Neck Pain Patients Research Articles

Comparison between Immediate Effect of Postero-Anterior and Antero-Posterior Cervical Mobilization on Chronic Mechanical Neck Pain

Abstract Background: Chronic mechanical neck pain is a common problem that can cause economic and social problems for an individual, although there were different types of joint mobi-lization that have an effect on pain but it still debates which type is more effective than others. Aim of Study: This study was conducted to compare the immediate effect of different techniques of cervical mobiliza-tion (anterior posterior-posterior anterior) on pain intensity in chronic mechanical neck pain. Subjects and Methods: Forty five chronic mechanical neck pain patients were recruited and assigned into 3 groups 2 study and one control group, Group A, B and C with their mean age SD (27.6±6.77), (27.07±6.42) and (28.8±6.99) years with BMI (27.32±2.37), (26.43±2.08) and (26.38±2.14) KG/m2 were recruited and assigned into three groups (two study and one control groups). The study groups (A) and (B) received the mobilization technique (posterior anterior-anterior posterior respectively) and the control group (C) received only ultra-sound assessment was conducted by VAS for pain intensity. Results: There was significant difference in each group (A), (B), and (C) pre and post treatment on pain intensity (p=0.0001). While comparison between the two-study group and the control group, in post treatment effect on pain there was non-significant difference between group (A and B) (p=0.285) and significant difference between groups (A and C), and (B and C) (p=0.0001). Conclusion: There was an immediate effect of posterior anterior-anterior posterior mobilization on pain intensity in patients with chronic mechanical neck pain, but in compare between the two different technique the posterior anterior mobilization had the more immediate effect on decreasing pain.

Effects of McKenzie Exercise on the Neck Muscles Fatigue, and Neck Disability Index in Chronic Neck Pain Patients

Effects of McKenzie Exercise on the Neck Muscles Fatigue, and Neck Disability Index in Chronic Neck Pain Patients

Hub disruption in patients with chronic neck pain: a graph analytical approach.

Chronic pain is known to alter the brain's network dynamics. These dynamics are often demonstrated by identifying alterations in the brain network topology. A common approach used for this purpose is graph theory. To date, little is known on how these potentially altered networks in chronic pain relate to the symptoms reported by these patients. Here, we applied a graph theoretical approach to identify network changes in patients suffering from chronic neck pain, a group that is often neglected in chronic pain research. Participants with chronic traumatic and nontraumatic neck pain were compared to healthy pain-free controls. They showed higher levels of self-reported symptoms of sensitization, higher levels of disability, and impaired sensorimotor control. Furthermore, the brain suffering from chronic neck pain showed altered network properties in the posterior cingulate cortex, amygdala, and pallidum compared with the healthy pain-free brain. These regions have been identified as brain hubs (ie, regions that are responsible for orchestrating communication between other brain regions) and are therefore known to be more vulnerable in brain disorders including chronic pain. We were furthermore able to uncover associations between these altered brain network properties and the symptoms reported by patients. Our findings indicate that chronic neck pain patients reflect brain network alterations and that targeting the brain in patients might be of utmost importance.

Comparing the range of musculoskeletal therapies applied by physical therapists with postgraduate qualifications in manual therapy in patients with non-specific neck pain with international guidelines and recommendations: An observational study

The aim of this study is to compare Dutch usual care musculoskeletal therapy in patients with non-specific neck pain with recommendations from international clinical practice guidelines. Physical therapy is diverse, as it may consist of exercise, massage, advice, and other modalities. Physical therapists with post graduate qualifications in manual therapy (MT) may additionally apply spinal thrust manipulation or non-thrust mobilization techniques to treat neck pain. It is important that, in the absence of a Dutch clinical guideline for the treatment of patients with neck pain, musculoskeletal therapists use the available recommendations from international clinical practice guidelines when treating patients with neck pain. One updated clinical practice guideline was identified (Blanpied, 2017), a report from the Task Force on Neck Pain (Guzman et al., 2008) and the IFOMPT International Framework for Examination of the Cervical Region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy Intervention (Rushton et al., 2014). At baseline 1193 patients are included and data with regard to pain, disability, fear avoidance, expectations and applied treatment modalities are gathered. Outcome is measured using the Global Perceived Effect questionnaire. Results show that patients with acute neck pain are treated significantly more often with manipulation compared to patients with sub-acute or chronic neck pain (p < .000) and younger patients are treated with manipulation more often than older patients (p < .000). In the presence of comorbidity, the preference of spinal manipulation seems to diminish, in favour of mobilization and exercise. Almost every patient receives multimodal therapy (94.3%) and spinal manipulation and mobilization are rarely used as a stand-alone treatment (4.5% and 0.8%). Dutch musculoskeletal therapists choose treatment strategies that correspond with recommendations from international guidelines.

Recurrent neck pain patients exhibit altered joint motion pattern during cervical flexion and extension movements

BackgroundImpaired sensorimotor ability has been demonstrated in recurrent neck pain patients. It is however not clear if cervical joint motion and pressure pain sensitivity in recurrent neck pain patients are different from asymptomatic controls. MethodsCervical flexion and extension motions were examined by video-fluoroscopy and pressure pain thresholds were assessed bilaterally over C2/C3, C5/C6 facet joints and right tibialis anterior in eighteen recurrent neck pain patients and eighteen healthy subjects. Individual joint motion was analyzed by dividing fluoroscopic videos into 10 epochs. The motion opposite to the primary direction (anti-directional motion) and motion along with the primary direction (pro-directional motion) of each joint were extracted across epochs. Total joint motion was the sum of anti-directional and pro-directional motions. Joint motion variability was represented by the variance of joint motions across epochs. FindingsCompared to controls, recurrent neck pain patients showed: 1) decreased anti-directional motion at C2/C3 and C3/C4 (P < 0.05) and increased anti-directional motion at C5/C6 and C6/C7 (P < 0.05) during extension motion. 2) Increased overall anti-direction motion during flexion motion (P < 0.05). 3) Lower joint motion variability at C3/C4 during extension motion (P < 0.05). InterpretationRecurrent neck pain patients showed a redistribution of anti-directional motion between the middle cervical spine and the lower cervical spine during cervical extension and increased overall anti-directional motion during cervical flexion compared with healthy controls. The anti-directional motion was more sensitive to neck pain compared to other cervical joint motion parameters in the present study.

Reliability and validity of the Turkish version of the Core Outcome Measures Index for the neck pain.

The Core Outcome Measures Index (COMI) is a short and multidimensional scale covering all domains recommended to be included in outcome measures for patients with neck pain. The purpose of the present study was to translate and cross culturally adapt the COMI into Turkish and to test its reliability and validity in patients with neck pain. One hundred and six patients with a complaint of chronic neck pain (> 3months) were enrolled in the present study. Participants completed a questionnaire booklet containing the COMI-neck, Neck Disability Index (NDI), Neck Pain and Disability Scale (NPDS), Short Form-36 (SF-36), and pain Numeric Rating Scale (NRS). The validation of the COMI included the assessment of its construct validity and reliability. Cronbach's alpha value of the questionnaire was found to be 0.774 indicating a high internal consistency. Intraclass correlation coefficient values for test-retest reliability were found to be in the range of 0.817-0.986, which indicates a sufficient level of test-retest reliability. Pearson's correlation coefficient values of the COMI with SF-36, NDI, NPDS, and NRS ranged between 0.417 and 0.700, indicating a good correlation. Considering the analyses, it was concluded that the Turkish version of the COMI is a valid and reliable scale for chronic neck pain patients. These slides can be retrieved under Electronic Supplementary Material.

Examination of Regional Interdependence Theory in Chronic Neck Pain: Interpretations from Correlation of Strength Measures in Cervical and Pain-Free Regions.

Impairments present in chronic pain conditions have been reported not to be limited to the painful region. Pain-free regions have also been proposed to be adversely affected as a cause or consequence of the painful condition. The aim of this study was to investigate the association between muscle strength in painful and pain-free regions and chronic neck pain. A cross-sectional study. Rehabilitation hospital laboratory. One hundred twenty-two patients with chronic neck pain (87 female) and 98 asymptomatic volunteers (52 female) were included in the study. Maximal isometric strength measures of the neck, scapulothoracic, shoulder, trunk, and hip muscles were assessed using a hand-held dynamometer in all participants. Pain intensity and pain-related disability were also assessed in patients through visual analog scale and Neck Disability Index scores, respectively. Principal component analysis revealed one component for each of the studied regions. Multivariate analysis of variance found neck (d = 0.46), scapulothoracic (d = 0.46), shoulder (d = 0.60), trunk flexor (d = 0.38), extensor (d = 0.36), and hip (d = 0.51) strength components to be lower in the neck pain patients compared with asymptomatic participants (P < 0.01). Logistic and linear regression analyses found the shoulder strength component both to be a significant predictor for neck pain occurrence (β = 0.53, P < 0.01) and to have a considerable effect on pain intensity score (β=-0.20, P = 0.02), respectively. The results found that some pain-free regions in addition to the cervical spine to exhibit lower levels of muscular strength in neck pain patients. These findings support the regional interdependence theory, which proposes that impairments are not limited to the painful area and are possibly mediated by central mechanisms.

Development and validation of a case-finding algorithm for neck and back pain in the Canadian Armed Forces using health administrative data

Introduction: In military organizations, neck and back pain are a leading cause of clinical encounters, medical evacuations out of theatres of operations, and involuntary release from service. However, tools to efficiently and accurately study these conditions in Canadian Armed Forces (CAF) personnel are lacking, and little is known about their distribution across the Canadian military. Methods: We reviewed the medical charts of 691 randomly sampled CAF personnel, and determined whether these subjects had suffered from neck or back pain at any point during the 2016 calendar year. We then developed an algorithm to identify neck or back pain patients, using large clinical and administrative databases. The algorithm was then validated by comparing its output to the results of our medical chart review. Results: Of the 691 randomly sampled subjects, 190 (27%) had experienced neck or back pain at some point during the 2016 calendar year, 43% of whom had experienced chronic pain (i.e. pain lasting for at least 90 consecutive days). Our final algorithm correctly identified 65% of all patients with past-year pain, and 80% of patients with past-year chronic pain. Overall, the algorithm’s measures of diagnostic accuracy were as follows: 65% sensitivity, 97% specificity, 91% positive predictive value, and 88% negative predictive value. Discussion: We have developed an algorithm that can be used to identify neck and back pain in CAF personnel efficiently. This algorithm is a novel research and surveillance tool that could be used to provide the epidemiological data needed to guide future intervention and prevention efforts.

Strength and Range of Motion in the Contralateral Side to Pain and Pain-Free Regions in Unilateral Chronic Nonspecific Neck Pain Patients.

The aim of the study was to determine whether strength and range of motion deficits are present in patients with unilateral chronic neck pain at contralateral side to pain and at other regions. Forty-nine patients with unilateral chronic neck pain and 98 asymptomatic subjects participated in this case-control study. Range of motion and muscle strength of the cervical, shoulder, trunk, and hip regions were assessed bilaterally using inclinometer and dynamometer, respectively. Chronic neck pain patients demonstrated reduced cervical, shoulder, and trunk range of motion in their ipsilateral side to pain comparing the asymptomatic participants (P < 0.05). The ipsilateral side to pain cervical and shoulder range of motion were also significantly lower than the contralateral side to pain (P < 0.05). Significant differences were also observable in the contralateral side to pain comparing the asymptomatic group (P < 0.05). Cervical, shoulder, and scapulothoracic muscles were found weaker both in the ipsilateral side to pain and contralateral side to pain comparing the asymptomatic group (P < 0.05). Ipsilateral side to pain and contralateral side to pain in hip flexors were also found to be significantly weaker than the asymptomatic group (P < 0.01). The results revealed range of motion and strength deficits in the pain-free regions of the body in unilateral chronic neck pain patients. Findings support the regional interdependence theory and emphasize the need for managing seemingly intact neighboring and more remote regions in unilateral chronic neck pain patients.

42. The impact of surgical decompression on neck pain outcomes in patients with degenerative cervical myelopathy: results from the multicenter prospective AOSpine studies

BACKGROUND CONTEXT Surgery is increasingly recommended for the treatment of degenerative cervical myelopathy (DCM) as it effectively halts neurological progression and improves functional impairment, disability and quality of life. Although neck pain is a common complaint in patients with DCM, high-quality, prospective studies that summarize the incidence and severity of preoperative pain and evaluate the impact of surgery on pain outcomes are scarce. PURPOSE The objectives of this study are to (1) summarize the incidence and severity of preoperative pain in patients with DCM and (2) assess pain outcomes at 2 years following surgery. STUDY DESIGN/SETTING Ambispective cohort study. PATIENT SAMPLE From 2005 to 2011, 757 patients with DCM were enrolled in either the AOSpine North America or International study at 16 global sites. All patients underwent surgical decompression of the cervical spine and were followed up for 2 years postoperatively. A total of 664 patients had complete preoperative pain scores and 497 had pain outcomes at 2 years following surgery. Patients who reported no neck pain before surgery were excluded from the outcome analysis as they had no room for improvement. OUTCOME MEASURES Pain intensity subscore of the Neck Disability Index (NDI). METHODS As part of the NDI questionnaire, patients were asked to rate their neck pain as none, very mild, moderate, fairly severe, very severe or the worst imaginable. Frequencies and percentages were used to summarize the incidence and severity of preoperative pain and to describe pain outcomes at 2 years following surgery. Paired t-tests were conducted to determine differences in mean NDI pain intensity scores between baseline and 2 years postoperatively. Finally, the percentage of patients who exhibited an improvement, no change, or regression in pain scores was computed for each preoperative intensity group. Logistic regression was used to compute odds ratios with confidence intervals to determine whether pain improvement was associated with preoperative pain severity. RESULTS At baseline, 138 (20.8%) patients indicated they had no pain, whereas 134 (20.2%) rated their pain as very mild, 185 (27.9%) as moderate, 130 (19.6%) as fairly severe, 64 (9.6%) as very severe and 13 (2.0%) as the worst imaginable. At 2-year follow-up, 263 (67.6%) patients exhibited an improvement in their neck pain intensity score by at least one point, with 156 (40.1%) reporting no pain at all. The overall pain intensity score decreased from 2.3±1.0 to 1.1±1.2 (mean change: 1.1, 95% CI: 1.0 to 1.3, p-value CONCLUSIONS To our knowledge, this is the first multicenter, international study to quantify the preoperative incidence and severity of neck pain in patients with DCM and demonstrate significant improvements in neck pain at 2 years after surgery. Further studies are needed to evaluate important predictors of improvement in neck pain. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Cervical surgery rate in neck pain patients with and without acupuncture treatment: a retrospective cohort study.

Surgical treatment of neck pain often entails high costs and adverse events. The present cohort study investigated whether utilisation of acupuncture in neck pain patients is associated with a reduced rate of cervical surgery. The Korean National Health Insurance Service National Sample Cohort (NHIS-NSC) database was retrospectively analysed to identify the 2 year incidence of cervical surgery in Korean patients suffering neck pain from 2004 to 2010. The incidence was calculated and compared between patients receiving and not receiving acupuncture treatment using Cox proportional hazards models. Cumulative survival rates were compared using Kaplan-Meier survival analysis. The acupuncture and control groups included 50 171 and 128 556 neck pain patients, respectively. A total of 50 161 patients were selected in each group following propensity score matching with regard to sex, age, income and Charlson comorbidity index. The hazard ratio (HR) for surgery within 2 years was significantly lower in the acupuncture group compared with the control group (HR 0.397, 95% CI 0.299 to 0.527). In addition, subgroup analyses according to gender, age and income revealed consistent results for both men (HR 0.337, 95% CI 0.234 to 0.485) and women (HR 0.529, 95% CI 0.334 to 0.836); the results were consistently observed across all age and income strata. Sensitivity analysis with varying numbers of acupuncture treatments and treatment course duration also consistently indicated lower HRs for surgery within 2 years in the acupuncture group compared with the control group. A significantly lower HR for cervical surgery was observed in neck pain patients following acupuncture treatment. Acupuncture treatment may therefore be an effective method for managing neck pain, and has the potential to mitigate unnecessary surgery. These findings need to be confirmed by prospective studies.

Correlation between cervical lordosis and cervical disc herniation in young patients with neck pain.

Abnormal cervical curvature and cervical disc herniation are closely related to neck pain and should be taken into account before any treatment. However, studies have rarely reported on the correlation between cervical lordosis and cervical disc herniation in patients with neck pain. Therefore, in this study, we collect young neck pain patients with abnormal cervical curvature to evaluate the relationship between cervical lordosis and cervical disc herniation.Three hundred patients below 40 years old with neck pain were enrolled. Patient sex, age, apical vertebra, segment of intervertebral disc protrusionl, sagittal diameter of spinal duramater, saggital diameter of spinal canal, height of disc space were recorded, and the cervical curvature, and degree of cervical spinal cord compression (G/F ratio) were calculated. The change of degree of disc herniation and degree of cervical spinal cord compression were analyzed in different cervical curvature groups. Further more, collected these patients who had improved cervical curvature over a period of time, to compare the changes of degree of disc herniation, G/F ratio, and height of disc space.The median age of patients with kyphosis was lower than those with lordosis and straight cervical spine. The degree of disc herniation was higher in the straight and kyphosis groups compared to the lordosis group. Cervical lordosis was inversely correlated with the degree of disc herniation and positively with G/F ratio. Cervical curvature was significantly affected by sex, age, and the degree of disc herniation. With the improvement of cervical lordotic curvature, the degree of disc herniation decreased and height of disc space increased.The degree of disc herniation and cervical spinal cord compression are inversely correlated to cervical lordosis in young neck pain patients, and the degree of disc herniation and height of disc space can recover with the recovery of cervical lordotic curvature. These findings may indicating a link between cervical curvature and degenerative changes which have important clinical implications.

Cervical intradural disc herniation with Brown-Séquard syndrome: case report and literature review.

ObjectiveTo report a rare case of cervical intradural disc herniation (IDH) with Brown-Séquard syndrome and to review the related literature.MethodsPathogenesis, preoperative diagnosis, and the surgical technique are discussed, and previous literature reports are reviewed.ResultsA 44-year-old woman complained of weakness of the left upper and lower extremities and paresthesias in the right limbs after a bicycle ride 3 days earlier. She had a history of neck pain for 2 years prior. CT showed obvious ossification of the posterior longitudinal ligament (OPLL), and MRI revealed C3-7 disc herniations, with a positive “halo sign” around the herniated C4/5. We performed emergency decompression through anterior cervical corpectomy, and vertebrotomy decompression and fusion. At review 3 months after surgery, the patient’s neck pain was markedly relieved, and motor strength in the limbs had improved. At 1 year after surgery, she had recovered completely.ConclusionCervical IDH is a rare condition that may be related to the traumatic inflammatory response and OPLL. Relatively rare imaging features such as the hawk-beak sign, halo sign, Y sign, and epidural gas sign could help in preoperative diagnosis. Prompt anterior cervical decompression is the preferred treatment for this condition.

Recruitment and inclusion procedures as "pain killers" in clinical trials?

BackgroundRecruitment and inclusion procedures in clinical trials are time critical. This holds particularly true for studies investigating patients with fluctuating symptom patterns, like those with chronic neck pain. In a feasibility study on neck pain, we found a clinically relevant decrease in pain ratings within the recruitment period. This paper analyses the phenomenon and gives recommendations for recruitment procedures in clinical trials on pain.MethodsChanges in pain intensity scores of 44 chronic neck pain patients (6 males and 36 females; mean age: 45.3±13.2 years) between the first telephone contact and baseline assessment were analyzed. Inclusion criterion was a mean pain intensity of ≥40 on a 0–100 numerical rating scale during the last three months. Statistical analyses were performed using ANOVA and parametric/non-parametric correlation coefficients.ResultsAverage pain intensity score decreased significantly from 60.3±13.3 at telephone interview to 38.1±21.7 at baseline assessment. This represents a relative change of 36.8%. A weak but significant negative correlation was found between number of days between assessments and pain rating differences. There was a positive correlation between change of pain intensity and the pain level at the first contact, indicating that the decreased pain ratings over time were also dependent on the initial pain rating.ConclusionsThe clinically significant changes in pain intensity were weakly related to waiting time and moderately dependent on initial pain intensity, suggesting regression to the mean. The natural course of the disease and the Hawthorne effect are also discussed as contributing factors.

Age-related kinematic performance should be considered during fast head-neck rotation target task in individuals aged from 8 to 85 years old.

Kinematic behavior during fast cervical rotations is a useful parameter for assessing sensorimotor control performances in neck-pain patients. However, the influence of age in asymptomatic individuals from children to older people still needs to be explored. Our aim was to assess the impact of age on sensorimotor control performance of the head-neck with execution time and kinematic variables (time of task, mean speed/acceleration/deceleration, overshoots (OSs), minimum/maximum speed) during standardized fast rotation target task using the DidRen Laser test. A total of 80 volunteers were stratified in four different age-groups: Children (8–14 years): n = 16; Young Adults (18–35 years): n = 29; Old Adults (36–64 years): n = 18; Seniors (65–85 years): n = 17. Results showed that to perform the test, Children were slower (69.0 (60.6–87.3)s) compared to Young Adults (49.6 (45.6–55.6)s) with p < 0.001, and Old Adults (51.7 (48.4–55.8)s) with p < 0.001. It was also slower in Seniors (57 (52.3–67.6)s) compared to Young Adults with p < 0.013. Mean speed was slower in Children (9.4 ± 2.3 °s−1) and Seniors (10.6 ± 2.4 °s−1) compared to Young Adults (13.7 ± 1.9 °s−1) with p < 0.001 and Old Adults (13.3 ± 2.4 °s−1) with p < 0.001. Mean acceleration was slower for Children (8.4(7.6–10.2) °s−2) compared to Young Adults (11.1 (8.8–15.3) °s−2) with p < 0.016, and Old Adults (12.0(8.4–15.3) °s−2) with p < 0.015. Mean deceleration was slower for Children (−1.9(−2.6–1.4) °s−2) compared to Young Adults (−2.9(−3.7–2.5) °s−2) with p < 0.001 and Old Adults (−3.2(−3.7–2.3) °s−2) with p < 0.003. The DidRen Laser test allows us to discriminate age-specific performances for mean speed, acceleration and deceleration. Seniors and Children needed to be slower to become as precise as Young Adults and Old Adults. No difference was observed for OSs which assesses accuracy of movement. Age should therefore be considered as a key parameter when analyzing execution time and kinematic results during DidRen Laser test. These normative data can therefore guide clinicians in the assessment of subjects with neck pain.

Pain, disability and adherence to home exercises in patients with chronic neck pain: long term effects of phone surveillance. A randomized controlled study.

Effectiveness of phone surveillance and other communication technologies in the management of neck pain patients have been evaluated previously only at the suspension of the service. To verify whether a phone surveillance program can improve pain, disability, and adherence to home exercises in neck pain patients, and whether the improvement achieved continues to be maintained also after suspension of the support. This is a randomized controlled study. Outpatients of Rehabilitation Unit. 84 out of 100 outpatients consecutively randomized (by blocks of four) to Phone group (N.=42, performing a 6-month home-based phone surveillance program) or to Control group (N.=42, with the only recommendation to continue exercising at home without phone surveillance) were considered. The home-based phone surveillance program consisted of 12 scheduled phone calls, each performed every fortnight by a nurse-tutor with expertise in rehabilitation for the first six months of the study. At the end of phone surveillance period, Phone patients were encouraged to continue home exercises for a further 6 months period. Pain severity (assessed with Pain VAS), disability (Neck Disability Index), and adherence to exercises performed at home (classified as: ≥5 sessions/week, 2-4 sessions/week, occasional or no sessions) were outcome measures. Pain severity and disability were assessed at entry, at 6 and 12 months, while adherence to exercises was self-reported and recorded at 6 and 12 months. Differences between groups were analyzed with χ2 test, Student's t-test or ANOVA. At 6 months, Pain VAS (P=0.013) and Neck Disability Index scores (P=0.012) were lower in Phone patients than Controls. At 12 months, Neck Disability Index scores (P=0.026) continued to be lower in Phone patients than Controls. At 6 months, 97.6% of Phone patients and 80.9% of Controls performed rehabilitation at home with a range of 2 to 7 sessions/week; while at 12 months, the respective percentages of Phone and Control patients were 92.9% and 73.8%. Adherence to home exercises was higher in Phone patients than in Controls at 6 (P=0.013) and 12 months (P=0.019). In patients with chronic neck pain, the positive effects of phone surveillance on the neck disability and adherence to home exercises still persist 6 months after the suspension of the support. This knowledge can be useful for physicians to plan home rehabilitation of neck pain patients.

Thoracic Posture and Mobility in Mechanical Neck Pain Population: A Review of the Literature.

Neck pain is a common condition with several proposed biomechanical contributing factors. Thoracic spine dysfunction is hypothesized as one of the predisposing factors, which necessitates the need to explore the contribution of thoracic posture and mobility toward neck pain. Accordingly, the present work aimed to review the existing literature investigating the presence of thoracic spine dysfunction in individuals with neck pain. A literature search was conducted in the three electronic databases of PubMed, CINAHL, and Web of Science. Studies published between 1990 and 2017 were considered. After reviewing the abstracts, two authors independently scrutinized the full-text documents for their relevance. The initial search yielded 2,167 articles, of which nine studies involving comparisons of neck pain patients and healthy controls were identified for the review. Increased thoracic kyphosis was positively correlated with the presence of forward head posture but not uniformly associated with neck pain intensity and disability. Thoracic mobility was reduced in the neck pain population, and the role of thoracic kyphosis as a risk factor for pain development could not be confirmed. Thus, an association exists between thoracic kyphosis and postural alteration in the cervical spine. The review favors the inclusion of thoracic spine assessment and treatment in mechanical neck pain patients. Further studies are needed to investigate the cause-effect relationship between thoracic posture and cervical dysfunction.

Experiences With Chiropractic Care for Patients With Low Back or Neck Pain.

Background:Musculoskeletal disorders are the second leading cause of disability worldwide.Objective:Examine experiences of chiropractic patients in the United States with chronic low back or neck pain.Method:Observational study of 1853 chronic low back pain and neck pain patients (74% female) who completed an online questionnaire at the 3-month follow-up that included Consumer Assessment of Healthcare Providers and Systems (CAHPS) items assessing their experiences with care.Results:We found similar reports of communication for the chiropractic sample and patients in the 2016 CAHPS National Database, but 85% in the database versus 79% in the chiropractic sample gave the most positive response to the time spent with provider item. More patients in the CAHPS database rated their provider at the top of the scale (8 percentage points). More chiropractic patients reported always getting answers to questions the same day (16 percentage points) and always being seen within 15 minutes of their appointment time (29 percentage points).Conclusions:The positive experiences of patients with chronic back and neck pain are supportive of their use of chiropractic care.

Is the presence of neck pain associated with more severe clinical presentation in patients with migraine? A cross-sectional study.

To investigate the association between the presence of self-reported neck pain in patients with migraine and clinical features, upper cervical mobility, and neck muscle performance. A total of 142 patients with migraine were recruited and stratified by the presence (n = 99) or absence of self-reported neck pain (n = 43). The clinical examination included the Migraine Disability Assessment, the 12-item Allodynia Symptom Checklist, a flexion rotation test, and the Craniocervical Flexion Test. Migraine-related disability was reported by more than 80% in both groups (p = 0.82). However, there was a greater prevalence and severity of cutaneous allodynia observed in the group with neck pain (p < 0.001). Reduced upper cervical mobility was verified in 67% of the patients with neck pain and in 41% of those without neck pain (p = 0.005). In addition, 67% of the patients with neck pain and 40% without neck pain were not able to maintain the third stage of the Craniocervical Flexion Test without compensation (p = 0.003). The presence of self-reported neck pain in patients with migraine was associated with a poor clinical presentation regarding cutaneous allodynia, neck mobility, and muscle function. However, there were no differences in migraine-related disability.

Prevalence and risk factors of axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery

ObjectivesThe aim of this study was to explore the prevalence and risk factors for axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery.MethodsIn this study, 88 patients, who underwent multilevel anterior cervical decompression with fusion surgery from January 2012 to January 2017, were retrospectively reviewed. Based on the postoperative axial neck pain, the patients were classified into two groups: axial pain group and no axial pain group. The patients were followed up 3 weeks, 3 months, and 1 year after cervical anterior surgery for the early- and long-term clinical evaluation. The possible effect factors included demographic variables (age, sex, BMI, smoking, drinking, heart disease, hypertension, diabetes, preoperative kyphosis, preoperative axial neck pain, preoperative JOA scores, and ODI) and surgery-related variables (surgical option, vertebral lesions, spinal canal stenosis rate, superior fusion segment, presence of intramedullary high signal intensity).ResultsThe prevalence of axial neck pain was 27.3% (24 cases of 88). Our results showed that preoperative axial neck pain (62% vs 23%, P < 0.001) and preoperative kyphosis (42% vs 21.9%, P < 0.001) were risk factors for axial pain after multilevel anterior cervical surgery. Additionally, for patients with preoperative cervical kyphosis, compared to no axial pain group, the axial neck group was significantly more likely to exist a higher preoperative angle of C2–7 (13.31 ± 2.33 vs 7.33 ± 2.56, P < 0.001) and a higher correction range for kyphosis (20.24 ± 4.12 vs 12.34 ± 3.12, P < 0.001). However, for all the patients with postoperative axial symptoms, the improvement rate of axial pain was significantly higher for patients without cervical kyphosis at the early-term follow-up (3 weeks) (P = 0.032), no significant differences were found at the medium-term (P = 0.554) and long-term follow-up (P = 0.902), and improvements of clinical symptom have no obvious difference at the last follow-up.ConclusionsOverall, preoperative axial neck pain and kyphosis could predict axial neck pain for patients undergoing multilevel anterior cervical decompression with fusion surgery, and recovery of cervical kyphosis may contribute to the long-term recovery of neural function, but may also suffer from risk of short-term axial pain, which could be reduced through moderate cervical curvature recovery.