Neck Pain Research Articles

Primary care seeking among adults with chronic neck and low back pain in Norway: A prospective study from the HUNT study linked to Norwegian primary healthcare registry.

To describe the frequency of primary care seeking for neck or back-related conditions among people with chronic neck and low back pain and to develop prediction models of primary care seeking and frequent visits. We included participants of the Trøndelag Health Study (HUNT4, 2017-19) in Norway who self-reported chronic neck and/or low back pain in the preceding year, and extracted data of primary care visits from the Norwegian primary healthcare registry. We investigated a total of 23 potential predictors and used multivariable logistic regression models to predict primary care seeking for neck or back-related conditions and frequent visits by healthcare provider (i.e., the highest quartile of number of visits). Among the 15,352 HUNT4 participants with chronic neck and/or low back pain, 6231 participants (40.6%) sought primary care for neck or back-related conditions (median = 5 visits, IQR 2-15) within 2 years after the study. Participants who consulted physical therapists sought care the most frequently (median = 10 visits, IQR 3-26). Discrimination of the best-fit prediction model of primary care seeking and frequent visits by healthcare provider, assessed by C-statistic, ranged from 0.66-0.76. Participants who made frequent primary care visits in the preceding year were highly likely to continue frequent care seeking in the following 2 years. Around 40% of people seek primary care for chronic neck and low back pain, and frequent care seeking may continue for years. Future studies should investigate strategies to reduce recurrent primary care visits, especially seeking physical therapist care, and promote self-management of chronic pain. People with chronic neck and low back pain who seek physical therapist care had the highest frequency of care seeking, underscoring the significant burden on healthcare systems. The high frequency of visits and associated healthcare expenditures highlight the critical need for effective and valuable primary care for chronic pain management. To mitigate recurrent visits and reduce costs, it is essential to provide patients with evidence-based treatments and self-management interventions.

Spontaneous spinal epidural hematoma with hemiparesis: A stroke mimic.

Spontaneous spinal epidural hematoma (SSEH) is a rare cause of neck pain and hemiparesis. Clinicians should keep SSEH in mind as a rare stroke mimicpresenting with hemiparesis to avoid needless and potentially hazardous thrombolytic therapy. Taking a careful history is useful for making a correct diagnosis.

Developing survey instruments for low back and neck pain to improve disease severity estimates for burden of disease assessment

Abstract Two people living with the same disease can have very different experiences; one has little consequence, whilst the other struggles with much more debilitating consequences that impacts how they live their lives day-to-day. A growing body of research highlights the need for better estimates of disease severity to facilitate better estimation of the non-fatal burden of disease (BOD). Routine data does not always offer solutions because it’s often not coded at a granular enough level to map to individual health states. Data offering solutions are scarce and therefore not available across time or space. Most commentators have quantified the problem of assuming the same proportional severity splits to fill data gaps; a problem common to the Global Burden of Disease (GBD) study and independent BOD studies. However, whilst the need for highlighting the problems associated with this assumption remains, there are other positive steps that can be taken to overcome it. We propose how reproducible approaches can be developed, and present how they can be used to develop disease severity estimates. This involves developing a survey instrument to estimate the overall and health state prevalence of back pain and neck pain, basing health state definitions from the GBD non-fatal disease models, where the classification of cases by severity is based on the combination of respondent’s answers. Furthermore, we discuss how self-assessed severity estimates allow for internal validity checks, but also more widely offer opportunities to appraise the appropriateness of GBD non-fatal disease models. The development, and publication, of survey instruments can assist both independent studies and the GBD study to improve estimates of disease severity, as well as retaining important opportunities for cross-country comparability. Understanding the spectrum of severity is important for understanding how disease impacts populations and can inform healthcare provision and expenditure strategies.

Safety, tolerability, and basic pharmacokinetic parameters of AUX-001, a once-daily extended release nicorandil in healthy volunteers under fasting and fed conditions

Abstract Introduction Chronic-stable angina pectoris (CSAP) is one of the most common cardiovascular conditions in the developed world with a rising prevalence in both Europe and North America. Mounting evidence from chronic angina outcomes studies, including COURAGE, BARI, ORBITA and recently ISCHEMIA, has reemphasized optimized medical therapy (OMT) as first-line treatment for most chronic-stable angina pectoris (CSAP) patients over coronary revascularization. Yet, there has been a lack of development of new antianginal medications since 2006. To lessen polypharmacy and enable better long-term compliance in CSAP patients, AUX-001, a once-daily (QD), extended-release (ER) nicorandil is in clinical development for treating CSAP as an innovative, novel version of the immediate-release (IR) antianginal. Objective To test the safety, tolerability, and basic pharmacokinetic (PK) parameters of AUX-001 QD in fasting and fed conditions in healthy volunteers during this first-in-human phase 1a study. Methods 16 healthy adult volunteers were enrolled. Vital signs (HR, BP, respiratory rate) and any adverse events were collected during screening, pre-dose, 1, 2, 6, 12, 24-h, and 48-h post-dose and at end-of-study for the two respective periods (fasting and fed). Results Evaluable information was available on 16 patients for fasting and 15 for fed conditions with one patient excluded due to protocol violation. No patient discontinued due to safety or tolerability. No severe AEs were recorded. AEs observed during period 1 included headaches (n=12), asymptomatic hypotension (n=3), palpitation (n=1) and nasal congestion (n=1). In period 2, leading AEs were headaches (n=11), neck pain (n=1) and decreased hemoglobin (n=1). Most AEs were mild and transitory and did not trigger medical intervention or discontinuation. AUX-001 pharmacokinetics exhibited a reduced Cmax, a right-hand shift in Tmax, and an extension of T1/2 beyond 9 hours compared to the historical data of the commercially available IR nicorandil. AUX-001 had a small, temporary effect on heart rate and systolic and diastolic blood pressure but within the normal compensatory haemodynamic steady-state stability. The peak effect with the current AUX-001 prototype was at 6 hours, independent of the food effect. Conclusion AUX-001 was safe and well tolerated. Initial vasodilator-induced headaches were manageable by using simple OTC NSAIDs and led to no dropouts. No patients discontinued due to AEs or tolerability issues. There were no lasting significant haemodynamic effects of AUX-001 beyond 24hours. PK parameters of AUX-001 are characteristic of an ER formulation. Observed pharmacokinetics indicates that the achieved T1/2 is substantially longer than with IR nicorandil (~1hour vs >9h) and shows promise for a potential once daily treatment of exercise induced chronic angina.AUX-001 Study Data ESC Abstract 2024

Multidimensional assessment and analysis of the mental health of teachers and police officers

Abstract Background The years-long COVID-19 pandemic, the proximity of the Russian-Ukrainian war, high inflation, and the economic recession are significant stressors for the Hungarian people. Numerous domestic and international surveys are prepared every year, in which the most stressful professions are ranked. In recent years, based on Hungarian, American and European surveys, teachers and police officers have always been included in the 10 most stressful jobs. They also rank the most valued jobs and highest paid jobs every year. In this relation, police and teaching jobs never made it into the top 10, despite the fact that both professions are very important on a social level. Methods 20 male and 20 female teachers and police officers completed a complex quality of life and psychological assessment using international tests with ethics approval. We measured pain syndromes, such as headache, neck and back pain, joint pain, assessed depression, anxiety, sleep quality, and gastrointestinal symptoms. Results For police officers and teachers, gender differences were not verified with regard to any parameter. None of the parameters differed significantly for male police officers and teachers. Many significant differences were confirmed between female police officers and female teachers, in all of them the results of the teachers were worse: depression (9,4±10,3 vs 2,9±4,3; p = 0.02) anxiety(43,3±12,2 vs 33±4,6; p = 0.01), sleep disorders(32,7±8,2 vs 24,3±7,8; p = 0.01), gastrointestinal complaints(24,7±9,4 vs 17,6±2,3; p = 0.01). Conclusions The sleep quality, depression and anxiety levels of female teachers are worse than those of female police officers who live at least as stressful a life. There is no difference between the mental and psychological state of male teachers and police officers. It is important to pay attention to the mental support of female teachers. Key messages • We consider the assessment of the mental state of police officers and teachers and the creation of primary prevention programs and a mental support network to be an important public health task. • In particular, the mental state of female teachers should be monitored and supported.

Effects of upper thoracic Mulligan mobilization on pain, range of motion and function in patients with mechanical neck pain: A randomized placebo-controlled trial.

This study aimed to assess the impact of Mulligan Reverse Natural Apophyseal Glides (RNAGS) applied to the upper thoracic region on pain, movement limitation, and function in individuals with mechanical neck pain. Conducted between January 2021 and May 2021, the study involved 69 participants randomly assigned to a sham group, physiotherapy group, and Mulligan group. A two-week, 11-session treatment program was administered with shared physiotherapy interventions and stretching exercises to all groups. The Mulligan group received additional mobilization with the Mulligan RNAGS technique. The sham group received sub-standard Mulligan mobilization. Outcome measures included Range of Motion (ROM), Visual Analogue Scale (VAS), and Neck Disability Index (NDI). No baseline differences were found in measurements among the groups. After the intervention, all groups showed increased ROM and decreased VAS and NDI scores (p<0.001). The Mulligan group exhibited significantly greater improvement in VAS, ROM, and NDI compared to other groups (p<0.001). The sham group demonstrated greater improvement in NDI and extension ROM compared to the physiotherapy group (p<0.001). Mulligan RNAGS technique in the upper thoracic region proved beneficial for pain relief, range of motion, and functionality in mechanical neck pain. Long-term effects warrant further exploration through population-based studies.

Radiographic Indicators of Craniocervical Instability: Analyzing Variance of Normative Supine and Upright Imaging in a Healthy Population.

Single-institution retrospective review. To establish baseline ranges and variability of 7 radiographic measurements of the cervical spine in a healthy patient population as potential diagnostic tools for craniocervical instability. Craniocervical instability, common in patients with connective tissue disease such as Ehlers-Danlos Syndrome, often presents with a wide range of symptoms, including neck pain. Current diagnostic methods employ a range of clinical and radiographic features, but diagnostic challenges remain due to missed indications on static imaging and a lack of standardized measurement values and normalized variance. Seventy-two healthy patients with cervical imaging were analyzed. Surgimap software was used to annotate supine computed tomography images, flexion, extension, and neutral x-ray images for measurement. These measurements included the atlanto-dental interval, clival-axial angle, basion-dens interval, basion-axis interval, perpendicular basion to the inferior aspect of C2, also known as Grabb Oakes measurement, and the hard palate to C1 and hard palate to C2. Statistical analysis assessed differences among imaging modalities, and coefficients of variation were calculated for each measurement. Our cohort consisted of a total of 72 patients with a mean age of 64 (SD: 13.54). All measurements except for the basion-axial interval and atlanto-dental interval demonstrated a significant difference between extension and flexion x-ray measurements. clivo-axial angle, hard palate to C1, and hard palate to C2 demonstrated the lowest coefficients of variance across imaging modalities. Understanding normal variance in cervical measurements is invaluable for accurate CCI diagnosis. Using a cohort of healthy patients, this study delineates the distribution and spread of 7 cervical measurements, delineating reference values and variability in these key measurements and highlighting their potential for use as imaging markers for CCI. Level III.

Effects of Cervical Mobilization on Balance and Proprioception in Patients With Nonspecific Neck Pain

ObjectiveThis study investigates the effect of cervical mobilization on balance and cervical proprioception in patients with nonspecific neck pain. MethodsA prospective, double-blind, randomized clinical trial was conducted involving a 3-week treatment protocol for which 66 patients were randomly assigned to 2 groups. Both groups underwent conventional physiotherapy (hot pack and transcutaneous electrical nerve stimulation) twice a week for 3 weeks along with additional cervical mobilization in the mobilization group, and sham mobilization in the sham control group. Static and dynamic balance, cervical proprioception, cervical mobility, and pain intensity were evaluated using a Kinesthetic Skill Training System 3000 device, the “Joint Position Error Test,” Cervical Range-of-Motion Instrument, and the visual analog scale, respectively. ResultsAfter treatment, significant improvements were noted in dynamic balance, mobility, pain intensity (P < .001, P < .001, P < .001, respectively), and proprioception in the left direction of rotation in the mobilization group (P = .003) that were significantly greater than those observed in the sham mobilization group (P < .001, P < .001, P < .001, P = .003, respectively). Although a significant decrease was observed in the deficits of static balance (P = .044) and proprioception in the right direction of rotation (P = .011) after mobilization, the changes were similar in both the mobilization and sham mobilization groups (P = .192, P = .154, respectively). ConclusionCervical mobilization led to significant improvements in dynamic balance, pain intensity, mobility, and partial improvements to proprioception in a comparison with a sham mobilization group, while the effect on static balance was not significant.

Eagle Syndrome: The Huge Socioprofessional Impact of a Minor Lengthening of the Styloid Process

agle Syndrome (ES) is a rare clinical condition presenting with anterolateral neck pain and potential serious complications. This case report details a head nurse in the emergency room (ER) with a severe throbbing headache, trismus, left-sided dysphagia, left otalgia, gum pain, and a very intense left-sided headache, associated with ipsilateral facial hypoesthesia. The patient met the International Classification of Headache Disorders (ICHD-3) criteria for headaches attributed to inflammation of the stylohyoid ligament, establishing the diagnosis of Eagle syndrome. Chronic headaches associated with ES, as observed in this case, can impact concentration, comprehension, communication, and work performance, leading to economic loss. This prompts the question: Are individuals with ES capable of working under intense physical and psychological conditions? The paper proposes a management strategy for ES patients, emphasizing the need for further research on the impact of ES on occupational fitness, as no published studies currently address this concern.

Effectiveness of a dynamic seat cushion on recovery and recurrence of neck and low back pain in office workers: a secondary analysis of a randomized controlled trial

BackgroundNeck and low back pain are prevalent issues among office workers due to prolonged sitting, necessitating effective interventions. Dynamic seat cushion, designed to promote postural shifts, have emerged as promising solutions to address this concern. This study aims to evaluate the effectiveness of a dynamic seat cushion on recovery and recurrence of neck and/or low back pain in office workers.MethodsThis study used 6-month follow-up data of a randomized controlled trial, involving 66 office workers who reported neck and/or low back pain during the trial. At baseline, participants were cluster-randomized into an intervention group, which received a dynamic seat cushion designed to encourage postural shifts, or a control group, which received a placebo seat pad. Health outcomes included recovery duration and recurrence of pain. Analyses utilized log rank test and Cox proportional hazard models.ResultsThe recovery rate from neck and/or low back pain was 100% for the intervention group, and 86% for the control group. The median recovery duration of participants who reported pain during the 6-month period was 1 month in the intervention group and 3 months in the control group. The intervention group had a higher probability of recovery compared to the control group (HRadj 4.35, 95% CI 1.87–10.11; p < 0.01). The recurrence rate of neck and low back pain was 27% in the intervention group, which was 75% in the control group. The Hazard Ratio, after adjustment, for the intervention group compared to the control group was 0.50 (95% CI = 0.11–2.12).ConclusionsA dynamic seat cushion that encourages postural shifts shortened recovery duration of neck and low back pain among office workers. Due to small numbers, a potentially relevant reduction in the recurrence of neck and low back pain could not be statistically confirmed. A power analysis was not conducted for this secondary analysis, and future studies should be designed with adequate sample sizes to explore the recurrence of pain with greater statistical power.Trial registrationThis trial is retrospectively registered under the Thai Clinical Trials Registry: TCTR20230623002 (23/06/2023).

Photobiomodulation on shoulder and neck pain and disability: A comprehensive review.

The purpose of this review was to evaluate the effect of Photobiomodulation (PBM) in managing shoulder and neck pain and disability. A literature search was conducted using the PubMed and ScienceDirect/EMBASE databases. The keywords used were "Low-level laser therapy", "photobiomodulation", "LASER", combined with "shoulder" or "neck". Only clinical studies written in English, Portuguese, Spanish, Italian, French, and German, were included. The review included 36 studies applying PBM therapy to alleviate pain or disability in patients with shoulder and neck conditions. Of these, 12 studies focused on neck conditions, and 24 studies addressed shoulder conditions, with one study concurrently examining both areas. This review on PBM therapy for shoulder and neck conditions shows promising results, particularly in pain relief and functional improvements, with infrared wavelengths being the most commonly used. Subacromial Impingement Syndrome (SAIS) and Myofascial Pain Syndrome (MPS) were the most frequently studied conditions. However, chronic and complex conditions like cervical osteoarthritis and post-stroke shoulder pain were less frequently represented, indicating a research gap. PBM was found to be a safe and non-invasive therapeutic option. Despite positive outcomes, variability in PBM protocols remains a challenge. Further standardized trials are needed to confirm its effectiveness across diverse conditions. This review updates current knowledge, highlights key findings, and provides direction for future research and clinical applications.

A strong association between Modic changes type 2 and endplate defects at non-fused segments after ACDF

To determine the association between Modic changes (MC) with other MRI parameters and clinical symptoms of cervical degenerative disc disease (DDD). A retrospective analysis of data on patients with cervical DDD who underwent single-level anterior cervical discectomy and fusion. Preoperative demographic data (age, sex, surgical data) were collected, cervical MRI parameters (disc degeneration grade, MC and endplate defects, each determined at each cervical level) and clinical data (Numerical pain rating scale (NPRS) neck and arm, the Neck Disability Index (NDI)) were compared to preoperative data. The study included 121 patients at Visit 1 and 83 patients at Visit 2. The median follow-up duration was 26.5 [18.9; 33.1] months. Patients with MC had more intense NPRS-based neck pain before surgery compared to patients without MC (p=0.001). There were significant changes in MC rate at the C5-C6 levels due to a significant number of new MCs type 1 and MCs type 2 (p=0.002 and p<0.001, respectively). MC type 2 was associated with disc degeneration, endplate defects defects, patients' age and clinical scales (NDI, NPRS) (p<0.05). The endplate defects defect score threshold for predicting MC type 2 at the С3-С7 cervical levels was 5. The factor predicting MC type 2 at the C3-C7 cervical levels is submaximal damage to the endplate. The MC rate is increased due to MC type 1 and MC type 2. MC types at the cervical levels may not represent consecutive stages of the same process.

Known-Group Validity and Sensitivity to Change in the Sensory-Motor Dysfunction Questionnaire in Individuals with Neck Pain: A Pilot Study

Background/Objectives: Sensorimotor dysfunction is often reported in individuals experiencing neck pain, irrespective of severity and chronicity. The treatment of neck dysfunction has been found to positively impact sensorimotor integration (SMI), thereby improving sensorimotor function. However, no patient-reported outcome measure has been validated for discrimination between healthy individuals and neck pain patients with disordered SMI, nor has there been documentation of positive change in SMI following neck pain treatment.The purpose of this study was to administer the Sensory-Motor Dysfunction Questionnaire (SMD-Q), for the purposes of: (1) known-group validity between individuals without and with chronic neck pain (CNP) or subclinical neck pain (SCNP); (2) assess the questionnaire’s capacity to quantify changes in altered SMI following a tailored treatment plan. Methods: Part 1—Known Group Validity: The SMD-Q was administered to 30 neck pain (13 with CNP, and 17 with SCNP), and 30 healthy participants. Part 2—Sensitivity to Change: The SMD-Q was re-administered to neck pain participants following their tailored treatment plans (SCNP—8-weeks and CNP—12 weeks). Results: The SMD-Q can discriminate between healthy and neck pain participants (p ≤ 0.001), and may be sensitive to showing treatment effects (ηp2 = 0.162; large effect size (ES)), but the sample size was too small to determine if it can discriminate treatment effects between groups (ηp2 = 0.070; medium ES). Conclusions: Differing degrees of disordered SMI can be discriminated by the SMD-Q, but further research is needed to determine its sensitivity to treatment.

Analysis of pharmacological effects and mechanisms of compound essential oils via GC-MS and network pharmacology.

Aromatherapy based on essential oil (EO) has been widely used for alleviating pain and intense where no compound EO reports its application on pharmacological effects. In order to explore the active pharmaceutical ingredients (API) and mechanism of a compound EO, a blend of Artemisia argyi, Boswellia carterii, Commiphora myrrha, Cinnamomum cassia, Zingiber oj-jicinale, and Ilex pubescens EO, in treating neck and shoulder pain (NSP). Network pharmacology hyphenated with mice model was employed to investigate. Gas chromatography-mass spectrometry (GC-MS) was applied for the identification of constituents in compound EO. Lastly, transdermal absorption of compound EO was studied before verifying analgesic and anti-inflammatory effects in mice. Totally, 75 compounds were tentatively identified through GC-MS, predicting 46 potential analgesic targets. Moreover, 11 core targets were obtained through network topology screening. Animal test resulted that the compound EO had significantly stronger anti-inflammatory and analgesic effects compared to single EO. Multiple API in compound EO affected on targets and exerted therapeutic effects on NSP through multiple pathways. Afterwards, eucalyptol, camphor, and borneol from compound EO exhibited a sustained-release effect, which provide scientific basis to illustrate the application of compound EO in clinical.

Rotation Preserving Fixation for the Treatment of C1 Burst Fracture Combined With Type II Odontoid Fracture: 2 Case Reports and Literature Review.

This study aimed to evaluate the clinical feasibility and effectiveness of a monoaxial screw-rod system and anterior screw fixation for C1 and type II odontoid fractures. We conducted a retrospective review of 2 consecutive patients with acute C1 and Anderson-D'Alonzo type II odontoid fractures. Both patients underwent treatment using a posterior monoaxial screw-rod system and anterior screw fixation. We reviewed their clinical records, including the visual analog pain scale and Neck Disability Index scores, as well as pre- and postoperative radiographs. Additionally, pre- and postoperative computed tomography images were used to classify the fracture types and assess the C1 to C2 reduction, rotation, and instability. Both patients presented with type II C1 and type II B odontoid fractures, combined with Dickman type II transverse atlantal ligament injuries. All surgical procedures were successfully performed without complications such as vertebral artery injury, neurological deficit, esophageal injury, or wound infection. Both patients achieved almost complete bone healing of the fractures, and C1 to C2 rotation was well preserved (32° and 49°) without atlantoaxial instability after follow-ups of 21 and 25 months, respectively. A monoaxial screw-rod system and anterior screw fixation could be promising surgical strategies for C1 fractures combined with type II odontoid fractures, even in cases involving transverse atlantal ligament injuries. The preservation of C1 to C2 rotation without atlantoaxial instability was observed after fixation. However, extensive case-finding and long-term follow-up are needed to understand the effectiveness of this treatment. In order to preserve the C1-C2 rotation, a monoaxial screw-rod system and anterior screw fixation may be more suitable for patients with C1 fractures combined with type II odontoid fractures.

Assessing the Diagnostic Value of Brain White Matter Hyperintensities and Clinical Symptoms in Predicting the Detection of CSF Venous Fistula in Patients with Suspected Spontaneous Intracranial Hypotension.

Spontaneous intracranial hypotension (SIH) due to CSF venous fistula (CVF) is increasingly recognized as a secondary cause of headaches, with symptoms often overlapping with primary headache syndromes such as migraine. While brain MRI studies have focused on features indicative of SIH, findings that support an alternate headache etiology, such as the bifrontal white matter hyperintensities (WMH) often seen in migraines, have not been explored in this context. This study assesses 1) the quantity and distribution of WMH and 2) the presenting clinical features in patients with and without CVF found on dynamic decubitus CT myelography (dCTM). 72 consecutive patients underwent clinical workup for SIH due to suspected CVF, including pre-procedural brain and spine MRI followed by dCTM. Brain imaging features were analyzed, including Bern score, quantitative WMH burden, and WMH distribution. Demographics and clinical symptoms present at the time of presentation were recorded. Imaging features were compared between groups with and without CVF using parametric or nonparametric comparisons according to variable normality. Multivariate logistic regression explored the relationships between imaging features, clinical symptoms, and the presence of CVF. The cohort included 40 patients with (CVF+) and 32 patients without (CVF-), with no significant age or sex differences. CVF+ patients had significantly higher Bern scores and significantly fewer WMH. There were significant differences in the frequencies of WMH patterns between groups, with a migrainous pattern observed most frequently in CVF-patients. Logistic regression combining Bern score, WMH burden, and WMH pattern demonstrated a better fit for predicting CVF than using Bern score or WMH features alone. Fourteen clinical symptoms showed the greatest differences between CVF+ and CVF-groups. Logistic regression demonstrated a positive association between CVF detection and a pressure/throbbing headache quality, and negative associations for neck pain, facial pain, phonophobia, and anhedonia/depression. These findings suggest a negative association between CVF detection, increased burden of WMH, and a migrainous WMH pattern. Symptom analysis describes distinct clinical phenotypes, challenging orthostatic headache as a defining characteristic. These results support a comprehensive assessment of imaging and clinical presentations in the workup of suspected SIH. SIH = spontaneous intracranial hypotension; CVF = CSF venous fistula; WMH = white matter hyperintensities; dCTM = dynamic CT myelography; dDSM = dynamic digital subtraction myelography; PPV = positive predictive value; NPV = negative predictive value Received month day, year; accepted after revision month day, year.

Objective Measures of Work and Non-Work Physical Behaviors Associated with Neck and Back Pain in Viticulture Workers

Musculoskeletal disorders are prevalent among agricultural workers, increasing the risk of work-related diseases due to manual labor, repetitive tasks, and prolonged postures. This study evaluates the association between physical behaviors during work and non-work, measured objectively, and musculoskeletal pain in the neck, upper back, and lower back in viticulture workers. A cross-sectional quantitative study was conducted with 75 viticulturists of both sexes aged 18 years or older. An accelerometer measured physical behaviors (lying down, sitting, standing, moving, walking, and sleeping) during work and non-work periods. Pain intensity was quantified using a 0–10 scale and categorized as “Low” and “High” pain intensity. Binary logistic regression tested the association between pain and time spent on physical behaviors. Results indicated a high prevalence of pain: 46.7% cervical, 52% upper back, and 60% lower back. Standing was the most common behavior during work, while lying and sitting were predominant during non-work. An increased sleeping time was associated with a decreased probability of experiencing high-intensity neck pain. Increased time spent lying down during non-work hours was associated with an increased probability of experiencing high-intensity upper back pain. No physical behavior was associated with high-intensity lower back pain. In conclusion, sedentary behaviors worsen upper back pain, and sleep reduces neck pain in viticulture workers.

Unlocking the Potential of the Superficial Cervical Plexus Block in Chronic Pain Management: A Narrative Review and Single-Center, Retrospective Case Series

Background/Objectives: The anesthetic block of the sensory branches of the superficial cervical plexus renders a specific area of the face, head, and anterior neck insensible and painless. Chronic pain in these areas can be difficult to diagnose and treat. In this report, we briefly review the existing evidence on the topic of the superficial cervical plexus block (SCPB) to set the context for our research. We then share our own clinical experience with the SCPB for managing chronic pain syndromes from both cancerous and non-cancerous etiologies. Methods: We first performed a comprehensive literature search and narrative review of clinical cases and studies that utilized the SCPB as an analgesic technique. We then conducted a retrospective case series of all patients who had received an SCPB at our pain clinic since 2020. Results: Our literature review found only a few cases reported, with most of them focusing on acute painful emergencies and perioperative pain syndromes and only very few addressing chronic pain. In our pain clinic, 14 patients received one or more SCPBs for chronic pain management. In 43% of these cases, the pain was related to cancer. The most common areas of pain corresponded to the regions supplied by the transverse cervical and great auricular nerves. The procedures were uneventful in all cases, and patients rated them as effective and worthwhile 71% of the time. Conclusions: Despite the lack of high-quality studies on SCPBs in pain management, the authors’ experience suggests that it is a valid minimally invasive alternative for managing chronic face, head, and neck pain.

The effect of posture regulation training on musculoskeletal disorders, fatigue level and job performance in intensive care nurses

BackgroundIntensive care units (ICUs) are one of the high-risk working areas in terms of musculoskeletal disability and ergonomic risks including the environment and posture factors. Correct posture technique is often ignored by nurses working in these units. This study was conducted to determine the effect of posture regulation training on work-related musculoskeletal disorders, fatigue level and job performance in nurses working in ICUs.MethodsThis quasi-experimental study with one-group pretest-posttest design included 64 intensive care nurses. The nurses received posture regulation training in three different sessions. The post-test was administered four months after the posture regulation training.ResultsThe nurses reported to frequently have aches, pains and discomfort in the neck, upper back and lumbar regions. After the posture regulation training, their level of pain, ache and discomfort in the neck, right and left shoulder, upper back, lower back and right/left foot areas decreased significantly (p < 0.05). The posture regulation training reduced the levels of behavior/severity and affect, which are sub-dimensions of fatigue, and increased the level of contribution to work, which is a sub-dimension of job performance (p < 0.05).ConclusionThe posture regulation training decreased the level of symptoms in the neck, shoulder, upper back, lower back and foot regions of intensive care nurses and partially improved their fatigue level and job performance. Therefore, posture regulation training should be added to in-service training programs and permanent measures should be taken for ergonomic risks in ICUs.

Could resistance training prevent or improve work-related musculoskeletal disorders among surgeons?

Studies have demonstrated the negative impact that work-related musculoskeletal disorders (WMSDs) have on surgeons. These are also likely to affect some allied healthcare professionals such as interventional radiologists. Problems from WMSDs include pain, diminished technical and cognitive performance, and work absence. These could contribute to burnout, to which surgeons are already vulnerable owing to other working practices such as shift patterns and long hours. WMSDs could negatively affect working performance, and lead to poorer surgical outcomes and patient care. Surgeons are at risk of WMSDs of the neck and back that result from fixed and damaging postures while operating. Some have reduced their operation numbers and working days as result of WMSDs. Theatre ergonomics (e.g. table positioning, operating stools and monitors), intraoperative breaks and stretching may improve WMSDs for some. Strength/resistance training (RT) may be used to prevent or mitigate WMSDs. RT can also enhance general health and concentration, and combat intraoperative fatigue. Low engagement times of moderate-intensity RT of 20 minutes, twice a week, improve neck and back pain from WMSDs. Moreover, RT has been shown to reduce all-cause mortality by up to 15%, increase bone density, improve proprioception and reduce the fear of movement due to pain. Alongside ergonomic improvement and stretching, we recommend RT as an activity to improve general health and WMSDs.