chronic neck pain demonstrate characteristic angular movement deviations during repeated cervical spine movements. Sixteen patients with chronic neck pain and a group of 18 aged-matched healthy control subjects performed 10 repetitive maximal cervical movement cycles (flexion/extension, rotation, lateral flexion) at a self-determined velocity. To collect the kinematic data of the cervical spine, a three-dimensional ultrasonic movement analysis system (Zebris CMS70, Germany) was used. To describe the movement variability in the maximum oscillation amplitudies the intra-subject coefficients of variation (CV %) was calculated. The maximum difference was characterized by the absolute differences between the minimum and maximum oscillation amplitudes of iterated movement cycles. Pain intensity was obtained by visual analogue scales (VAS). The average pain rating of the patients with chronic neck pain indicated moderate neck pain intensity (3.7 (+/-0.8)). Independent Student's t-tests revealed a significantly decreased range of movement (ROM) in the chronic neck pain group for all anatomic values (p < 0.05), except for the lateral flexion to the right. The maximum differences and variability parameters showed significantly increased values in the chronic neck pain group in all directions (p < 0.001). Maximal cervical ROM was significantly lower, and movement variability was significantly higher, in patients compared with healthy control subjects. The differences of cervical motion variability point towards increased movement irregularities in patients with chronic neck pain. The present study shows evidence to support the hypothesis that additional information may be gained from the analysis of movement variability.

Is Temporomandibular Pain in Chronic Whiplash-Associated Disorders Part of a More Widespread Pain Syndrome?

The prevalence of temporomandibular disorders in patients with chronic whiplash-associated disorder is a controversial issue that may be influenced by the widespread pain character and psychologic distress frequently observed in patients with chronic pain. The aim of this study was to determine the prevalence of temporomandibular disorder pain, widespread pain, and psychologic distress in persons with chronic whiplash-associated disorder pain, using a controlled, single blind study design. The prevalence of temporomandibular disorder pain in the chronic whiplash-associated disorder pain group was compared with 2 control groups: a chronic neck pain group and a no neck pain group. From 65 persons, a standardized oral history was taken, a physical examination of the neck and the masticatory system was performed, widespread pain was investigated by tender point palpation, and psychologic distress was measured with a questionnaire (SCL-90). Because the recognition of temporomandibular disorder pain and neck pain remains a matter of debate, 3 well-defined classification systems were used: one based on the oral history, a second on a combination of oral history and pain on active movements and palpation, and a third one based on a combination of oral history and function tests. Irrespective of the classification system used, the chronic whiplash-associated disorder pain group more often suffered from temporomandibular disorder pain (0.001<P<0.028) and widespread pain (0.001<P<0.003) than the no neck pain group. Moreover, patients with whiplash-associated disorder showed more psychologic distress (0.000<P<0.044) than the other 2 groups. The higher prevalence of widespread pain and psychologic distress in patients with chronic whiplash-associated disorder suggests that the higher prevalence of temporomandibular disorder pain in these patients is part of a more widespread chronic pain disorder.

Widespread Sensory Hypersensitivity Is a Feature of Chronic Whiplash-Associated Disorder but not Chronic Idiopathic Neck Pain

To investigate sensory changes present in patients with chronic whiplash-associated disorders and chronic idiopathic neck pain using a variety of quantitative sensory tests to better understand the pain processing mechanisms underlying persistent symptoms. A case control study was used with 29 subjects with chronic whiplash-associated disorders, 20 subjects with chronic idiopathic neck pain, and 20 pain-free volunteers. Pressure pain thresholds were measured over the articular pillars of C2-C3, C5-C6, the median, radial, and ulnar nerve trunks in the arm and over a remote site, the muscle belly of tibialis anterior. Heat pain thresholds, cold pain thresholds, and von Frey hair sensibility were measured over the cervical spine, tibialis anterior, and deltoid insertion. Anxiety was measured with the Short-Form of the Spielberger State Anxiety Inventory. Pressure pain thresholds were decreased over cervical spine sites in both subject groups when compared with controls (P < 0.05). In the chronic whiplash-associated disorders group, pressure pain thresholds were also decreased over the tibialis anterior, median, and radial nerve trunks (P < 0.001). Heat pain thresholds were decreased and cold pain thresholds increased at all sites (P < 0.03). No differences in heat pain thresholds or cold pain thresholds were evident in the idiopathic neck pain group at any site compared with the control group (P > 0.27). No abnormalities in von Frey hair sensibility were evident in either neck pain group (P > 0.28). Both chronic whiplash-associated disorders and idiopathic neck pain groups were characterized by mechanical hyperalgesia over the cervical spine. Whiplash subjects showed additional widespread hypersensitivity to mechanical pressure and thermal stimuli, which was independent of state anxiety and may represent changes in central pain processing mechanisms. This may have implications for future treatment approaches.

Decreased isometric neck strength in women with chronic neck pain and the repeatability of neck strength measurements

Ylinen J, Salo P, Nykänen M, Kautiainen H, Häkkinen A. Decreased isometric neck strength in women with chronic neck pain and the repeatibility of neck strength measurements. Arch Phys Med Rehabil 2004;85:1303–8. Objectives To evaluate neck flexion, extension, and, especially, rotation strength in women with chronic neck pain compared with healthy controls and to evaluate the repeatability of peak isometric neck strength measurements in patients with neck pain. Design Cross-sectional. Settings Rehabilitation center and physical and rehabilitation medicine department at a Finnish hospital. Participants Twenty-one women with chronic neck pain and healthy controls matched for sex, age, anthropometric measures, and occupation. Interventions Not applicable. Main outcome measures Peak isometric strength of the cervical muscles was tested in rotation, flexion, and extension. Results Significantly lower flexion (29%), extension (29%), and rotation forces (23%) were produced by the chronic neck pain group compared with controls. When the repeated test results were compared pairwise against their mean, considerable variation was observed in the measures on the individual level. Intratester repeatability of the neck muscle strength measurements was good in all the 4 directions tested in the chronic neck pain group (intraclass correlation coefficient range, .74–.94). The coefficient of repeatability was 15N, both in flexion and extension, and 1.8Nm in rotation. On the group level, improvement up to 10% due to repeated testing was observed. Conclusions The group with neck pain had lower neck muscle strength in all the directions tested than the control group. This factor should be considered when planning rehabilitation programs. Strength tests may be useful in monitoring training progress in clinical settings, but training programs should be planned so that the improvement in results is well above biologic variation, measurement error, and learning effect because of repeated testing.

Are cervical physical outcome measures influenced by the presence of symptomatology?

Outcome measures must be repeatable over time to judge changes as a result of treatment. It is unknown whether the presence of neck pain can affect measurement reliability over a time period when some change could be expected as a result of an intervention. The present study investigated the reliability of two measures, active cervical range of movement (AROM) and pressure pain thresholds (PPTs), in symptomatic and asymptomatic subjects. A repeated-measures study design with one week between testing sessions was used. Nineteen healthy asymptomatic subjects and 19 subjects with chronic neck pain participated in the study. The neck movements measured were: flexion, extension, right and left lateral flexion, and axial rotation. PPTs were measured over six bilateral sites, both local and remote to the cervical spine. The between-week intra-class correlation coefficients (ICCs2,1) for AROM ranged from 0.67 to 0.93 (asymptomatic group) and from 0.64 to 0.88 (chronic neck pain group). Standard error of measurement (SEM) was similar in both groups, from 2.66 degrees to 5.59 degrees (asymptomatic group) and from 2.36 degrees to 6.72 degrees (chronic neck pain group). ICCs2,1 for PPTs ranged from 0.70 to 0.91 (asymptomatic group) and from 0.69 to 0.92 (chronic neck pain group). SEM ranged from 11.14 to 87.71 kPa (asymptomatic group) and from 14.25 to 102.95 kPa (chronic neck pain group). The findings of moderate to very high between-week reliability of measures of AROM and PPTs in both asymptomatic and chronic neck pain subjects suggest the presence of symptomatology does not adversely affect reliability of these measures. The results support the use of these measures for monitoring change in chronic neck pain conditions.

Orthopedics (77)

Can discography cause long‐term back symptoms in previously asymptomatic subjects? (Stanford University School of Medicine, Stanford, CA) Spine 2000;25:1803–1808.This prospective controlled study aimed to determine whether discography might cause long‐term low back symptoms in selected patients. Twenty‐six patients without preexisting low back pain were observed for 1 year after lumbar discography to determine the effects of lumbar discography in 3 experimental groups: 10 patients who had remote cervical spine surgery with excellent results (pain‐free group); 10 patients who had the same surgery with poor results (chronic pain group); and 6 patients who had primary somatization disorders. Two control groups were also observed: a group of patients with somatization disorder who were similarly evaluated but without discography and a group of patients with low back pain observed for 1 year after discography without surgery. In the 3 experimental groups (no back pain before discography) no subject with normal psychometric testing had persistent pain after discography (0/11), whereas 6 (40%) of the 15 with abnormal psychometric tests results reported significant new low back pain. None of the pain‐free group (0/10), 20% of the chronic neck pain group (2/10), and 66% of the somatization group (4/6) continued to have significant back pain 1 year after injection. Psychological testing and occupational disability strongly predicted continued pain after discography. The control groups had no significant change in low back symptomatology during the year of observation. Conclude that discography in a subject group without low back pain, but with significant emotional and chronic pain problems may result in reports of significant back pain for at least 1 year after injection. Subjects with normal psychometric test results had no reports of significant long‐term back pain after discography.