Relief Of Neck Pain Research Articles

Meridian massage in the treatment of cervical spondylotic radiculopathy

To observe the clinical efficacy of meridian massage in the treatment of cervical spondylotic radiculopathy. Sixty-four patients with cervical radiculopathy treated from March 2020 to June 2023 were divided into the observation group and the treatment group, with 32 cases in each group. The observation group received conventional treatment, including 14 males and 18 females with an average age of (41.34±7.23) years old ranging from 32 to 55 years old;the disease duration ranged from 9 to 17 months with an average of (14.23±3.56) months;C5 and C6 nerve root compression occurred in 12 cases, C7 nerve root compression occurred in 17 cases, C8 nerve root compression occurred in 3 cases. The treatment group received massage therapy on the basis of conventional treatment, including 17 males and 15 females with an average age of (40.86±6.97) years old ranging from 30 to 54 years old;the disease duration ranged from 8 to 18 months with an average of (15.43±3.48) months;C5 and C6 nerve root compression occurred in 14 cases, C7 nerve root compression occurred in 16 cases, C8 nerve root compression occurred in 2 cases. The clinical efficacy was evaluated by visual analogue scale(VAS), neck disability index(NDI) and clinical assessment scale for cervical spondylosis(CASCS) before and after 2-week treatment, and the range of motion of cervical spine was compared before and after treatment. After 2-week treatment, the VAS and NDI scores of the treatment group and the observation group decreased, while the CASCS scores increased(P<0.001). After 2-week treatment, the VAS and NDI scores were lower and the CASCS scores were higher in the treatment group than those of the observation group(P<0.001). Comparing with those before treatment, the range of motion of flexion, extension, left flexion, right flexion, left rotation and right rotation after 2-week treatment increased in two groups(P<0.05). Comparing with the observation group, the range of motion of flexion, extension, left flexion, right flexion, left rotation and right rotation increased more significantly in the treatment group(P<0.05). Meridian massage is effective in the treatment of cervical Spondylotic radiculopathy, which can effectively relieve neck pain, improve clinical symptoms and improve patient satisfaction.

Anterior Cervical Decompression and Fusion for Neck Pain in Patients with Cervical Spondylosis: Pooled Results of Three Prospective Cohort Studies

IntroductionCurrently, there is a lack of large-scale prospective cohort data to explore the response of neck pain to anterior cervical decompression and fusion (ACDF). The aim of this study was to investigate whether patients with neck pain can achieve consistent neck pain relief following ACDF regardless of preoperative neurological symptoms and number of surgical segments. Materials and MethodsThe study was a pooled analysis of three multicenter prospective cohort studies. Patients with cervical radiculopathy and/or myelopathy with significant neck pain (visual analogue scale [VAS] ≥ 4) underwent ACDF were included. Neck pain VAS scores (VAS-neck) were collected at preoperative and postoperative follow-up time points (3 months, 6 months, and 1 year). Subgroup analyses were conducted for patients with radiculopathy, myelopathy, or myeloradiculopathy, as well as for single- versus multi-segment ACDF. ResultsA total of 237 patients were confirmed. Patients showed significant improvement in VAS-neck at all follow-up time points compared with baseline (P < 0.001 for each). In the first year after surgery, VAS-neck were reduced by 3.3 points (57.0%) on average, and the rates of achieving minimum clinically important difference (MCID) and patient acceptable symptom state (PASS) were 72.2% and 73.8%, respectively. Meanwhile, one year after surgery, there was no significant difference in ΔVAS-neck, recovery rate, MCID and PASS attainment rate between the radiculopathy, myelopathy and myeloradiculopathy groups, and the same trend was observed between the single-segment and multi-segment groups. ConclusionThis study found that ACDF significantly improved neck pain in the patients with cervical spondylosis, regardless of preoperative neurological symptoms and number of surgical segments.

Outcomes of cooled radiofrequency ablation of cervical nerves for the treatment of chronic pain.

Chronic pain, defined as pain persisting for more than 3-6 months, has a mean one-year prevalence in the United States of 25.8% and is one of the most frequent reasons adults seek medical care. Treatment options include physical therapy, analgesics, anticonvulsants, exercise, and muscle relaxants. Even with conventional treatment modalities, in a subset of patients, pain may persist. Cooled radiofrequency ablation (c-RFA), a minimally invasive therapy, employs thermal energy generated by electrical currents to disrupt the transmission of pain stimuli along nociceptive pathways. This leads to an attenuation of pain impulses, primarily through nerve tissue necrosis. The potential of c-RFA to alleviate chronic pain for patients who struggle to find relief elsewhere accentuates the importance of rigorously investigating its outcomes. This study investigates whether patients receiving c-RFA for relief of chronic neck pain caused by cervical facet joint arthropathy experience a reduction in pain scores, the length of this reduction in pain scores, and the magnitude of this reduction in pain. This study was a retrospective analysis of data extracted from UW-Health Electronic Medical Health records (EMR), encompassing cervical c-RFA procedures performed from 2015 through 2022. Patient data were obtained, including diagnosis, pre-operative pain score, post-operative pain score, duration of relief, patient age, sex, and BMI. A two-tailed paired t-test was used to statistically analyze the pre-operative and post-operative pain scores, in which a p-value ≤0.05 was considered significant. A total of 450 cervical c-RFA procedures were reviewed, 152 were excluded due to absent pre- or post-op pain scores. 298 were included in the analysis, comprising 203 unique patients: 129 females and 74 males with an average age of 56.03 ± 12.76 and a BMI of 28.76 ± 6.05. Improvement of pain symptoms was reported in 85.23% (n = 263), 6% (n = 19) reported complete pain remission, 8.72% (n = 26) reported no change, and 3.02% (n = 9) reported worsening symptoms. Patients reported an average pre-operative pain score of 6.15 (M = 6.15, SD = 1.55) and an average post-operative pain score of 3.64 (M = 3.64, SD = 2.09) this achieved significance (p < 0.0001). Of the 85.23% (n = 263) charts that noted improvement, there is an average of 48.04% ± 26.53 reduction from their pre-operative pain scores. The average duration of relief lasted 6.67 ± 4.84 months. This study supports the potential efficacy of c-RFA as a minimally invasive treatment for chronic neck pain secondary to cervical facet joint arthropathy refractory to conventional treatment measures, demonstrating significant relief for a substantial length of time. Due to chronic pain's detrimental effect on one's quality of life, finding effective treatment options is essential, especially for those refractory to conventional treatments.

Minimally invasive posterior cervical foraminotomy vs. anterior cervical discectomy and fusion in the treatment of patients with single-level unilateral cervical radiculopathy.

The aim of this study was to observe the clinical efficacy and safety of minimally invasive posterior cervical foraminotomy (MI-PCF) and anterior cervical discectomy and fusion (ACDF) in the treatment of single-level unilateral cervical radiculopathy (SLUCR). We retrospectively analyzed 81 patients with SLUCR in two hospitals from February 2020 to February 2022, including the MI-PCF group (n=40) and the ACDF group (n=41). The differences in neck and shoulder pain, visual analog score (VAS), upper limb radiating pain (VAS), and neck disability index (NDI) were compared. Operative time, intraoperative bleeding, hospital stay, and complications were also compared between the two groups. The degree of neck and shoulder pain relief at 1 day postoperatively was better in the ACDF group than in the MI-PCF group (p<0.05), while there were no significant differences between the two groups in terms of neck and shoulder pain relief at 1 month, 3 months, 6 months, and 12 months postoperatively, (p>0.05). There were no significant differences in the relief of upper limb radiating pain and the decrease of NDI scores between the two groups at 1 day, 1 month, 3 months, 6 months, and 12 months after surgery (p>0.05). The patients in MI-PCF group had shorter operative time, less bleeding, and shorter hospital stay, which were statistically different (p<0.05). There was no statistical difference in the complication rate between the two groups, (p>0.05). The clinical efficacy and safety of MI-PCF and ACDF in the treatment of SLUCR are satisfactory, meanwhile, MI-PCF has shorter operative time, less bleeding and shorter hospital stay than ACDF, which is worthy of clinical promotion.

Effectiveness and safety of thoracic manipulation in the treatment of neck pain: An updated systematic review and meta-analysis.

The purpose of this meta-analysis was to evaluate the effectiveness and safety of thoracic manipulation (TM) in patients with neck pain (NP). The purpose of this meta-analysis was to evaluate the effectiveness and safety of thoracic manipulation (TM) in patients with neck pain (NP). Seven electronic databases were searched from their inception through October 2023 by two authors. The methodological quality assessments were performed with the Physiotherapy Evidence Database (PEDro) scale. Pain, cervical range of motion (ROM), disability, and quality of life (QOL) were estimated for TM treatment in patients with NP. Eighteen randomized controlled trials (RCTs) with 914 patients were included with a PEDro score of 6.923 ± 3.120. Pooled effect sizes of pain (SMD =-0.481, 95% CI -0.653 to -0.309, P= 0.000), disability (SMD =-1.435, 95% CI -2.480 to -0.390, P= 0.007), QOL-physical component score (PCS) (SMD = 0.658, 95% CI 0.290 to 1.025, P= 0.000), ROM of flexion (SMD = 0.921, 95% CI 0.287 to 1.555, P= 0.000), ROM of extension (SMD = 0.572, 95% CI 0.321 to 0.822, P= 0.000), ROM of left lateral flexion (SMD = 0.593, 95% CI 0.075 to 1.112, P= 0.025) and ROM of left rotation (SMD = 0.230, 95% CI 0.010 to 0.450, P= 0.04) were favored by the TM group. TM provides short-term effect on relieving neck pain, increasing cervical ROM, and disability in patients with NP without serious side effects. Continuous therapy and distraction therapy are recommended as optimal choice on reducing pain and improving cervical ROM, especially in patients with chronic NP (> 3 months). The TM-induced improvements in the QOL of patients with NP should be verified by more further high-quality RCTs.

CT-Guided Radiofrequency Ablation Targeting the Herniation Edge of the Cervical Disc for the Treatment of Neck Pain: A Retrospective Study.

Sinuvertebral nerve overactivation is one of the mechanisms of neck pain caused by cervical disc herniation. Radiofrequency ablation (RFA) of sinuvertebral nerves has shown efficacy for the treatment of discogenic low back pain. However, relatively few studies evaluated the efficacy of RFA of sinuvertebral nerves for the treatment of chronic neck pain caused by cervical disc herniation. Clinical data were retrospectively collected from 168 patients diagnosed with cervical disc herniated neck pain from January 1, 2019, to September 1, 2022, who were treated with computed tomography (CT)-guided cervical disc RFA of at the Pain Medicine Center of Zhejiang Provincial People's Hospital. A 22-G RFA needle (Inomed, Emmendingen, Germany) was inserted between the carotid artery and trachea to the intervertebral disc under the direction of CT the scanner. Depending on the position of the protruding nucleus pulposus or the rupture of the annulus fibrosus, the needle was inserted into the posterior side of the intervertebral disc until the tip of the needle reached the target position. The numeric rating scale (NRS) score, pain relief and appearance of complications after RFA were evaluated. A total of 168 patients underwent CT-guided RFA for cervical disc herniation. The average duration of pain was 67.07 ± 70.42months. At 6months of follow-up, the median preoperative NRS score decreased significantly from preoperative 5.41 ± 1.08 to postoperative 1.341 ± 1.25 at 1month, 1.4 ± 1.38 at 3months and 1.72 ± 1.41 at 6months after RFA (p < 0.01). The numbers of patients with ≥ 50% of their neck pain relieved were 84% (141/168), 87% (147/168), 87% (147/168) and 79% (133/168) at 1day, 1month, 3months and 6months after RFA, respectively. No serious complications related to treatment or long-term complications were observed. This study highlights that CT-guided RFA targeting the edge of cervical disc herniation to destroy the sinuvertebral nerves can effectively relieve neck pain, and the computed tomography (CT)-guided RFA treatment strategy has the advantages of having few complications.

Athrodesis of the lateral atlanto-axial joint for the relief of neck pain and cervicogenic headache.

Osteoarthrosis of the lateral atlanto-axial joint (LAAJ) may be a cause of upper neck pain and headache. Intra-articular injection of steroids may provide only short-lasting relief. For intractable pain, arthrodesis of the joint might be considered. To determine the success rates of arthrodesis of the lateral atlanto-axial joint for relieving neck pain and disability. Practice audit. Private practice of senior author. Prospective series of 23 consecutive patients. Outcomes were measured using a numerical rating scale for neck pain, and the Neck Disability Index for disability. Success rates were calculated for various degrees of improvement of neck pain at long-term follow-up (8-40 months), and for achieving various combinations of improvement of both neck pain and disability. Complete relief of pain was achieved in 40% of patients, with a further 40% achieving at least 50% relief. At long-term follow-up, 30% of patients had no neck pain and no disability, and a further 25% had only minimal pain, minimal disability, or both. The present study did not corroborate earlier studies that claimed outstanding outcomes for arthrodesis of the LAAJ, but its outcomes are consonant with more recent studies that provided transparent outcome data. These studies provide Pain Physicians with empirical data on success rates and outcomes, upon which they can base their consideration of referral for arthrodesis.

Effectiveness of the Modified Formula of Ya-Tha-Pra-Sen on Relieving Neck and Shoulder Muscle Pain: Clinical Randomize Control Trail.

Ya-Tha-Pra-Sen (YTPS) has been utilized as a topical remedy to alleviate muscle pains since the Ayutthaya period. Formulated from a combination of 13 distinct herbs, YTPS offers a range of medicinal properties. This study aimed to develop an enhanced YTPS gel formula, referred to as YTPS-DG, by incorporating an additional 5 traditional Thai herbs. The efficacy of YTPS-DG in reducing muscle pains was then compared with the traditional YTPS formula. A randomized controlled trial was undertaken with 45 participants, aged 20 to 60. Participants were randomly assigned to one of three groups: the YTPS-DG group (modified formula), the YTPS-TG group (traditional formula), or the placebo group (PCBG). Each participant received gel samples packaged in 2.5 g units and was instructed to apply one package's worth to their upper trapezius muscle twice daily over a span of six days. Daily results were systematically documented in case record forms, and participants were monitored with follow-up checks every three days. Our findings revealed that YTPS-DG exhibited the most pronounced efficacy. There was a statistically significant reduction in pain from baseline for the YTPS-DG group (P&lt;0.05) when compared to the YTPS-TG and placebo groups. Furthermore, YTPS-DG notably increased weight-bearing capacity (in kg) and enhanced the Range of Motion (ROM) in participants' neck and shoulder areas, as demonstrated by comparing results before and after application. In conclusion, the modified YTPS-DG formula proved to be superior in alleviating muscle pains and enhancing functional parameters compared to the traditional YTPS and placebo. Further studies are warranted to explore the underlying mechanisms and potential applications.

Evaluation of the clinical effect of acupuncture in treatment of neck pain in cervical spondylosis based on propensity score matching

To observe the clinical effect and safety of acupuncture in treatment of neck pain due to cervical spondylosis. According to the patients' preference and acceptance for the interventions of neck pain induced by cervical spondylosis, an acupuncture group (221 cases) and a non-acupuncture group (251 cases) were divided. After the control of confounding factors with propensity score matching, 218 cases were included in either acupuncture group or non-acupuncture group. In the acupuncture group, acupuncture was applied to Dazhui (GV 14), Baihui (GV 20), ashi points, bilateral neck-Jiaji (EX-B 2), Fengchi (GB 20), Houxi (SI 3), Shenmai (BL 62), etc. The treatment was given once daily, one course of intervention was composed of 5 treatments and 3 courses were included. In the non-acupuncture group, the oral administration of imrecoxib tablets and cobalt tablets was prescribed for 2 weeks. Before and after treatment, the scores of Northwick Park questionnaire (NPQ) and the simplified McGill pain questionnaire (SF-MPQ) were observed, and the safety was assessed in patients of the two groups. After treatment completion, the scores of NPQ and SF-MPQ were all reduced when compared with those before treatment in each group (P<0.001), and the scores of NPQ and SF-MPQ in the acupuncture group were lower than those of the non-acupuncture group (P<0.001). The incidence of adverse reactions was 6.0% (13/218) in the acupuncture group and was 10.1% (22/218) in the non-acupuncture group, without statistical significance in comparison (P>0.05). Acupuncture is effective and safe in the relief of neck pain and the improvement of comprehensive quality of life in the patients with cervical spondylosis.

Effectiveness of ischemic compression on myofascial trigger points in relieving neck pain: A systematic review and meta-analysis.

Ischemic compression is widely used to clinically treat neck pain. However, no meta-analysis has been conducted to evaluate the effects of this process on neck pain. This study aimed to evaluate the effects of ischemic compression on the myofascial trigger points for improving neck pain-related symptoms (mainly pain, joint mobility limitation and function limitation) and to compare ischemic compression with other therapies. Electronic searches were conducted in PubMed, OVID, Web of Science, EBSCO, SCOUPS, Cochrane Library, PEDro, Wanfang, CNKI and Chinese VIP Database in June 2021. Only randomised controlled trials on the effects of ischemic compression on neck pain were included. The major outcomes were pain intensity, pressure pain threshold, pain-related disability and range of motion. Fifteen studies involving 725 participants were included. Significant differences were observed between ischemic compression and sham/no treatment group in pain intensity, pressure pain threshold and range of motion immediately and in the short term. Significant effect sizes of dry needling were observed over ischemic compression in terms of improving pain intensity (SMD = 0.62; 95% CI: 0.08 to 1.16; P= 0.02), pain-related disability (SMD = 0.68; 95% CI: 0.19 to 1.17; P= 0.007) and range of motion (MD =-2.12; 95% CI: -2.59 to -1.65; P< 0.001) immediately after treatment. Dry needling also showed a significant small effect size for the short-term reduction of pain (SMD = 0.44; 95% CI: 0.04 to 0.85; P= 0.03). Ischemic compression can be recommended in the immediate and short-term pain relief and increase in the pressure pain threshold and range of motion. Dry needling is superior to ischemic compression in relieving pain and improving pain-related disability and range of motion immediately after treatment.

A Systematic Review of Anesthetic, Saline and Dry Needling Injections for Headache Patients

Objectives Earlier literature provided evidence of neck pain relief via cervical trigger point injections with anesthetic agents. However, recent evidence suggests that intramuscular or paraspinal cervical injections with local anesthetic may provide relief for various types of headaches and orofacial pain as well. The primary purpose of this systematic review was to determine whether a cohort of retrospective case studies and randomized controlled trials using paraspinal cervical or intramuscular anesthetic injections were associated with a decrease in headache and orofacial pain. Methods A systematic review of the literature was performed to observe the association between headache or orofacial pain relief and paraspinal cervical injections with various pain-relieving agents. Literature searches using the key terms “headaches”, “paraspinous cervical injections”, “neck/intramuscular injections” and “orofacial pain” were performed in PubMed, Google Scholar, and Scopus. We implemented the preferred reporting items for systematic reviews and meta-analyses (PRISMA) format for the systematic review. Results Initially, four hundred forty articles were located during the systematic review. Five total articles were selected for review and 435 were excluded because they did not meet search criteria. Another two relevant articles were found during manual searches within references of the systematic review. The seven studies included were retrospective case studies involving patients with headaches or orofacial pain who received paraspinal cervical or other intramuscular injections. A total of 841 patients’ data were tallied from the 7 articles and 683 of those patients received anesthetic injections. Significant pain relief due to intramuscular or paraspinal cervical injections was observed in 83.7% of the patients. Conclusion Our systematic review of association between headache or orofacial pain relief and paraspinal cervical injections with various pain-relieving agents demonstrated a frequency of headache and orofacial pain relief of 83.7%. Such a large percentage compared to a robust placebo study provides promising evidence that this treatment may have a therapeutic role in the management of headache and orofacial pain. Despite limitations faced in performing our systematic review, it seems quite clear that pain relief for these headache patients can be attributed to intramuscular anesthetic or dry needling injections. While larger prospective studies should be performed regarding specific location and anesthetic, our systematic review provides additional evidence that anesthetic intramuscular and dry needling injections provide pain relief intension-type headaches (TTH), migraine headaches, cervicogenic headache pain, and orofacial pain.

The application of three-dimensional printed patient-specific drilling templates for expansive open-door laminoplasty: A single-center, prospective randomized controlled study.

The choice of trough position in Expansive open-door laminoplasty (EOLP) mostly relied on bony landmarks and surgeons' experience. The present study was to validate the efficacy of the three-dimensional (3D) printed patient-specific drilling templates with the function of locating and depth control for EOLP. A single-center, prospective randomized controlled study was conducted on the patients who underwent unilateral EOLP from August 2019 to December 2020. The 3D printed patient-specific drilling template was fabricated and used in the template group. All the EOLP were performed by a senior surgeon and a junior surgeon. The clinical outcomes and radiographic results were evaluated. A total of 37 patients who completed the 12-month follow-up were analyzed. The clinical outcomes were significantly improved after surgery in both groups (P < 0.05). The visual analogue scale (VAS) scores were significantly lower in the template group at 12 months postoperatively (P < 0.05). The anteroposterior diameter, Pavlov's ratio and Open angle were all higher in the template group than those in the control group at 3 days and 12 months postoperatively (P < 0.05). The satisfaction of the trough position on both sides and incomplete fracture rate on the hinge side were higher in the template group based on the CT scans taken 3 days after surgery (P < 0.05). To the junior surgeon, the satisfaction and the incomplete fracture rate were significantly higher in the template group compared with those in the control group (P < 0.05). The application of 3D printed patient-specific drilling templates with the function of locating and depth control for EOLP could improve the outcome of neck pain relief and expand the decompression. It can also improve the satisfaction of the trough position on the open-door side and the hinge side and decrease the complete fracture rate on the hinge side, especially for the junior surgeon.

The Impact of Single-Level ACDF on Neural Foramen and Disc Height of Surgical and Adjacent Cervical Segments: A Case-Series Radiological Analysis.

Background: ACDF has become one of the established procedures for the surgical treatment of symptomatic cervical spondylosis, showing excellent clinical results and effective improvements in neural functions and neck pain relief. The main purpose of ACDF is neural decompression, and it is considered by some authors as an indirect result of the intervertebral distraction and cage insertion and the consequent restoration of the disc space and foramen height. Methods: Radiological data from 28 patients who underwent single-level ACDF were retrospectively collected and evaluated. For neural foramen evaluation, antero-posterior (A-P) and cranio-caudal (C-C) diameters were manually calculated; for intervertebral disc height the anterior, centrum and posterior measurement were calculated. All measurements were performed at surgical and adjacent (above and below) segments. NRS, NDI and also the mJOA and Nurick scale were collected for clinical examination and complete evaluation of patients’ postoperative outcome. Results: The intervertebral disc height in all its measurements, in addition to the height (C-C diameter) of the foramen (both right and left) increase at the surgical segment when comparing pre and postop results (p < 0.001, and p = 0.033 and p = 0.001). NRS and NDI radiculopathy scores showed improved results from pre- to post-op evaluation (p < 0.001), and a negative statistical correlation with the improved disc height at the surgical level. Conclusions: The restoration of posterior disc height through cage insertion appears to be effective in increasing foraminal height in patients with symptomatic preoperative cervical foraminal stenosis.

Unusual worm-like radiopacities in the radiographs of patients with cervical spondylosis

This report describes three patients with cervical spondylosis whose diagnostic radiographs showed worm-like, irregularly curved radiopaque lines and strings in the head and neck region during routine chiropractic examinations. Such artifacts are frequently misinterpreted as parasitic infection, electrostatic discharges, detector image lag, fracture, or ligature wires. All three patients with worm-like radiopacities disclosed their 15-20 years of history of acupuncture treatment to relieve neck pain. The present cases of unexpected and coincidental findings may suggest a possible acupuncture-caused radiographic artifacts in the neck and jaw bones. In particular, the patient had previous gold thread treatments possibly associated with the observed radiographic artifacts. These cases may emphasize the importance of having a thorough understanding of patient history regarding unexpected radiographic artifacts.

Electroacupuncture relieves hyperalgesia by regulating neuronal-glial interaction and glutamate transporters of spinal dorsal horns in rats with acute incisional neck pain.

Glial cells are involved in the analgesic effect of electroacupuncture (EA) in rats with chronic neurological pain. The objective of this study was to observe the role of neuronal-glial interaction and glutamate (Glu) transporters in EA-induced acute neck pain relief in rats. Male rats were placed into the following five groups: control, model, EA Futu (LI18), EA Hegu (LI4)-Neiguan (PC6), and EA Zusanli (ST36)-Yanglingquan (GB34). The incisional neck pain model was established by making a longitudinal incision along the midline of the neck. The thermal pain threshold (TPT) was measured using a radiation heat detector. The immunoactivities of glial fibrillary acidic protein (GFAP), ionized calcium-binding adapter molecule 1 (Iba-1), neurokinin-1 receptor (NK-1R), Glu aspartate transporter (GLAST), and Glu transporter-1 (GLT-1) in the dorsal horns (DHs) of the cervico-spinal cord (C2-C5) were detected using immunofluorescence histochemistry. The expression levels of GFAP, Iba-1, GLAST, and GLT-1 mRNAs were determined using quantitative real-time polymerase chain reaction (PCR). The TPT and levels of mRNAs expression and immunoactivity of GLT-1 and GLAST were significantly decreased, and those of Iba-1 and GFAP were significantly increased in the model group than those of the control group (P < 0.05). The activated microgliacytes were gathered around the NK-1R positive neurons, and co-expression of NK-1R and astrocytes was observed in the model group. EA LI18 significantly increased the TPT and expression of GLAST and GLT-1 mRNAs (P < 0.05) and notably decreased the number of Iba-1 positive cells and Iba-l mRNA expression (P < 0.05), whereas GLAST and GLT-1 antagonists inhibited the analgesic effect of EA LI18. However, these effects, except for the downregulation of Iba-1 mRNA, were not observed in the EA ST36-GB34 group. Fewer NK-1R-positive neurons were visible in the spinal DHs in the EA LI18 group, and the co-expression of NK-1R and astrocytes was also lower than that in the three EA groups. Electroacupuncture of LI18 had an analgesic effect in rats with neck incisions, which may be related to its functions in suppressing the neuronal-glial cell interaction through NK-1R and upregulating the expression of GLAST and GLT-1 in the spinal DHs.

The association between forward head posture and masticatory muscle pressure pain thresholds in patients with temporomandibular joint dissorders: a cross-sectional observational study.

Forward head posture (FHP) is common in patients with temporomandibular joint disorders (TMDs); however, whether it contributes to TMD symptoms remains unclear. The aim of this study was to investigate the association between (1) FHP and masticatory muscle pressure pain thresholds (PPTs) and (2) neck muscle and masticatory muscle PPTs. A total of 145 patients diagnosed with TMD were recruited between December 2020 and April 2021. Data regarding FHP and neck and masticatory muscle PPTs were collected. FHP was characterized by the craniocervical angle (CVA) measured between the horizontal line through C7 and the line between the tragus of the ear and C7. Patients were divided into either the FHP group (CVA ≤ 51°) or the non-FHP group. Differences in the masseter and temporalis muscle PPTs between the two groups were analyzed using the Mann-Whitney U test. The correlation between the CVA, neck, and masticatory muscle PPTs in all patients was determined by Spearman's correlation analysis. There were 70 patients in the FHP group and 75 patients in the non-FHP group. No significant difference in masseter and temporalis muscle PPTs was found between the two groups (p > 0.05). No correlation was found between FHP and masticatory muscle PPTs (p > 0.05). A significant association was found between the neck muscle and masticatory muscle PPTs (p < 0.05). The C5-C6 pillar and masticatory PPTs were either moderately (r = 0.435, masseter muscle) or strongly (r = 0.608, temporalis muscle) correlated, while the correlation between the trapezius and masticatory muscles was moderate (r = 0.378, masseter muscle and r = 0.461, temporalis muscle). FHP was not directly associated with masticatory muscle PPTs. Masticatory muscle PPTs were strongly or moderately associated with neck muscle PPTs. Therefore, the presence of neck pain, not the degree of FHP, in patients with TMD is of significance. In TMD treatment, we should pay attention to and actively relieve neck pain.

Effects of isometric training on the treatment of patients with neck pain: A meta-analysis.

Background:The aim of this meta-analysis was to evaluate the effects of isometric training interventions on the treatment of patients with neck pain.Methods:Electronic databases, including PubMed, The Cochrane Library, Web of Science, etc., were retrieved and screened by computer, and 18 articles with a total of 868 samples were included. Review Manager 5.4 software was used for the meta-analysis.Results:The meta-analysis results showed that isometric training can reduce visual analogue scale scores of patients[weighted mean difference (95% confidence interval) = -0.80(-0.88, -0.73), P < .00001]; decrease patients neck disability index score, isometric training was better than the control group [weighted mean difference (95% confidence interval) = 5.55 (4.57, 6.53), P < .0001]; in improving patients’ motion of the sagittal plane [weighted mean difference (95% confidence interval) = 1.53 (-0.40, 3.63), P = .12], coronal plane [weighted mean difference (95% confidence interval) = 2.12 (0.56, 3.68), P = .008], horizontal plane [weighted mean difference (95% confidence interval) = 3.58 (1.56, 5.59), P = .0005], isometric training was superior to the control group. More than 20 isometric training interventions had more significant effects on visual analogue scale and range of motion. And isometric training for more than 8 weeks had more significant effects on the visual analogue scale and neck disability index scores.Conclusion:Isometric training has significant effects on relieving neck pain, improving neck dysfunction, and improving joint mobility. However, the two indicators of visual analogue scale and neck disability index had more influential factors; the sample size of most studies was relatively small, and the intervention measures in the control group were relatively simple. It is expected that more abundant research will expand and deepen in the future, laying the foundation for meta-analysis.

탄성밴드와 짐볼을 이용한 목 어깨안정화 운동이 경부 통증 및 경부 정렬에 미치는 영향

The purpose of this study was to analyze the effect of neck and shoulder stabilization exercises using thera-bands and gym balls on neck pain relief, strength of deep cervical flexor, and cervical alignment in college students with forward neck position. For this purpose, the exercise program was performed twice a week for 8 weeks and was divided into a thera-band group (11 individuals), a gym ball group (11 individuals), and a combined group using thera-band and gym ball (11 individuals). The Visual Analogue Scale (VAS), Neck Disability Index (NDI), strength of deep cervical flexor, Craniovertebral Angle (CVA), and Cranial Rotation Angle (CRA) were measured at week 0, week 4, and week 8, respectively. According to the results of the study, firstly, VAS, NDI, strength of deep cervical flexor and CVA improved significantly as the term of training increased in every group, but combined group showed the fastest and most significant improvements at week 8 compared to week 4. Second, CRA decreased significantly as the term of training increased in every group. However, at weeks 4 and 8 of exercise, the rate of decline was significantly faster for combined group and gym ball group than for thera-band group. To summarize the results, when neck and shoulder stabilization exercises using thera-band and gym ball were used on patients with neck pain due to frontal head position, positive results were shown in reducing neck pain, increasing the strength of the deep neck flexor and improving cervical spine alignment. Moreover, the group of combined intervention not only improved strength but also motor-sensory skills, which showed better results than single exercise trainig group, leading to implementation of combined training significant.

C1-ring osteosynthesis versus C1-2 fixation fusion in the treatment of unstable atlas fractures: a multicenter, prospective, randomized controlled study with 5-year follow-up.

The aim of the present study was to compare the long-term effects of posterior C1-ring osteosynthesis and C1-2 fixation fusion in the treatment of unstable atlas fractures. A multicenter, prospective, randomized controlled trial was conducted to analyze 73 patients with atlas fractures who underwent posterior fixation. The intervention group was treated with C1-ring osteosynthesis, and the control group was treated with C1-2 fixation fusion. The patients were followed up for 6 months, 1 year, 2 years, and 5 years after the operation. Fifty-two patients had complete data at the last follow-up. The visual analog scale (VAS) score for neck pain in the intervention group was lower than that in the control group (p < 0.001). The operation time, intraoperative blood loss, radiation dose, bedridden period, hospital stay, and cost in the intervention group were significantly lower than those in the control group (p < 0.001). At the last follow-up, the Neck Disability Index in the intervention group was higher than that of the control group, and the angle of flexion-extension and axial rotation in the intervention group were greater than those in the control group (p < 0.001). In this study, the authors found that posterior C1-ring osteosynthesis is superior to C1-2 fixation fusion in terms of long-term relief of neck pain and preservation of the physiological function of the cervical vertebrae. This technique is a reliable choice for the treatment of unstable C1 fractures.

The CX-DZ-II intelligent electronic stimulator for neck pain caused by cervical spondylosis: A two-center, randomized, controlled, and non-inferiority trial.

BackgroundElectroacupuncture (EA) has been commonly used for the management of neck pain caused by cervical spondylosis (NPCS); however, current electrical instruments have limitations on intelligence, digitalization, and visualization. The intelligent electronic stimulator (CX-DZ-II) is a digital device with an evidence-based diagnosis and treatment system. This study aimed to investigate the efficacy and safety of the CX-DZ-II intelligent EA instrument for NPCS.Materials and MethodsA total of 164 patients with NPCS [mean age (SD), 49.48 (13.47) years] were randomly assigned to receive 8 sessions (over 2 weeks) EA of the intelligent electronic stimulator (CX-DZ-II) or the regular electronic stimulator (SDZ-II). The primary outcome was the change of the visual analog scale (VAS) from baseline to 2 weeks of treatment. Secondary outcomes included mean scores of the VAS after each treatment in 1 week, responder rate, drug-usage rate of non-steroidal antipyretic analgesics (NSAAs), the occurrence rate of adverse events (AEs), proportions of apparatus with defect during treatment, and excellent rate of apparatus.ResultsThe intelligent electronic stimulator (CX-DZ-II) was non-inferior to the regular electronic stimulator (SDZ-II) for changes from baseline in the VAS [3.36 vs. 3.23, with a difference of 0.17 (95% CI, −0.36 to 0.69), P < 0.025 for non-inferiority]. No between-group differences were found in outcomes of VAS in 1 week, overall responders, and drug-usage rate of NSAAs. The defect rate and excellent rate of the instrument were similar in the CX-DZ-II and SDZ-II groups. Adverse events occurred in 9 (10.84%) patients in the CX-DZ-II group and 4 (5.00%) patients in the SDZ-II group.ConclusionThe intelligent electronic stimulator (CX-DZ-II) was non-inferior to the regular electronic stimulator (SDZ-II) in relieving neck pain. The intelligent electronic stimulator (CX-DZ-II) is a promising non-inferior alternative instrument for NPCS.Clinical Trial Registration[https://clinicaltrials.gov/], identifier [NCT030 05301].