Increased Neck Pain Research Articles

Gender differences on chest pain perception associated with acute myocardial infarction in Chinese patients: a questionnaire survey

To investigate gender differences in chest pain perception among Chinese patients with acute myocardial infarction. Thrombolytic therapy is beneficial to outcomes of acute myocardial infarction if administered within 12 hours from the onset of chest pain. However, cardiac symptom interpretation may impact time of presentation to hospital. Differences in cardiac symptom reports by gender partly explain misdiagnoses and delays in treatment, particularly among women. Whether, such trends apply to Chinese patients with myocardial infarction is unknown. A descriptive prospective study. Using questionnaires, data on demographic variables, the number of patients reporting chest pain and other chest sensations at the onset of acute myocardial infarction and chest pain intensity, description, location and radiation across the chest were collected. A total of 128 participants equally divided by gender were recruited. Chest pain was more prevalent among men than women (84.37% vs. 67.19%, p < 0.05). Although no statistical significance was found, Chinese men had higher mean chest pain intensity scores (7.54 SD 2.35 vs. 7.51 SD 2.25) and reported less atypical chest pain (0.00% vs. 9.3%) compared with women. Men had more upper right sided chest pain (40.74% vs. 20.93%, p = 0.038) whereas women experienced increased neck pain and pain to the upper central chest, middle central chest, upper central back, middle central back and middle right back regions. Discreet gender differences in chest pain perceptions exist between Chinese men and women, with the latter group, who may be considered as a high-risk group for missed and delayed diagnosis from myocardial infarction, reporting more atypical presentations. Irrespective of culture, women with myocardial infarction tend to present with atypical chest pain symptoms and therefore they should be aggressively investigated.

Predictors of Adverse Events Following Chiropractic Care for Patients With Neck Pain

Objective This study examines which variables may predict adverse events in subjects undergoing chiropractic treatment for neck pain. Methods This was a prospective, multi-center, cohort study. All new patients, 18 to 65 years of age with neck pain of any duration, who had not undergone chiropractic care or manual therapy in the prior 3 months, were eligible. Sources of data were questionnaires administered during the first 3 treatments. In all, 60 putative prognostic variables were examined, including descriptors of the patient, chiropractor, and type of treatment delivered. Adverse events were defined as either a new complaint, or the worsening of an existing complaint by more than 30% on an 11-point numerical rating scale. Multivariate random coefficients logistic regression analyses were conducted to determine predictors for the following outcome variables: (1) any adverse event after any of the first 3 visits, (2) any type of adverse event after the first visit only, and (3) specific types of adverse events after the first visit only (ie, headache, increased neck pain, pain and/or stiffness at the treated area). Results In total, 579 patients were recruited, of whom 529 fulfilled the inclusion criteria. The reported use of a manipulative technique involving cervical rotation, and working status of the patient (sick leave or workers' compensation) were moderately associated with an adverse event after any of the first 3 visits. Patients who had visited their general practitioner in the 6 months before treatment, however, were less likely to have an adverse event. A longer duration with neck pain in the preceding year was moderately associated with specific types of events after the first visit, namely, headache or worsening of the presenting neck pain. Increased neck pain after the first visit was the easiest outcome variable to predict (area under the curve, 0.88; 95% confidence interval, 0.84-0.91). Conclusions Of the 60 independent variables examined, only 4 were found to be predictive of adverse events after chiropractic treatment for neck pain, one of which was found to be protective. The chiropractic practitioner can identify 3 of these variables before initiating treatment.

Frequency and Clinical Predictors of Adverse Reactions to Chiropractic Care in the UCLA Neck Pain Study

Randomized clinical trial. To document the types and frequencies of adverse reactions associated with the most common chiropractic treatments for neck pain, and to identify possible clinical predictors of adverse reactions to chiropractic treatment. Chiropractic care is frequently sought by patients for relief from neck pain; however, adverse reactions related to its primary modes of treatment have not been well examined. A total of 336 patients with neck pain presenting to 4 southern California health care clinics were randomized in a balanced 2 x 2 x 2 factorial design to manipulation with or without heat, and with or without electrical muscle stimulation (EMS); and mobilization with or without heat and with or without EMS. Discomfort or unpleasant reactions from chiropractic care were self-assessed at 2 weeks after the randomization/baseline visit. Of the 280 participants (83%) who responded, 85 (30.4%) had 212 adverse symptoms as a result of chiropractic care. Increased neck pain or stiffness was the most common symptom, reported by 25% of the participants. Less common were headache and radiating pain. Patients randomized to manipulation were more likely than those randomized to mobilization to have an adverse symptom occurring within 24 hours of treatment (adjusted odds ratio [OR] = 1.44, 95% confidence interval [CI] = 0.83, 2.49). Heat and EMS were only weakly associated with adverse symptoms (heat: OR = 0.94, 95% CI = 0.54, 1.62; EMS: OR = 1.09, 95% CI = 0.63, 1.89). Moderate-to-severe neck disability at baseline was strongly associated with adverse neurologic symptoms (OR = 5.70, 95% CI = 1.49, 21.80). Our results suggest that adverse reactions to chiropractic care for neck pain are common and that despite somewhat imprecise estimation, adverse reactions appear more likely to follow cervical spine manipulation than mobilization. Given the possible higher risk of adverse reactions and lack of demonstrated effectiveness of manipulation over mobilization, chiropractors should consider a conservative approach for applying manipulation to their patients, especially those with severe neck pain.

Complications and side effects of cervical and lumbosacral selective nerve root injections

Huston CW, Slipman CW, Garvin C. Complications and side effects of cervical and lumbosacral selective nerve root injections. Objective To determine the incidence of complications and side effects of cervical and lumbosacral selective nerve root injections (SNRIs). Design Prospective, nonrandomized controlled trial of consecutive patients with independent interviews for immediate, 1-week, and 3-month follow-ups. Setting Tertiary, academic spine center. Participants Of 160 patients eligible for SNRI, 151 underwent 306 SNRIs (study group). Sixty patients who had not undergone any intervention served as the control group. Interventions Diagnostic and therapeutic fluoroscopically guided cervical and lumbosacral SNRIs. Lidocaine (Xylocaine) was used in the diagnostic injections and a mixture of lidocaine and betamethasone was used in the therapeutic injections. Main outcome measures Complications and side effects experienced during the procedure were recorded by the interventionalist. Side effects and complications experienced immediately, 1 week, and 3 months after injection were determined through independent interviews using a questionnaire format. The control group was independently interviewed using the same questionnaire. Results There were no major complications, such as death, paralysis, spinal nerve injury, infection, or allergic reaction, during the study. Ninety-one percent of subjects had no side effects during the procedure. A positive response on interview was reported by 39.4% of the study subjects immediately after the procedure. Lumbosacral SNRI side effects were as follows: increased pain at the injection site (17.1%); increased radicular pain (8.8%); lightheadedness (6.5%); increased spine pain (5.1%); nausea (3.7%); nonspecific headache (1.4%); and vomiting (0.5%). Immediate side effects from cervical SNRI were as follows: increased pain at injection site (22.7%); increased radicular pain (18.2%); lightheadedness (13.6%); increased spine pain (9.1%); nonspecific headache (4.5%); and nausea (3.4%). At the 1-week interview, comparison of the study and control groups showed statistical significance for the following: pain at injection site, cervical ( P=.001) and lumbar ( P=.005); nonspecific headache, cervical ( P=.019); and nonspinal headache, cervical ( P=.002). At 3 months, 2 subjects complained of increased neck pain and 1 reported heartburn and fluid retention. Two lumbar SNRI subjects were lost to follow-up. Conclusions There were no major complications with cervical and lumbosacral SNRIs, although various minor side effects occurred.

Complications of fluoroscopically guided interlaminar cervical epidural injections

Botwin KP, Castellanos R, Rao S, Hanna AF, Torres-Ramos FM, Gruber RD, Bouchlas CG, Fuoco GS. Complications of fluoroscopically guided interlaminar cervical epidural injections. Arch Phys Med Rehabil 2003;84:627–33. Objectives: To assess the incidence of complications of fluoroscopically guided interlaminar cervical epidural injections. Design: A retrospective cohort design study. Setting: A multidisciplinary spine care center. Participants: One hundred fifty-seven consecutive patients with cervical radicular pain caused by cervical spondylosis or herniated nucleus pulposus confirmed by magnetic resonance imaging or computed tomography scanning. Interventions: Fluoroscopically guided interlaminar cervical epidural injections were performed at the C7-T1 or C6–7 level using an 18-gauge, 9-mm Tuohy needle with 2mL of 1% lidocaine (Xylocaine) and 80-mg of triamcinolone acetonide (Kenalog). All injections were performed consecutively over a 12-month period by 1 of 5 physicians. Main Outcome Measures: An independent observer reviewed medical charts, which included a 24-hour postprocedure telephone call by an ambulatory surgery center nurse who asked a standardized questionnaire about complications after the injections. Also reviewed were physician notes regarding office follow-up consultations 3 weeks or less after the injections and epidurograms. Results: The charts of 157 patients, who received 345 injections, were reviewed. Complications per injection included 23 increased neck pain (6.7%), 16 transient nonpositional headaches that resolved within 24 hours (4.6%), 6 episodes of insomnia the night of the injection (1.7%), 6 vasovagal reactions (1.7%), 5 facial flushing (1.5%), 1 fever the night of the procedure (0.3%), and 1 dural puncture (0.3%). The incidence of all complications per injection was 16.8%. Conclusions: Because all complications resolved without morbidity and no patient required hospitalization, fluoroscopically guided interlaminar cervical epidural injections may be a safe procedure for use in patients with cervical radicular pain.

Measurement of pain among electricians with neck dysfunction

The aim of the study was to develop a pain measurement instrument in Swedish intended for use in epidemiological surveys, and to report the pain assessments of individuals in a working population. The focus was on somato-sensory description in relation to work performance. The material comprised 22 randomly selected electricians attending health checkups, and reporting neck pain during the past week. The pain estimations were made in oral interviews using a specially developed questionnaire. Neck extension and hands above shoulder height caused increased neck pain in all the subjects. The quantitative assessments of present pain showed a limited intensity. To describe the pain quality a wide spectrum of words was used as pain descriptors, but five adjectives were preferred. The more the pain was spread on the pain drawing, the more differentiated was the assessment of its quality. The results concluded that the pain assessment instrument might be useful in epidemiological investigations of musculoskeletal neck dysfunctions.

Measurement of pain among electricians with neck dysfunction

The aim of the study was to develop a pain measurement instrument in Swedish intended for use in epidemiological surveys, and to report the pain assessments of individuals in a working population. The focus was on somato-sensory description in relation to work performance. The material comprised 22 randomly selected electricians attending health checkups, and reporting neck pain during the past week. The pain estimations were made in oral interviews using a specially developed questionnaire. Neck extension and hands above shoulder height caused increased neck pain in all the subjects. The quantitative assessments of present pain showed a limited intensity. To describe the pain quality a wide spectrum of words was used as pain descriptors, but five adjectives were preferred. The more the pain was spread on the pain drawing, the more differentiated was the assessment of its quality. The results concluded that the pain assessment instrument might be useful in epidemiological investigations of musculoskeletal neck dysfunctions.