Treatment Of Chronic Neck Pain Research Articles

Efficacy and safety of Myofascial-meridian Release Acupuncture (MMRA) for chronic neck pain: a study protocol for randomized, patient- and assessor-blinded, sham controlled trial.

BackgroundThe purpose of this study is to evaluate the efficacy and safety of myofascial-meridian release acupuncture (MMRA) in the treatment of chronic neck pain compared with sham acupuncture.Methods/designA protocol for a randomized, patient- and assessor-blinded, sham controlled parallel trial is presented. Seventy-four participants with a ≥3 month history of neck pain and a score of ≥4 on the 11-point pain intensity numerical rating scale (PI-NRS) will be randomly assigned to the MMRA group (n = 37) or sham acupuncture group (n = 37). The participants will receive the MMRA treatment or sham acupuncture treatment twice per week for 4 weeks. The primary outcome is the mean change in the PI-NRS (0 = no pain and 10 = worst possible pain, 11-point Likert scale) from baseline to 4 weeks. The secondary outcomes are the mean change from baseline on the clinical relevance of the pain (ratio of changes greater than 1.5 or with percentiles greater than 30 % and 50 % in the PI-NRS), function (Neck Disability Index and Cervical Range of Motion), autonomic and psychometric measurements (Heart Rate Variability and Perceived Stress Scale), quality of life (EuroQol), global assessment (Patient Global Impression of Change), semi-objective outcomes (pressure pain threshold, consumption of rescue medicine and days of restricted activity) and immunologic/stress biomarkers. Adverse events will be evaluated at every visit.DiscussionThe results of this trial will provide evidence to confirm the efficacy and safety of acupuncture for chronic neck pain.Trial registrationThe trial is registered with the Clinical Research Information Service (CRiS), Republic of Korea: KCT0001573.

Transcutaneous electrical nerve stimulation (TENS) for chronic neck pain

Background Chronic neck pain is a highly prevalent condition, affecting 10% to 24% of the general population. Transcutaneous electrical nerve stimulation (TENS) is the noninvasive, transcutaneous use of electrical stimulation to produce analgesia. It is a simple, low-cost and safe intervention used in clinical practice as an adjunct treatment for painful musculoskeletal conditions that have a considerable impact on daily activities, such as chronic neck pain. This review is a split from a Cochrane Review on electrotherapy for neck pain, published in 2013, and focuses specifically on TENS for chronic neck pain. Objectives To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) (alone or in association with other interventions) compared with sham and other clinical interventions for the treatment of chronic neck pain. Search methods We searched Cochrane Back and Neck Trials Register, CENTRAL, MEDLINE, Embase, five other databases and two trials registers to 9 November 2018. We also screened the reference lists of relevant studies to identify additional trials. There were no language, source, or publication date restrictions. Selection criteria We included randomised controlled trials (RCTs) involving adults (≥ 18 years of age) with chronic neck pain (lasting > 12 weeks) that compared TENS alone or in combination with other treatments versus active or inactive treatments. The primary outcomes were pain, disability and adverse events. Data collection and analysis Two independent review authors selected the trials, extracted data and assessed the risk of bias of included studies. A third review author was consulted in case of disagreements. We used the Cochrane 'Risk of bias' tool (adapted by Cochrane Back and Neck), to assess the risk of bias of individual trials and GRADE to assess the certainty of evidence. We used risk ratios (RRs) to measure treatment effects for dichotomous outcomes, and mean differences (MDs) for continuous outcomes, with their respective 95% confidence intervals (CIs). Main results We included seven RCTs with a total of 651 participants, mean age 31.7 to 55.5 years, conducted in three different countries (Turkey, Jordan and China). The length of follow-up ranged from one week to six months. Most RCTs used continuous TENS, with a frequency of 60 Hz to 100 Hz, pulse width of 40 μs to 250 μs and tolerable intensity, described as a tingling sensation without contraction, in daily sessions lasting 20 to 60 minutes. Due to heterogeneity in interventions and outcomes, we did not pool individual study data into meta-analyses. Overall, we judged most studies as being at low risk for selection bias and high risk for performance and detection bias. Based on the GRADE approach, there was very low-certainty evidence from two trials about the effects of conventional TENS when compared to sham TENS at short-term (up to 3 months after treatment) follow-up, on pain (assessed by the Visual Analogue Scale (VAS)) (MD -0.10, 95% CI -0.97 to 0.77) and the percentage of participants presenting improvement of pain (RR 1.57, 95% CI 0.84 to 2.92). None of the included studies reported on disability or adverse events. Authors' conclusions This review found very low-certainty evidence of a difference between TENS compared to sham TENS on reducing neck pain; therefore, we are unsure about the effect estimate. At present, there is insufficient evidence regarding the use of TENS in patients with chronic neck pain. Additional well-designed, -conducted and -reported RCTs are needed to reach robust conclusions.

Lidocaine Injection in the Intramuscular Innervation Zone Can Effectively Treat Chronic Neck Pain Caused by MTrPs in the Trapezius Muscle

Background: An increasing number of people suffer from neck pain due to life style and prolonged use of computers. Research has revealed that myofascial trigger points (MTrPs) and the intramuscular innervation zone (IZ) are involved in neck pain. MTrPs are induced mainly by IZ dysfunction of the affected skeletal muscle and the 2 do not overlap in location. The question is whether injection treatment in MTrPs or in the IZ is more effective to relieve MTrPs-associated pains. The precise location and body-surface map of the intramuscular IZ in the trapezius muscle and a clinical injection study in the IZ may provide a useful answer to the question. Objectives: This study aimed to investigate the efficacy of lidocaine injection in the intramuscular IZ for the treatment of chronic neck pain caused by MTrPs in the trapezius muscle. Study Design: Prospective observational study, approved by the local research ethics. Setting: University hospital, departments of Anesthesiology and Anatomy. Methods: First, for the determination of IZ distribution and body-surface mapping, a modified intramuscular Sihler’s neural staining technique was applied to elucidate nerve distribution patterns of the trapezius muscle. Then, 120 patients with myofascial pain syndrome (MPS) of the trapezius muscle were randomly divided into 5 groups for analysis. Group 1 (n = 24) received injections of saline (0.9% NaCl) at the MTrPs. Group 2 (n = 24) received injections of 0.5% lidocaine at the MTrPs. Group 3 (n = 24) received injections of saline (0.9% NaCl) at the mid-upper trapezius (Point E). Group 4 (n = 24) received injections of 0.5% lidocaine at Point E. Group 5 (n = 24) received a combined injection of 0.5% lidocaine treatment at both Point E and the lower trapezius (Point F). The injection dose was 4 mL at each injection site. All patients received injections once a week for 4 weeks. The visual analogue scale (VAS) and the frequency of painful days per month (FPD) were obtained before treatment and at 2, 4, and 6 months after treatment. Results: The intramuscular terminal nerve branches presented a “dendritic” distribution in the trapezius muscle and were connected with each other to form an S-shaped IZ belt in the middle of the muscle belly. Compared with the MTrP injection group, lidocaine-injection therapy in the IZ significantly reduced the degree and frequency of neck pain in patients at 6 months after treatment, especially the combined lidocaine-injection therapy in the IZ of both the mid-upper trapezius and the lower trapezius are more effective (all P < 0.05). Conclusions: This study confirms that lidocaine-injection therapy in the IZ significantly reduces the degree and frequency of neck pain in patients at 6 months after treatment. The combined lidocaine-injection therapy in the IZ of both the mid-upper trapezius and the lower trapezius is more effective. In addition, this study establishes a clear distribution map of intramuscular nerves that will be conducive to the future use of chemical blockers and electrical stimulation in the nervous system in treating MPS of the trapezius muscle. Limitations: The small number of patients and the short duration of follow-up. Key words: Neck pain, intramuscular innervation zone, myofascial trigger points, lidocaine

Effects of Miniscalpel-Needle Release on Chronic Neck Pain: A Retrospective Analysis with 12-Month Follow-Up.

ObjectiveChronic neck pain is a highly prevalent condition, and is often treated with non-steroidal anti-inflammatory drugs. Limited clinical studies with short-term follow-up have shown promising efficacy of acupuncture as well as miniscalpel-needle (MSN) release. In this retrospective study, we examined whether MSN release could produce long-lasting relief in patients with chronic neck pain.MethodsWe retrieved the medical records of all patients receiving weekly MSN release treatment for chronic neck pain at this institution during a period from May 2012 to December 2013. Only cases with the following information at prior to, and 1, 6, and 12 months after the treatment, were included in the analysis: neck disability index (NDI), numerical pain rating scale (NPRS), and active cervical range of motion (CROM). The primary analysis of interest is comparison of the 12-month measures with the baseline. Patients who took analgesic drugs or massage within 2 weeks prior to assessment were excluded from the analysis. For MSN release, tender points were identified manually by an experienced physician, and did not necessarily follow the traditional acupuncture system. MSN was inserted vertically (parallel to the spine) until breaking through resistance and patient reporting of distention, soreness or heaviness. The depth of the needling ranged from 10 to 50 mm. The release was carried out by moving the MSN up and down 3–5 times without rotation.ResultsA total of 559 cases (patients receiving weekly MSN release treatment for chronic neck pain) were screened. The number of cases with complete information (NDI, NPRS, and CROM at baseline, 1, 6 and 12 months after last treatment) was 180. After excluding the cases with analgesic treatment or massage within 2 weeks of assessment (n = 53), a total of 127 cases were included in data analysis. The number of MSN release session was 7 (range: 4–11). At 12 months after the treatment, both NPRS and NDI were significantly lower [3 (0, 9) vs. 7 (5, 10) at the baseline for NPRS; [7 (0, 21) vs. 17 (9, 36) for NDI; p<0.001 for both]. All 6 measures of CROM were significantly higher at 12 months vs. the baseline. No severe complications (such as nerve damage and hematoma) were noted.DiscussionMSN release is effective, even 12 months after the treatment, in patients with chronic neck pain. Caution must be exercised in data interpretation due to the respective nature of the study and lack of a comparator group.

Acupuncture Plus Dry Needling, an Effective Treatment Method for Chronic Neck Pain

Background: In recent years, acupuncture has attracted much attention as a complementary therapy in the management of chronic neck pain, but the definite effect of this method has not yet been proven in reducing pain and improving function. Objectives: This study was conducted to evaluate the effects of acupuncture plus dry needling in relieving chronic neck pain and its lasting effects for up to 3 months after treatment. Patients and Methods: Thirty-eight patients with chronic neck pain were included in this study. Each patient received 10 minutes of acupuncture in two forms (acupoints and trigger point needling), twice a week for 6 weeks. The acupoints were GB20, GB21, BL10, BL12, BL 18, DU14, SI11, and SI13. Simultaneously, trigger points in trapezius muscles also took needle. The neck disability index (NDI) and neck pain and disability scale (NPDS) questionnaires were completed by the patients before performing intervention and again at 6 weeks and 3 months after the intervention, and the obtained data were statistically analyzed. Results: Mean NPDS score upon admission was 56.3 ± 16.1, which dropped to 20.9 ± 19.4 at the end of 6 weeks of treatment (P < 0.001). At the end of 3 months, the score reached 20.3 ± 26.6; although recovery was significant compared to the start of treatment, it was not significant compared to the end of 6 weeks (P = 0.84). Mean NDI score at pre-intervention was 20.3 ± 7.5, which reduced to 7.3 ± 6.7 after 6 weeks of treatment (P < 0.001). After 3 months, it decreased to 5.9 ± 8.4; and although recovery was significant (P < 0.001) compared to the time of admission, it was not statistically significant compared to the end of 6 weeks of treatment (P = 0.27). Conclusions: Acupuncture plus dry needling is an effective short- as well as mid-term treatment method for chronic neck pain. The result of this study seems to be the cornerstone of further researches, which evaluate the new effective treatments for chronic neck pain.

Randomized clinical trial assessing whether additional massage treatments for chronic neck pain improve 12- and 26-week outcomes

Background contextThis is the first study to systematically evaluate the value of a longer treatment period for massage. We provide a framework of how to conceptualize an optimal dose in this challenging setting of nonpharmacologic treatments. PurposeThe aim was to determine the optimal dose of massage for neck pain. Study design/settingTwo-phase randomized trial for persons with chronic nonspecific neck pain. Primary randomization to one of five groups receiving 4 weeks of massage (30 minutes 2x/or 3x/wk or 60 minutes 1x, 2x, or 3x/wk). Booster randomization of participants to receive an additional six massages, 60 minutes 1x/wk, or no additional massage. Patient sampleA total of 179 participants from Group Health and the general population of Seattle, WA, USA recruited between June 2010 and August 2011 were included. Outcome measuresPrimary outcomes self-reported neck-related dysfunction (Neck Disability Index) and pain (0–10 scale) were assessed at baseline, 12, and 26 weeks. Clinically meaningful improvement was defined as greater than or equal to 5-point decrease in dysfunction and greater than or equal to 30% decrease in pain from baseline. MethodsClinically meaningful improvement for each primary outcome with both follow-up times was analyzed using adjusted modified Poisson generalized estimating equations (GEEs). Secondary analyses for the continuous outcomes used linear GEEs. ResultsThere were no observed differences by primary treatment group at 12 or 26 weeks. Those receiving booster dose had improvements in both dysfunction and pain at 12 weeks (dysfunction: relative risk [RR]=1.56 [1.08–2.25], p=.018; pain: RR=1.25 [0.98-1.61], p=.077), but those were nonsignificant at 26 weeks (dysfunction: RR=1.22 [0.85–1.74]; pain: RR=1.09 [0.82–1.43]). Subgroup analysis by primary and booster treatments found the booster dose only effective among those initially randomized to one of the 60-minute massage groups. Conclusions“Booster” doses for those initially receiving 60 minutes of massage should be incorporated into future trials of massage for chronic neck pain.

Patients’ experiences of Craniosacral Therapy in the treatment of chronic neck pain: a qualitative analysis of health outcomes

Purpose: This study aims to report the distribution of pattern identifications for stroke patients admitted National Rehabilitation Center (NRC) by using Korean Standard Pattern Identification for Stroke-III. Methods: Using Korean Standard Pattern Identification for Stroke-III, two Korean traditional medicine doctors conducted independent tests on total 50 patients admitted to NRC from June 2013 through November 2013, who were 20 years and older. The descriptive statistics were conducted to describe the distribution of pattern identification for subjects. ANOVA was used to analyze the difference in ages and K-MBI means according to the pattern identification, while Pearson’s chi -square test and Fisher’s exact testwere used to analyze difference in sex, type of stroke, and disease period within pattern groups, and to analyze the difference of pattern distribution between those who were 65 or older and those who were 64 or younger. Results: Average age for the 50 subjects is 56.7±11.0 years, with 33 men and 17 women. There were 37 patients of cerebral in farction, 13more than patients of cerebral hemorrhage, while the largest groupwith 24 patients developed strokeminimum 3months andmaximum 6months before. K-MBI mean was 55.7±18.6. 22 patients were qi deficiency type and 15 were dampness-phlegm type, while 8 were yin deficiency type and 5 were fire-heat type. The means of the age and K-MBI within 4 groups were not significantly different. Also there was no significant difference in sex, type of stroke and disease period according to the pattern identification. A comparison of pattern distribution between those who were 65 or older and those who were 64 or younger showed no significant difference. Conclusion: To ensure effective rehabilitation therapy, the fact that many of the rehabilitation patients are qi deficiency type needs to be considered. Contact: Chihyoung Son, cecilson@hanmail.net

Effects of the active release technique on pain and range of motion of patients with chronic neck pain.

[Purpose] To compare the influences of the active release technique (ART) and joint mobilization (JM) on the visual analog scale (VAS) pain score, pressure pain threshold (PPT), and neck range of motion (ROM) of patients with chronic neck pain. [Subjects] Twenty-four individuals with chronic neck pain were randomly and equally assigned to 3 groups: an ART group, a joint mobilization (JM) group, and a control group. Before and after the intervention, the degree of pain, PPT, and ROM of the neck were measured using a VAS, algometer, and goniometer, respectively. [Results] The ART group and JM group demonstrated significant changes in VAS and ROM between pre and post-intervention, while no significant change was observed in the control group. Significant differences in the PPT of all muscles were found in the ART group, while significant differences in all muscles other than the trapezius were found in the JM group. No significant difference in PPT was observed in any muscle of the control group. The posthoc test indicated no statistically significant difference between the ART and JM group, but the differences of variation in VAS, PPT, and ROM were greater in the ART group than in the JM and control groups. [Conclusion] ART for the treatment of chronic neck pain may be beneficial for neck pain and movement.

Kinematic effect of Chinese herbal fomentation on patients with chronic neck pain.

To clarify the effectiveness of Chinese herbal fomentation in treating chronic neck pain by means of changes in cervical kinematics. Seventy-six patients with chronic neck pain were included in the study and were randomized into two groups based on the random number generator of the SPSS software: fomentation combined with Chinese herbal (Group 1) and fomentation without any medicine (Group 2). In both groups, the fomentation lasted for 60 min and heated to 35 °C, once a day for 28 consecutive days. Standard lateral radiographs of the cervical spine were obtained including the neutral, full flexion, and full extension positions. Before and after intervention, the following parameters were used to evaluate the changes in kinematics: range of motion (ROM), sagittal alignment and instantaneous center of rotation (ICR). After treatment, the ROM was signifcantly higher than that of before treatment in Group 1 (51.5, 95% CI: 49.8-55.9; P<0.05). There was no significant difference between before and after treatment in Group 2 (P>0.05). Although C2-C7 cervical alignment was increased in both groups after treatment, no significant difference was detected between before and after treatment (P>0.05). For Group 1, the significant X coordinate variation was only observed at C5/C6 level (38.1; 95% CI: 34.0, 42.1; P<0.05). There was a significant upward trend in the Y coordinate of the ICR at C5/C6 (-30.5; 95% CI: -34.3, -26.8; P<0.05) and C6/C7 after treatment (-6.1; 95% CI: -6.7, -5.4; P<0.05). For Group 2, the ICR location of each level was not statistically different between the pre- and post-treatment (P>0.05). Chinese herbal fomentation could improve abnormal mobility in terms of ROM and ICR. Chinese herbal fomentation might be an effective treatment for chronic neck pain.

Craniosacral Therapy for the Treatment of Chronic Neck Pain: A Follow-up Study

Craniosacral Therapy for the Treatment of Chronic Neck Pain: A Follow-up Study

Acupuncture with Non-Steroidal Anti-Inflammatory Drugs (Nsaids) versus Acupuncture Or Nsaids Alone for the Treatment of Chronic Neck Pain: An Assessor-Blinded Randomised Controlled Pilot Study

ObjectiveTo investigate the feasibility and sample size required for a full-scale randomised controlled trial of the effectiveness of acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) for chronic neck pain compared with acupuncture or NSAID treatment alone.MethodsA total of 45 patients with chronic neck pain participated in the study. For 3 weeks the acupuncture with NSAIDs treatment group took NSAIDs (zaltoprofen, 80 mg) daily while receiving acupuncture treatment three times a week. The acupuncture treatment group received treatment three times a week and the NSAID treatment group took NSAIDs daily. The primary outcomes were to determine the feasibility and to calculate the sample size. As secondary outcomes, pain intensity and pain-related symptoms for chronic neck pain were measured.ResultsWith regard to enrolment and dropout rates, 88.2% of patients consented to be recruited to the trial and 15.6% of participants were lost to follow-up. The sample size for a full-scale trial was estimated to be 120 patients. Although preliminary, there was a significant change in the visual analogue scale (VAS) for neck pain intensity between the baseline measurement and each point of assessment in all groups. However, there was no difference in VAS scores between the three groups.ConclusionsThis pilot study has provided the feasibility and sample size for a full-scale trial of acupuncture with NSAIDs for chronic neck pain compared with acupuncture or NSAID treatment alone. Further research is needed to validate the effects of acupuncture with NSAIDs.Clinical Trial RegistrationNIH ClinicalTrials.gov NCT01205958.

Three-Dimensional Computerized Mobilization of the Cervical Spine for the Treatment of Chronic Neck Pain: A Pilot Study

Manual therapies for chronic neck pain are imprecise, inconsistent, and brief due to therapist fatigue. A previous study showed that computerized mobilization of the cervical spine in the sagittal plane is a safe and potentially effective treatment of chronic neck pain. To investigate the safety and efficacy of computerized mobilization of the cervical spine in a three-dimensional space for the treatment of chronic neck pain. Pilot, open trial. Physical therapy outpatient department. Nine patients with chronic neck pain. A computerized cradle capable of three-dimensional neck mobilizations was used. Treatment sessions lasted 20 minutes, biweekly, for six weeks. Visual analog scale (VAS) for pain, cervical range of motion (CROM), neck disability index (NDI), joint position error (JPE), and muscle algometry. Comparing baseline at week one with week six (end of treatment), the VAS scores dropped by 2.9 points (P < 0.01). The six directions of movement studied by the CROM showed a combined increase of 11% (P = 0.01). The NDI decreased significantly from 16 to 10 (P = 0.03), and the JPE decreased significantly from 3.7° to 1.9° (P = 0.047). There was no change in the pressure pain threshold in any muscle tested. There were no significant adverse effects. These preliminary results demonstrate that this novel, computerized, three-dimensional cervical mobilization device is probably safe. The data also suggest that this method is effective in alleviating neck pain and associated headache, and in increasing the CROM, although the sample size was small in this open trial.

A randomized placebo-controlled clinical trial of phonophoresis for the treatment of chronic neck pain

The aim of this trial was to investigate and compare the effects of phonophoresis (PP), placebo PP and exercise therapies on pain, disability, sleep quality, and depression in the patients with chronic neck pain (CNP). This is a randomized, single-blind, placebo-controlled study. A total of 61 patients with definite CNP were included in this study. The patients were randomized into three groups. Group 1 (n=21) received PP with capsaicin treatment and exercises. Group 2 (n=20) received placebo PP with capsaicin and exercises. Group 3 (n=20) was given only exercises. All of the programs were performed 3days a week, for 6weeks. The pain (visual analog scale), disability (the neck pain disability index), depression (Beck Depression Inventory scores), and sleep quality (Pittsburgh Sleep Quality Index) of all participants were evaluated. Measurements were taken before and after treatment. All of the groups showed statistically significant improvements in pain, disability, sleep quality, and depression. While there was no difference between groups regarding depression and sleep quality, intergroup comparison showed significant differences in pain and disability among three groups. These differences were statistically significant in group 1 and 2 compared to group 3, and also in group 1 compared to group 2. We observed that PP treatment was effective in the treatment for patients with CNP. A combination of PP with exercises can be used to obtain optimal clinical results.

Treatment of chronic neck pain by two combined physiotherapy programs: Comparison of phonophoresis and ultrasound

Background: Chronic neck pain is common. The value of various physiotherapy, phonophoresis, and ultrasoundis not known. Objective: We determined the short-term effect of combined physiotherapy methods on pain intensity, disability,and quality of life in patients with chronic neck pain (CNP). We also compared the short-term effectiveness ofphonophoresis (PP) and therapeutic ultrasound (US). Methods: Fifty-five patients (48 women, 7 men) aged 25 to 65 years who had neck pain at least twelve weeksparticipated in this study. The patients were randomly divided into two groups: US (n = 29) and PP (n = 26).The patients in both groups received the same combined physiotherapy treatment programme includingthermotherapy, TENS, therapeutic massage, therapeutic exercises, and recommendations for daily living activities.Additionally, the patients in the PP group received phonophoresis (5% lidocaine), and the US group receivedultrasound therapy. All patients received 14 sessions of treatment throughout three weeks. Pain intensity,disability, and quality of life were measured at baseline and after the treatment programme. Pain intensity wasassessed by using a visual analog scale, the Neck Pain Disability Index was used to assess disability andthe SF-36 Health Survey was used to assess quality of life. A Wilcoxon signed rank test, Mann-Whitney U test,and effect size were used for statistically analysis. Results: In both groups, pain intensity, disability and quality of life scores were found to have improved afterthe treatment programme (p 0.05)and the effect sizes for pain intensity, disability, and quality of life were large in both groups. Conclusion: The results suggest that phonophoresis and ultrasound combined with physiotherapy methodscan have positive effects in the management of patients with chronic neck pain. However, no superiority ofphonophoresis or ultrasound was determined. Keywords: Disability, neck pain, phonophoresis, physiotherapy, quality of life, ultrasound

Evidence-Based Guidelines for the Chiropractic Treatment of Adults With Neck Pain

ObjectiveThe purpose of this study was to develop evidence-based treatment recommendations for the treatment of nonspecific (mechanical) neck pain in adults. MethodsSystematic literature searches of controlled clinical trials published through December 2011 relevant to chiropractic practice were conducted using the databases MEDLINE, EMBASE, EMCARE, Index to Chiropractic Literature, and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, weak, or conflicting) and to formulate treatment recommendations. ResultsForty-one randomized controlled trials meeting the inclusion criteria and scoring a low risk of bias were used to develop 11 treatment recommendations. Strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy, and exercise in combination with other modalities. Strong recommendations were also made for the treatment of chronic neck pain with stretching, strengthening, and endurance exercises alone. Moderate recommendations were made for the treatment of acute neck pain with manipulation and mobilization in combination with other modalities. Moderate recommendations were made for the treatment of chronic neck pain with mobilization as well as massage in combination with other therapies. A weak recommendation was made for the treatment of acute neck pain with exercise alone and the treatment of chronic neck pain with manipulation alone. Thoracic manipulation and trigger point therapy could not be recommended for the treatment of acute neck pain. Transcutaneous nerve stimulation, thoracic manipulation, laser, and traction could not be recommended for the treatment of chronic neck pain. ConclusionsInterventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain. Increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.

Three dimensional computerized mobilization of the cervical spine for the treatment of chronic neck pain and associated headache

Three dimensional computerized mobilization of the cervical spine for the treatment of chronic neck pain and associated headache

SAT0428 A Randomized Single-Blind Controlled Clinical Trial of Phonophoresis for the Treatment of Chronic Neck Pain

BackgroundChronic neck pain (CNP) is a severe health problem in the general population due to its high prevalence and frequent association with disability. There are various approaches involved in the...

Computerized Mobilization of the Cervical Spine for the Treatment of Chronic Neck Pain

Manual therapies for chronic neck pain (NP) are imprecise, inconsistent, and brief because of therapist fatigue. Investigate the safety and efficacy of computerized mobilization of the cervical spine in the sagittal plane for the treatment of chronic NP. Pilot open trial. : Physical therapy outpatient department. Ten patients with chronic NP. A computerized cradle capable of 3-dimensional neck mobilization was utilized. However, in the present trial the cradle was only utilized in the sagittal plane. Treatment sessions lasted 20 minutes, biweekly, for 6 weeks. : Numerical rating scale for pain, Neck Disability Index questionnaire, muscle algometry, cervical range of motion (CROM), surface electromyography, and 36-item Short Form Health Survey questionnaire. Treatment was not associated with any significant adverse effects. Pain scores reduced by 2 ± 0.5 numerical rating scale points. CROM showed significant improvement at the end of the study (P<0.05). Neck Disability Index showed marked improvement by the fourth week, end of study, and 2 weeks after treatment (P<0.05); headache subscale showed marked reduction. These preliminary results demonstrate the safety of a novel computerized mobilization of the cervical spine. In addition, the data suggest that this method is effective in increasing CROM and in alleviating NP and associated headache.

P02.18. Clinically meaningful differences in pain and disability after cupping treatment for chronic neck pain: reanalysis of 4 randomized controlled trials

Purpose The assessment of clinically meaningful differences in patients’ self-reported outcomes has become more important when interpreting the results of clinical studies. In conventional medicine these assessments are common; however, there is still doubt whether these results apply to complementary trials. The aim of this analysis is the determination of minimal clinically important differences (MCID) and substantial clinical benefits (SCB) in patients with chronic non-specific neck pain after cupping treatment. The MCID and SCB for pain intensity (VAS) and neck disability index (NDI) were estimated using common anchor-based methods.

Ultrasound Anatomy of the Nerves Supplying the Cervical Zygapophyseal Joints

Nerve blocks and radiofrequency neurotomy of the nerves supplying the cervical zygapophyseal joints are validated tools for diagnosis and treatment of chronic neck pain, respectively. Unlike fluoroscopy, ultrasound may allow visualization of the target nerves, thereby potentially improving diagnostic accuracy and therapeutic efficacy of the procedures. The aims of this exploratory study were to determine the ultrasound visibility of the target nerves in chronic neck pain patients and to describe the variability of their course in relation to the fluoroscopically used bony landmarks. Fifty patients with chronic neck pain were studied. Sonographic visibility of the nerves and the bony target of fluoroscopically guided blocks were determined. The craniocaudal distance between the nerves and their corresponding fluoroscopic targets was measured. Successful visualization of the nerves varied from 96% for the third occipital nerve to 84% for the medial branch of C6. The great exception was the medial branch of C7, which was visualized in 32%. The bony targets could be identified in all patients, with exception of C7, which was identified in 92%. The craniocaudal distance of each nerve to the corresponding bony target varied, the upper limit of the range being 2.2 mm at C4, the lower limit 1.0 mm at C7. The medial branches and their relation to the fluoroscopically used bony targets were mostly visualized by ultrasound, with the exception of the medial branch of C7 and, to a lesser extent, the bony target of C7. The nerve location may be distant from the fluoroscope's target. These findings justify further studies to investigate the validity of ultrasound guided blocks for invasive diagnosis/treatment of cervical zygapophyseal joint pain.