Neck Pain Intensity Research Articles

CUPPING THERAPY: A PRUDENT APPROACH IN PAIN MANAGEMENT-A SYSTEMATIC REVIEW

BACKGROUND AND AIMS Cupping Therapy is an ancient form of alternative medicine for treating variety of musculoskeletal disorders. Number of studies indicated the efficacy of various cupping methods in decreasing neck or back pain intensity within short duration and improves quality of life. DATABASES AND ELIGIBILITY CRITERIA The experimental studies were searched on the electronic databases including Google Scholar, PEDro, PubMed and Cochrane Library from June 2015 to December 2019. It was ensured that all articles were full-text in English language whereas screening was executed on relevant titles and abstracts, evaluated on the basis of cupping therapy and its effects on musculoskeletal pain. RESULTS A total of eight out of ten experimental studies showed significant decrease (p<0.05) in spinal pain in result of cupping therapy except for the two studies that demonstrated no significant pre-post group differences (p>0.05).

Immediate Effects of Dry Needling and Myofascial Release on Local and Widespread Pressure Pain Threshold in Individuals With Active Upper Trapezius Trigger Points: A Randomized Clinical Trial

ObjectiveThis study sought to compare the immediate effects of a single session of dry needling (DN), myofascial release (MR), and sham DN on pressure pain threshold (PPT) and neck pain intensity in individuals with chronic neck pain. MethodsThis was a randomized trial with a blinded outcome assessor. Forty-four individuals with chronic neck pain and unilateral myofascial trigger points in the upper trapezius muscle (UTM) were randomized to receive DN (n = 15), MR (n = 14), or sham DN (n = 15). The PPT over the UTM (ipsilateral and contralateral sides) and the proximal head of the radius (ipsilateral and contralateral to the treated side) and neck pain were assessed immediately and 10 minutes after the intervention. ResultsThere was no significant Group × Time interaction for PPT in the UTM on the treated side (F = 0.63, P = .641) or the contralateral side (F = 1.77, P = .144). However, there was a main effect of time on both the treated side (F = 4.917, P = .001) and the contralateral side (F = 4.70, P = .015), with DN and MR increasing PPT at the UTM. No significant Group × Time × Side interaction was found for PPT at the proximal head of the radius (F = 1.23, P = .276). Within-group analysis revealed a significant increase in PPT on the ipsilateral and contralateral sides in both DN and MR. Neck pain decreased after DN (P < .001), MR (P < .001), and sham DN (P = .008). ConclusionA single application of DN or MR generated local and distant hypalgesic responses superior to placebo. Future trials are needed to examine whether these findings occur in long-term follow-ups.

The Second Short Form of the McGill Pain Questionnaire as the useful additional tool for differential diagnostics of migraine and cervicogenic headache

OBJECTIVE To study the effectiveness of the Second Short Form of the McGill Pain Questionnaire (SF-MPQ-2) as an instrument for assessment and comparison of quantitative characteristics of pain in patients with chronic musculoskeletal impairment of the cervical spine and nonspecific neck pain accompanied by chronic migraine or cervicogenic headache (CeH). MATERIAL AND METHODS Forty-nine patients, aged from 19 to 60 years (mean age 42.8±10.4), were divided into 2 comparable by age and gender groups with migraine (n=18) and CeH (n=31). Neck pain and headache intensity was measured by the 11-points Numerical Rating Scale (NRS). Quality of pain and related symptoms were measured by SF-MPQ-2. Multidisciplinary and multimodal approaches were applied for treatment, including several modalities of manual therapy. RESULTS Headache intensity was higher in the migraine group in comparison with the CeH group (7.8±1.7 vs 6.0±1.5, respectively; p<0.05). No significant differences in neck pain intensity were found (6.2±1.8 vs 5.3±1.7; p=0.08). Patients with migraine usually chose more descriptors than patients with CeH (14 vs 4, respectively) and higher range of their intensity (p<0.001). By the end of treatment session, the number of descriptors and their intensity decreased significantly on all SF=MPQ-2 scales (p<0.001) in both groups. Most patients of migraine and CeH group were satisfied with treatment (83% and 97%, respectively) and marked «much improved» and «very much improved» on the 7-point Patient Global Impression of Change scale. CONCLUSION SF-MPQ-2 is a useful tool for differential diagnosis of migraine and CeH, as it contains the sufficient number of descriptors and the scale for measuring their intensity.

Effects of the Manual Therapy Approach of Segments C0-1 and C2-3 in the Flexion-Rotation Test in Patients with Chronic Neck Pain: A Randomized Controlled Trial.

Background: Flexion-rotation test predominantly measures rotation in C1-2 segment. Restriction in flexion-rotation may be due to direct limitation in C1-2, but also to a premature tightening of the alar ligament as a result of lack of movement in C0-1 or C2-3. The aim of this study was to compare the effect of a 20-min single cervical exercise session, with or without manual therapy of C0-1 and C2-3 segment in flexion-rotation test, in patients with chronic neck pain and positive flexion-rotation test. Methods: Randomized controlled clinical trial in 48 subjects (24 manual therapy+exercise/24 exercise). Range of motion and pain during flexion-rotation test, neck pain intensity and active cervical range of motion were measured before and after the intervention. Results: Significant differences were found in favour of the manual therapy group in the flexion-rotation test: right (p < 0.001) and left rotation (p < 0.001); pain during the flexion-rotation test: right (p < 0.001) and left rotation (p < 0.001); neck pain intensity: (p < 0.001); cervical flexion (p < 0.038), extension (p < 0.010), right side-bending (p < 0.035), left side-bending (p < 0.002), right rotation (p < 0.001), and left rotation (p < 0.006). Conclusions: Addition of one C0-C1 and C2-C3 manual therapy session to cervical exercise can immediately improve flexion-rotation test and cervical range of motion and reduce pain intensity.

Calcium Pyrophosphate Deposition Disease in the Craniovertebral Junction: An Unusual Cause of Neck Pain

Crowned Dens Syndrome (CDS) is a rare manifestation of Calcium Pyrophosphate Deposition (CPPD) disease characterised by calcification around the odontoid process in the atlantoaxial joint. It manifests as intense neck pain with signs of systemic inflammation, including elevated acute phase reactants. Thus, it can simulate other causes of neck pain and diagnosis can be challenging. Moreover, CPPD disease can be asymptomatic and observed as radiological finding. Here in, two cases of spinal CPPD disease with distinct presentations are reported. The first of 83-year-old woman describes CDS that was misdiagnosed as Polymyalgia Rheumatica (PMR) whereas in the second case of 70-year-old female calcification around the odontoid process was incidentally found in a patient with acute cervical spine fracture. These two reported cases highlight the spectrum of manifestations of spinal CPPD disease and support the notion that careful discrimination of the cause of neck pain is essential for improving outcomes.

The effectiveness of tensioning neural mobilization of brachial plexus in patients with chronic cervical radiculopathy: a randomized clinical trial

IntroductionTensioning neural mobilization (NM) is accomplished through increasing the distance between nerve bed ends via elongation. NM techniques have different biomechanical effects on the nervous system. Evidence for their use in treating certain upper-quarter conditions like cervicobrachial pain is limited. The study was to determine tensioning NM efficacy on unilateral chronic cervical radiculopathy regarding mechanosensitivity of the affected nerve roots and intensity of neck and arm pain.MethodsForty participants with chronic unilateral cervical radiculopathy were randomly assigned to group A (&lt;i&gt;n&lt;/i&gt; = 20), receiving traditional physical therapy (manual traction and infrared irradiation), and group B (&lt;i&gt;n&lt;/i&gt; = 20), receiving traditional physical therapy in addition to tensioning NM of brachial plexus. Mechanosensitivity of the affected brachial nerve roots and intensity of neck and arm pain were evaluated at baseline and after a 3-week program with the upper limb tension test-1 and visual analogue scale. The normal (Z) test, paired and unpaired t-test, Wilcoxon signed-rank test, and Wilcoxon rank-sum test (Mann-Whitney) were used in data analysis.ResultsThere were significant within-group differences in both groups regarding mechanosensitivity and pain intensity (mechanosensitivity: &lt;i&gt;p&lt;/i&gt; = 0.001 for group A, &lt;i&gt;p&lt;/i&gt; = 0.001 for group B; pain: &lt;i&gt;p&lt;/i&gt; &lt; 0.01 for group A, &lt;i&gt;p&lt;/i&gt; &lt; 0.01 for group B). There was no statistically significant between-group difference regarding mechanosensitivity (&lt;i&gt;p&lt;/i&gt; = 0.07) or pain intensity (&lt;i&gt;p&lt;/i&gt; = 0.838).ConclusionsThe addition of tensioning NM to traditional physical therapy had no significant benefits, although both groups showed decreased post-treatment mechanosensitivity and pain intensity.

Can a metric combining arm elevation and trapezius muscle activity predict neck/shoulder pain? A prospective cohort study in construction and healthcare

ObjectiveTo determine whether a composite metric of arm elevation and trapezius activity (i.e. neck/shoulder load) is more strongly associated with the 2-year course of neck and shoulder pain intensity (NSPi) among construction and healthcare workers than each exposure separately.MethodsDominant arm elevation and upper trapezius muscle activity were estimated in construction and healthcare employees (n = 118) at baseline, using accelerometry and normalized surface electromyography (%MVE), respectively. At baseline and every 6 months for 2 years, workers reported NSPi (score 0–3). Compositions of working time were determined for arm elevation (< 30°; 30–60°; > 60°), trapezius activity (< 0.5%; 0.5–7.0%; > 7.0%MVE), and a composite metric “neck/shoulder load” (restitution, low, medium, and high load). Associations between each of these three compositions and the 2-year course of NSPi were determined using linear mixed models.ResultsAssociations between exposure compositions and the course of NSPi were all weak and in general uncertain. Time spent in 0.5–7.0%MVE showed the largest and most certain association with changes in NSPi during follow-up (β = − 0.13; p = 0.037; corresponding to a −0.01 change in NPSi every 6 months). Among pain-free workers at baseline, medium (β = − 0.23; p = 0.039) and high (β = 0.15; p = 0.031) neck/shoulder load contributed the most to explaining changes in NSPi.ConclusionThe composite metric of neck/shoulder load did not show a stronger association with the course of NSPi than arm elevation or trapezius activity alone in the entire population, while some indications of a stronger association were found among those who were pain-free at baseline.

Validation of the Nepali versions of the Neck Disability Index and the Numerical Rating Scale for Neck Pain.

A cross-sectional study with a test-retest design. To translate and culturally adapt the numerical rating scale (NRS) for neck pain intensity and the Neck Disability Index (NDI), and asses their measurement properties in a Nepalese neck pain population. Neck pain is one of the most common musculoskeletal disorders in Nepal. Research on neck pain disorders has been hampered by lack of standardized patient-reported outcome measures (PROMs) in Nepali language. Therefore, we aimed at validating a Nepali version of the NDI and NRS neck pain. At Dhulikhel hospital in Nepal, 150 patients with neck pain and/or cervical radiculopathy completed the translated self-administered questionnaires. We had made one cultural adaption of the NDI driving item in the final Nepali version. Relative reliability was analyzed with intraclass correlation coefficient (ICC 2.1) and absolute reliability with the smallest detectable change (SDC). Internal consistency was assessed by Cronbach alpha. Construct and discriminative validity was assessed by Spearman correlation for a priori hypotheses, receiver-operating characteristics curves, and analysis of variance. Time spent and assistance needed to complete the questionnaires were used to assess feasibility. Test-restest reliability was excellent with ICC (95% confidence intervals) of 0.87 (0.66, 0.94) for NDI and 0.97 (0.94, 0.99) for NRS neck pain. The absolute reliability was acceptable (a SDC of 1.6 for NRS and 9.3 for NDI) and a Cronbach alpha (internal consistency) of 0.70 for NDI, as well as acceptable construct validity, discriminative validity, and feasibility. The Nepali versions of the NRS neck pain and NDI can be recommended for assessing pain and disability among patients with neck pain and cervical radiculopathy, but their responsiveness to change remains to be tested.Level of Evidence: 2.

Effects of Central Sensitivity Syndrome and Psychological Factors on the Clinical Features of Patients with Cervical Degenerative Disease: A Cross-Sectional Study.

Study DesignSingle-center cross-sectional study.PurposeThe present study aimed to clarify the effects of central sensitivity syndrome (CSS) and psychological factors on the clinical features in patients with cervical degenerative disease (CDD).Overview of LiteratureThe presence of CSS and psychological factors can influence the clinical features of patients with musculoskeletal disorders including CDD. However, the precise effects of CSS are unclear.MethodsPatients admitted for surgical treatment of CDD were recruited. The following patient-reported outcome measures were recorded on the day before the surgery: the Numerical Rating Scale (NRS) for neck pain intensity, Neck Disability Index (NDI), EuroQol 5-Dimensions (EQ-5D) survey, Central Sensitization Inventory (CSI), Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and the Hospital Anxiety and Depression Scale were used. We performed three multiple regression analyses to investigate the effects of CSS and psychological factors on the clinical features.ResultsMultiple regression analysis revealed that CSI had a significant effect on NRS (β, 0.50; 95% confidence interval [CI], 0.29 to 0.71), NDI (β, 0.64; 95% CI, 0.45 to 0.82), and EQ-5D (β, −0.55; 95% CI, −0.75 to −0.35). Multiple regression analysis revealed that psychological factors did not exert a significant effect on the clinical features.ConclusionsOur results demonstrated that CSI was able to identify the clinical features in CDD patients, suggesting that CSS does affect the clinical features of such patients.

The Prevalence and Intensity of Back and Neck Pain in Veterans with Upper Limb Amputation

The Prevalence and Intensity of Back and Neck Pain in Veterans with Upper Limb Amputation

Clinical predictive modelling of post-surgical recovery in individuals with cervical radiculopathy: a machine learning approach

Prognostic models play an important role in the clinical management of cervical radiculopathy (CR). No study has compared the performance of modern machine learning techniques, against more traditional stepwise regression techniques, when developing prognostic models in individuals with CR. We analysed a prospective cohort dataset of 201 individuals with CR. Four modelling techniques (stepwise regression, least absolute shrinkage and selection operator [LASSO], boosting, and multivariate adaptive regression splines [MuARS]) were each used to form a prognostic model for each of four outcomes obtained at a 12 month follow-up (disability—neck disability index [NDI]), quality of life (EQ5D), present neck pain intensity, and present arm pain intensity). For all four outcomes, the differences in mean performance between all four models were small (difference of NDI < 1 point; EQ5D < 0.1 point; neck and arm pain < 2 points). Given that the predictive accuracy of all four modelling methods were clinically similar, the optimal modelling method may be selected based on the parsimony of predictors. Some of the most parsimonious models were achieved using MuARS, a non-linear technique. Modern machine learning methods may be used to probe relationships along different regions of the predictor space.

The effect of Kinesio taping on cervical proprioception in athletes with mechanical neck pain\u2014a placebo-controlled trial

BackgroundNeck proprioception is critical in maintaining neuromuscular control in and around cervical joints. Kinesio™ tape may assist in rehabilitating joint position sense. The current study compares Kinesio™ tape’s effects versus a placebo on proprioception in college athletes experiencing mechanical neck pain.MethodsThis study randomized sixty-six athletes with mechanical neck pain into a Kinesio™ tape group (n = 33, mean age = 22.73 years) or placebo group (n = 33, mean age = 23.15 years). The Kinesio™ tape group received standard Kinesio™ taping applications with appropriate tension, while the placebo group received taping applications without tension. Outcome measures: The study assessed cervical joint position errors with a cervical range-of-motion (CROM) device, pain intensity with a visual analog scale (VAS), and neck functional disability with a neck disability index (NDI). It tested joint position errors through cervical flexion, extension, rotation left, and rotation right. All the outcome measures were recorded at the baseline and twice more following 3 and 7 days of tape applications.ResultsMultivariate analysis of variance test demonstrated a significant reduction in joint position errors in flexion, extension and right rotation following 3 days and 7 days of tape application among the Kinesio™ tape group. There was a significant main effect of time (P < 0.05) for joint position errors in left rotation and VAS after 3 days (p > 0.05), NDI after 3 and 7 days (p > 0.05).ConclusionsThe Kinesio™ tape application after 3 and 7 days effectively decreased joint position errors and neck pain intensity in mechanical neck pain participants compared to placebo, while there was no difference between both groups in the NDI.Trial registration(CTRI/2011/07/001925). This study was retrospectively registered on the 27th July, 2011.Level of evidenceIIB

Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery.

Thirty percent to sixty-four percent of patients experience poorly controlled pain following spine surgery, leading to patient dissatisfaction and poor outcomes. Identification of at-risk patients before surgery could facilitate patient education and personalized clinical care pathways to improve postoperative pain management. Accordingly, the aim of this study was to develop and internally validate a prediction score for poorly controlled postoperative pain in patients undergoing elective spine surgery. A retrospective cohort study was performed in adult patients (≥ 18 years old) consecutively enrolled in the Canadian Spine Outcomes and Research Network registry. All patients underwent elective cervical or thoracolumbar spine surgery and were admitted to the hospital. Poorly controlled postoperative pain was defined as a mean numeric rating scale score for pain at rest of > 4 during the first 24 hours after surgery. Univariable analysis followed by multivariable logistic regression on 25 candidate variables, selected through a systematic review and expert consensus, was used to develop a prediction model using a random 70% sample of the data. The model was transformed into an eight-tier risk-based score that was further simplified into the three-tier Calgary Postoperative Pain After Spine Surgery (CAPPS) score to maximize clinical utility. The CAPPS score was validated using the remaining 30% of the data. Overall, 57% of 1300 spine surgery patients experienced poorly controlled pain during the first 24 hours after surgery. Seven significant variables associated with poor pain control were incorporated into a prediction model: younger age, female sex, preoperative daily use of opioid medication, higher preoperative neck or back pain intensity, higher Patient Health Questionnaire-9 depression score, surgery involving ≥ 3 motion segments, and fusion surgery. Notably, minimally invasive surgery, body mass index, and revision surgery were not associated with poorly controlled pain. The model was discriminative (C-statistic 0.74, 95% CI 0.71-0.77) and calibrated (Hosmer-Lemeshow goodness-of-fit, p = 0.99) at predicting the outcome. Low-, high-, and extreme-risk groups stratified using the CAPPS score had 32%, 63%, and 85% predicted probability of experiencing poorly controlled pain, respectively, which was mirrored closely by the observed incidence of 37%, 62%, and 81% in the validation cohort. Inadequate pain control is common after spine surgery. The internally validated CAPPS score based on 7 easily acquired variables accurately predicted the probability of experiencing poorly controlled pain after spine surgery.

Is Myofascial Release Therapy Cost-Effective When Compared With Manual Therapy to Treat Workers’ Mechanical Neck Pains?

ObjectiveThe aim of this study was to do a cost-benefit analysis of myofascial release therapy (MRT) compared to manual therapy (MT) for treating occupational mechanical neck pain. MethodsVariables regarding the outcomes of the intervention were intensity of neck pain, cervical disability, quality of life, craniovertebral angle, and ranges of cervical motion. Costs were assessed based on a social perspective using diary costs. Between-groups differences in average cost, cost-effectiveness, and cost-utility ratios were assessed using bootstrap parametric techniques. The economic cost-benefit evaluation was with regard to an experimental parallel group study design. There were 59 participants. ResultsMyofascial released therapy showed significant improvement over MT for cervical mobility (side bending, rotation, and craniovertebral angle). The total cost of MRT was approximately 20% less (−$519.81; 95% confidence interval, −$1193.67 to $100.31) than that of MT, although this was not statistically significant. Cost-effectiveness and cost-utility ratios showed that MRT could be associated with lower economic costs. ConclusionWith probabilities of 93.9% and 95.8%, MRT seems to be cost-effective for treating mechanical neck pain without the need to add any additional cost to obtain a better clinical benefit. Consequently, we believe it could be included in the clinical practice guidelines of different Spanish health care institutions.

162. Two-level cervical disc replacement using a PEEK-on-ceramic device: prospective outcome data from an FDA IDE trial

BACKGROUND CONTEXT While there have been several large-scale FDA investigational device exemption (IDE) studies on single-level cervical total disc replacement (TDR) such information is available for only two devices used for two-level disc replacement. One of these devices has metallic endplates and a plastic core, the other is a two-piece device machined from a titanium-ceramic composite. A TDR designed with titanium-coated PEEK endplates and a biconvex zirconia toughened alumina ceramic core is being evaluated in an IDE trial for two-level implantation. PURPOSE The purpose of this study was to investigate preliminary outcomes of the PEEK-on-ceramic TDR based on three sites participating in the two-level trial. STUDY DESIGN/SETTING This was a prospective study based on data from three of 18 centers participating in the TDR arm of a prospective study evaluating two-level cervical TDR using a nonconcurrent historical control. PATIENT SAMPLE These preliminary outcomes were based on 62 patients at 12 months postoperative following two-level cervical TDR. OUTCOME MEASURES Patient reported outcome measures included the neck disability index (NDI) and numerical rating scores (NRS) separately assessing neck and arm pain intensity. Radiographic measures made at the index levels included disc height and flexion/extension range of motion (ROM). METHODS Patients enrolled in the trial received the Simplify® PEEK-on-ceramic TDR. Evaluations were conducted prior to surgery and at 6 weeks, and 3, 6 and 12 months after surgery. All radiographs were analyzed by an independent lab specializing in image assessment. RESULTS The mean NDI score decreased significantly (p CONCLUSIONS Preliminary results of this IDE study found that two-level cervical TDR using the PEEK-on-ceramic implant was associated with significant decreases in pain and function scores, which were maintained during 12-month follow-up. Disc height of the operated segments were increased after surgery and remained increased through 12-month follow-up. ROM was increased, significantly at the superior level and nonsignificantly at the inferior level. These early results suggest that the device may be a future consideration for the treatment of symptoms arising from two-level degenerative conditions of the cervical spine. Patients from all centers continue to be followed annually. FDA DEVICE/DRUG STATUS Simplify disc (Investigational/Not approved)

Relationship Between Intensity of Neck Pain and Disability and Shoulder Pain and Disability in Individuals With Subacromial Impingement Symptoms: A Cross-Sectional Study

ObjectiveThis study aimed to verify a possible relationship between shoulder disability and shoulder pain intensity and the variables related to cervical-spine dysfunction, and determine which of these can differentiate moderate to severe shoulder pain (>4 on a numerical rating scale [NRS]) from mild shoulder pain (≤4 on the NRS) in individuals with subacromial impingement symptoms. MethodsOne hundred and forty volunteers with shoulder pain were evaluated. Demographic information and variables related to the shoulder and neck were collected. Self-reported pain and disability of the shoulder and cervical spine were measured using the Shoulder Pain and Disability Index (SPADI) and Neck Disability Index (NDI) questionnaires, respectively. An NRS was used to measure pain in the shoulder and cervical spine. A purposeful modeling strategy was used to determine the best model to predict shoulder disability and shoulder pain (dependent variables). Multiple logistic regression analysis followed by receiver operating curve analysis was used to determine which variables better differentiated moderate to severe shoulder pain from mild shoulder pain. ResultsVariables such as Neck Disability Index (NDI) score (β = 1.09, P = .00) and age (β = −0.19, P = .03) were associated with the total SPADI score. Neck pain was significantly associated with shoulder pain (β = 0.40, P = .00). The combination of variables predicting moderate to severe shoulder pain was total SPADI score (odds ratio [OR] = 1.15, P = .003), neck pain (OR = 3.20, P = .04), and age (OR = 1.01, P = .05). ConclusionOur results demonstrate the important connection between shoulder- and neck-related symptoms in individuals with subacromial impingement symptoms.

Reciprocal roles of joint position error, visual dependency and subjective perception in cervicogenic dizziness

Aim Since cervical joint position error (JPE) and visual dependency (VD) may reflect altered ascending inputs from the neck receptors, the aim of the present study was to test how these parameters may be impacted by those clinical parameters in cervicogenic dizziness (CGD) patients when compared with healthy subjects participants. Materials and methods 93 subjects participants fulfilling inclusion criteria for CGD and 98 age- and gender-matched healthy subjects volunteers – undergoing cervical relocation and rod and disc test to evaluate JPE and VD, respectively – were compared to each other. Cervical range of motion (CROM), Dizziness Handicap Inventory (DHI), Neck Disability Index (NDI), Neck pain intensity (NPI), Tampa Scale for Kinesiophobia (TSK-17) and Hospital Anxiety and Depression Scale (HADS) were also collected in both groups Results When compared to healthy participants, CGD patients were found to have a higher degree of JPE in right (p = 0.008, mean difference, MD: 2.88) and left (p = 0.006, MD: 2.55) rotation as well as in extension (p = 0.011, MD: 2.31), flexion (p = 0.009, MD: 2.35) and mean value (p = 0.001, MD: 2.53) and higher degrees of error in CCW at +40° and −40° (p = 0.012, MD: 0.85 and p = 0.016, MD: 0.82, respectively) and CW at +40° and −40° (p = 0.018, MD: 0.83 and p = 0.015 MD: 0.81, respectively). CGD patients also demonstrated a significant reduction in degrees of CROM in active flexion (p = 0.011, MD: −34.63), extension (p = 0.018, MD: −21.67), left (p = 0.012, MD: −28.29) and right (p = 0.009, MD: −28.52) rotation, and left (p = 0.02, MD: −7.29) and right (p = 0.021, MD: −5.05) lateral flexion. Furthermore, these patients demonstrated higher scores in total DHI (p = 0.007, MD: 25.17) (and relative DHI-P, DHI-F, DHI-E; p = 0.009, MD: 11.4; p = 0.014, MD: 8.73 and p = 0.018, MD: 5.03, respectively), in TSK-17 (p = 0.017, MD: 17.56), and HADS, both in anxiety (p = 0.022, MD: 4.62) and depression (p = 0.02, MD: 7.31) subscale. Conclusions A possible common physiopathological background may impact on processes involved in both the JPE and VD behaviour, entangled in a vicious circle with the impaired subjective clinical and quality of life perception.

Immediate effects of cervicothoracic junction mobilization versus thoracic manipulation on the range of motion and pain in mechanical neck pain with cervicothoracic junction dysfunction: a pilot randomized controlled trial

BackgroundCervicothoracic (CT) junction hypomobility has been proposed as a contributing factor for neck pain. However, there are limited studies that compared the effect of CT junction mobilization against an effective intervention in neck pain. Thoracic spine manipulation is a nonspecific intervention for neck pain where remote spinal segments are treated based on the concept of regional interdependence. The effectiveness of segment-specific spinal mobilization in the cervical spine has been researched in the last few years, and no definite conclusions could be made from the previous studies. The above reasons warrant the investigation of the effects of a specific CT junction mobilization against a nonspecific thoracic manipulation intervention in neck pain. The present study aims to compare the immediate effects of C7-T1 Maitland mobilization with thoracic manipulation in individuals with mechanical neck pain presenting with CT junction dysfunction specifically.MethodsA randomized clinical trial is conducted where participants with complaints of mechanical neck pain and CT junction dysfunction randomly assigned to either C7-T1 level Maitland mobilization group or mid-thoracic (T3-T6) manipulation group (active control group). In both the groups, the post graduate student (SJ) pursuing Master’s in orthopedic physiotherapy delivered the intervention. The outcomes of cervical flexion, extension, side flexion & rotation range of motion (ROM) were measured before & after the intervention with a cervical range of motion (CROM) device. Self-reported pain intensity was measured with the numerical pain rating scale (NPRS). The post-intervention between-group comparison was performed using a one-way ANCOVA test.ResultsForty-two participants with mean age CT junction group: 35.14 ± 10.13 and Thoracic manipulation group: 38.47 ± 11.47 were recruited for the study. No significant differences in the post-intervention baseline adjusted outcomes of cervical ROM & self-reported pain intensity were identified between the groups after the treatment (p = 0.08, 0.95, 0.01, 0.39, 0.29, 0.27for flexion, extension, bilateral lateral flexion & rotations respectively) & neck pain intensity (p = 0.68). However, within-group, pre, and post comparison showed significant improvements in cervical ROM and pain in both groups.ConclusionThis preliminary study identified that CT junction mobilization is not superior to thoracic manipulation on the outcomes of cervical ROM and neck pain when level-specific CT junction mobilization was compared with remote mid-thoracic manipulation in individuals with mechanical neck pain and CT junction dysfunction.Trial registrationCTRI: 2018/04/013088, Registered 6 April 2018, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=24418

Visual trajectory pattern as prognostic factors for neck pain.

A novel approach capturing both temporal variation and pain intensity of neck pain is by visual trajectory patterns. Recently, both previous and expected visual trajectory patterns were identified as stronger predictors of outcome than traditional measures of pain history and psychological distress. Our aim was to examine patient characteristics within the various previous and expected patterns, relationship between the two patterns and predictive value of a variable combining the previous and expected patterns. Patients with neck pain (n=932) consulting chiropractors were included. Baseline measures included pain intensity, disability, psychological variables and symptom history and expectations. Participants reported global perceived effect after 12 weeks. Analyses included descriptive statistics and logistic regression. Pain intensity, disability, psychological and worse outcome expectations increased from a single pain episode to severe ongoing pain of previous and expected patterns. Having a severe pain history was associated with poor prognosis, particularly if combined with negative expectations. The variable combining previous and expected patterns had a discriminative ability similar to that of other predictors AUC=0.64 (95% CI=0.60-0-67) versus AUC=0.66 (95% CI=0.62-0.70). The model with highest discriminative ability was achieved when adding the combined patterns to other predictors AUC=0.70 (95% CI=0.66-0.73). The study indicates that pain expectations are formed by pain history. The patients' expectations were similar to or more optimistic compared with their pain history. The prognostic ability of the model including a simplified combination of previous and expected patterns, together with a few other predictors, suggests that the trajectory patterns might have potential for clinical use. The dynamic nature of neck pain can be captured by visual illustrations of trajectory patterns. We report, that trajectory patterns of pain history and future expectations to some extent are related. The patterns also reflect a difference in severity assessed by higher degree of symptoms and distress. Moreover, the visual trajectory patterns predict outcome at 12-weeks. Since the patterns are easily applicable, they might have potential as a clinical tool.

Motor control training of deep neck flexors with pressure biofeedback improves pain and disability in patients with neck pain: A systematic review and meta-analysis

BackgroundThe effects of motor control training with pressure biofeedback on neck pain and disability of patients with neck pain is a field that has drawn a lot of research interest. Therefore, the aim of this study was to conduct, for the first time, a systematic review and meta-analysis for examining whether motor control training of deep neck flexors with pressure biofeedback improves pain and disability in patients with neck pain. MethodsThe systematic review and meta-analysis were performed according to PRISMA guidelines. The databases PubMED, MEDLINE, EBSCOhost, Google scholar, SportDiscus, COCHRANE and EMBASE were searched for studies related to the research question. PEDro scale was used for examining methodological quality. A random effects model was used for data meta-analysis. ResultsSeventeen studies were included for qualitative synthesis and 10 were selected for further quantitative synthesis. Motor control training of deep neck flexors with pressure biofeedback was found to have equal or better effectiveness on neck pain intensity and disability in comparison to other control interventions. The meta-analyses show that motor control training of deep neck flexors with pressure biofeedback is more effective than strength-endurance training of cervical muscles for improving pain (Hedges’ g = 0.323, 95% CI 0.04–0.60, I2 = 50.94%) and disability (Hedges g = 0.401, 95% CI 0.12–0.68, I2 = 53.44%) in patients with neck pain. ConclusionsMotor control training of deep neck flexors with pressure biofeedback is an effective intervention for improving pain intensity and disability in patients with neck pain and preferable to strength-endurance training of cervical muscles.