Treatment Of Neck Pain Research Articles

What to Look Out for, What to Do, and When: 3 Key Messages for Safely Treating Neck Pain, Headache, and/or Orofacial Symptoms in Musculoskeletal Rehabilitation Settings.

SYNOPSIS: Neck pain, headache, and/or orofacial symptoms are potentially the first (nonischemic) symptoms of an underlying vascular pathology or blood flow limitation. If an underlying vascular pathology or blood flow limitation is not recognized by the musculoskeletal rehabilitation clinician, it can subsequently be aggravated by treatment, raising the risk of serious adverse events. We argue that clinicians can make an important, and potentially lifesaving, difference by providing specific information and advice. This is especially the case in patients with an intermediate level of concern, for example, in patients who only show a few concerning features regarding a possible underlying serious condition and for whom an initial vasculogenic hypothesis was rejected during the clinical reasoning process. We present background information to help the reader understand the context of the problem and suggestions for how clinicians can provide appropriate information and advice to patients who present with neck pain, headache, and/or orofacial symptoms. J Orthop Sports Phys Ther 2023;53(2):59-63. Epub: 28 October 2022. doi:10.2519/jospt.2022.11568.

Therapeutic and stabilization exercises after manual therapy in patients with non-specific chronic neck pain: A randomised clinical trial

ObjectiveThis study aimed to determine and compare the effects of therapeutic and stabilization exercises prescribed to patients after manual therapy sessions on pain, neck range of motion and disability. MethodsThirty patients with non-specific chronic neck pain were recruited. After the initial examination, one session of manual therapy was conducted. The examinations were repeated to assess the effect of manual therapy on pain intensity and neck range of motion. After manual therapy, patients were randomly allocated into two groups: stabilization exercise group (SEG) and therapeutic exercise group (2 days/week/6 week). Pain intensity was assessed using the visual analog scale. Joint movements assessed using goniometer and the lateral scapular shift test for scapular dyskinesia. In addition, disability status was assessed using a neck disability index. ResultsIn all patients, manual therapy decreased pain intensity and increased joint movements (p < 0.05). After 6 weeks of exercise therapy, pain intensity, neck flexion, extension, lateral flexion movement and disability improved in SEG (p < 0.05). ConclusionThis study demonstrated that stabilization exercises combined with manual therapy had more positive effects among patients with non-specific chronic neck pain. Implications for practice•The treatment for non-specific chronic neck pain should be supported with exercises after manual therapy sessions for reducing neck pain.•Instead of therapeutic isometric exercises, which are often clinically prescribed as home exercises, stabilization exercises may be preferred as they are performed by maintaining the neutral position of the neck and include stretching.

Ultrasound-Guided Trigger Point Injections for the Treatment of Neck and Back Pain in the Emergency Department: A Randomized Trial.

Patients frequently present to the emergency department (ED) with neck or back pain, which can be difficult to treat. We sought to compare ultrasound-guided trigger point injection (TPI) to standard medications for patients with neck or back pain. We performed a single-center, open label, randomized controlled trial on ED patients with neck or back pain from myofascial pain syndrome comparing ultrasound-guided TPIs to those who received the combination of a nonsteroidal anti-inflammatory drug (NSAID) and a muscle relaxant (MR). The primary outcome of this study was the reduction in mean pain score at the time of ED disposition. In total, we analyzed 196 patients. At the time of ED disposition, patients in the TPI group had a mean reduction in their pain scores of 45.0 mm as compared to 49.9 mm in the NSAID plus MR group (difference: 4.9 [95% confidence interval (CI) -3.0 to 12.7], P=.22). At the first reassessment, patients in the TPI group had greater pain reduction by 10.7 mm (95% CI 3.1 to 18.4). The rate of rescue therapy use was higher in the NSAID plus MR group (difference: 17.5% [95% CI 4.4 to 36.2]). We found no difference in pain reduction at the time of ED disposition between patients randomized to the ultrasound-guided TPI group as compared to those who received an NSAID plus a MR. However, patients in the TPI group had greater pain reduction at the time of first reassessment and lower rates of rescue therapy use.

O049 / #289 10 KHZ SPINAL CORD STIMULATION FOR THE TREATMENT OF FAILED NECK SURGERY SYNDROME: ANALYSIS OF DATA FROM TWO MULTICENTER STUDIES: TRACK 4: CLINICAL USE OF SCS / DRG

Failed neck surgery syndrome (FNSS) has historically been challenging to treat with conventional spinal cord stimulation (SCS) being limited by obtaining effective paresthesia coverage1. Previous multicenter studies showed the efficacy of 10 kHz SCS in the treatment of Upper Limb and Neck pain (ULN)2,3. The goal of this post hoc analysis is to assess the effectiveness of the 10 kHz SCS system, in subjects who had prior cervical spine surgery.

311 Ultrasound-Guided Trigger Point Injections for the Treatment of Neck and Back Pain in the Emergency Department: A Randomized Trial

311 Ultrasound-Guided Trigger Point Injections for the Treatment of Neck and Back Pain in the Emergency Department: A Randomized Trial

Acupuncture as Part of Multimodal Analgesia for Chronic Pain.

Chronic pain is a multifactorial condition that is afflicting populations worldwide causing an increasing economic, physical, mental, and emotional burden. Treatments range from medications to interventional procedures to complementary and alternative medicine (CAM), such as acupuncture. This review aims to discuss the use of acupuncture in the treatment of chronic pain, proposed mechanisms, indications, and efficacy for various chronic pain conditions. Evidence is varied on the efficacy and quality of data on the use of acupuncture in the treatment of chronic pain. Recent studies have demonstrated promising results in the support of acupuncture for the use in the treatment of cancer, neck, and back pain, functional dyspepsia, and various chronic abdominal pain syndromes. Acupuncture, deemed well-tolerated and safe to use, has been increasingly studied and is regarded as effective in clinical practice, but its efficacy is limited by the lack of well-conducted, high-quality clinical trials, lower quality evidence, and conflicting study results. Additionally, the exact analgesic mechanism of acupuncture remains to be fully elucidated. Increasing evidence supports the role of acupuncture as therapy in the treatment of cancer, neck, and back pain and functional dyspepsia. Further rigorous studies are needed to fully assess the use of acupuncture in various chronic pain conditions, determine its indications, and optimal treatment schedule. Overall, future studies could benefit from better designed experimental studies, larger groups, and more objectives ways to measure pain reduction and symptom improvement.

Cervical Stabilization Exercises Versus Scapular Stabilization Exercises in Treatment of Chronic Mechanical Neck Pain

Cervical Stabilization Exercises Versus Scapular Stabilization Exercises in Treatment of Chronic Mechanical Neck Pain

Effect of adding trunk core training exercise to conventional therapy on patients with chronic mechanical neck pain

Background: One of the most frequent causes of musculoskeletal pain in the general population is cervicalgia, sometimes known as neck pain. Its estimated prevalence ranges from 16.7% to 71.5 percent, and it should be noted that up to 50% of these cases may develop into chronic conditions. In this study, patients with persistent mechanical neck pain were examined to determine the effectiveness of trunk core training exercises on pain, range of motion, functional impairment, and muscle activity. Purpose: The goal of the study was to determine the impact of adding core training to patients' existing conventional treatments for chronic mechanical neck pain. Methods: Twenty male and twenty female patients with persistent mechanical neck pain, ranging in age from 18 to 40, participated in this study. The cases were classified into two equal groups randomly (A and B). Group A has got standard physiotherapy program (Passive stretching of the upper fibers of trapezius, sternocleidomastoid, and scalene muscles, Isometric strengthening exercises of neck muscles, hot pack). Group B has obtained standard physiotherapy program in addition to trunk core training program.

Efficacy of low-level laser therapy on pain, disability, pressure pain threshold, and range of motion in patients with myofascial neck pain syndrome: a systematic review and meta-analysis of randomized controlled trials.

Low-level laser therapy (LLLT) is one of recent modalities for treatment of myofascial neck pain (MNP). Several RCTs have been conducted on its effectiveness. The aim of this comprehensive meta-analysis was to evaluate the effectiveness of LLLT on MNP. Electronic databases were searched for identifying eligible studies comparing the effectiveness of LLLT using any wavelength with placebo or active control in myofascial neck pain up to June 2022. Data related to pain intensity, pain pressure threshold (PPT), range of motion (ROM), and disability was analyzed as a pooled estimate of mean difference or standard mean difference (SMD) with 95% confidence intervals (CIs) using random/fixed-effect model. Funnel plot and Egger's linear regression test were also conducted to examine the risk of publication bias. A total of 13 randomized controlled trials were included in this systematic review and meta-analysis. The data assessing laser effectiveness on different outcomes of 556 patients were considered for meta-analysis. Pooled results revealed that LLLT was significantly effective in pain reduction (MD = - 1.29, 95% CI = - 2.36; - 0.23, P < 0.001). Also, secondary outcomes including PPT (SMD of 2.63, 95% CI = 0.96; 4.30, P < 0.01) and right bending ROM (SMD of 3.44, 95% CI = 0.64; 6.24, P < 0.01) were improved, while disability (MD of - 7.83, 95% CI = - 17.1; 0.08, P = 1.34) did not improve significantly after LLLT. Our meta-data revealed that LLLT may reduce myofascial neck pain and its related outcomes. LLLT is suggested to be used by clinicians along with other therapies such as manual and exercise therapy.

Acupuncture and Chinese Herbal Medicine Treatment for Neck Pain and Cervical Disc Disease: A Retrospective Study in 42 Dogs

Cervical intervertebral disc disease accounts for 12.9-25% incidence of intervertebral diseases in dogs. This retrospective cohort study compared the efficacy of conventional treatment to traditional Chinese veterinary medicine (TCVM) for neck pain and/or cervical disc disease (CDD). Medical records were collected on 42 dogs that exhibited one or more of the following clinical signs: cervical pain, cervical stiffness, decreased range of motion of neck, hemiparesis or tetraparesis. Qualified cases were classified into a TCVM Treatment Group (n=31) using acupuncture/Chinese herbal medicine or a Control Treatment Group (n=11) using corticosteroids/non-steroidal anti-inflammatory drugs (NSAIDs). For each subject, assessment scores in cervical pain, stiffness, range of motion, neurological deficits and front limb lameness before and after 4 treatments were reviewed. The sum of all 5 clinical scores (overall improvement) was used as the final treatment outcome measurement for group comparisons. No statistically significant group differences were found in sex, age, weight and pre-treatment overall clinical score (p&gt;0.05). The Control Group had an overall pre-treatment score (M±SD) of 8.36±3.07, which significantly improved (decreased) to 4.91±3.73 after completing the treatments (p=0.006). The TCVM Group’s overall score (M±SD) improved from 9.39±3.13 to 1.23±0.72 (p=9.3×10-10). The improvement in the TCVM Group was significantly greater than the Control Group (p=0.00004). The results from this retrospective study suggest that, while both treatment schemes can improve clinical signs of cervical pain and/or cervical disc disease in dogs, the TCVM treatment has the potential for superiority to conventional medical treatment.

Comparison between upper thoracic spine mobilization and the Ergon technique in the treatment of mechanical neck pain

Upper thoracic spine mobilization and the Ergon technique are used to treat mechanical neck pain in order to speed recovery, promote tissue healing and improve range of motion. There have been a few studies discussing the Ergon IASTM and upper thoracic spine mobilization in patients with neck pain, but none compared the aforementioned techniques in the treatment of mechanical neck pain. This clinical trial was conducted on a sample of thirty participants (16 females and 14 males) with mechanical neck pain who were randomly divided into two groups: Upper Thoracic Spine Mobilization (n=15) and Ergon Technique (n=15). Twelve sessions were delivered to all participants over a four-week period, three days per week. Before and after treatment, pain severity was measured by Numeric Pain Rating Scale (NPRS), cervical spine's active range of motion was measured by using a Cervical Range of Motion (CROM) device, and cervical spine's disability index was measured by Neck Disability Index (NDI). The statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 25. Both groups showed improvement in neck pain, reduced functional disability and increased cervical range of motion after treatment. The upper thoracic spine mobilization group had significantly better results in terms of cervical left lateral flexion and left rotation ranges of motion, while the Ergon Technique group had significantly better results in terms of improvement of neck pain and reduction in functional disability. In conclusion, the upper thoracic spine mobilization was effective at increasing the range of motion of the cervical region, while the Ergon technique was effective at relieving pain and dysfunction in the cervical spine in patients with mechanical neck pain. Upper thoracic spine mobilization and the Ergon technique are used to treat mechanical neck pain in order to speed recovery, promote tissue healing and improve range of motion. There have been a few studies discussing the Ergon IASTM and upper thoracic spine mobilization in patients with neck pain, but none compared the aforementioned techniques in the treatment of mechanical neck pain. This clinical trial was conducted on a sample of thirty participants (16 females and 14 males) with mechanical neck pain who were randomly divided into two groups: Upper Thoracic Spine Mobilization (n=15) and Ergon Technique (n=15). Twelve sessions were delivered to all participants over a four-week period, three days per week. Before and after treatment, pain severity was measured by Numeric Pain Rating Scale (NPRS), cervical spine's active range of motion was measured by using a Cervical Range of Motion (CROM) device, and cervical spine's disability index was measured by Neck Disability Index (NDI). The statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 25. Both groups showed improvement in neck pain, reduced functional disability and increased cervical range of motion after treatment. The upper thoracic spine mobilization group had significantly better results in terms of cervical left lateral flexion and left rotation ranges of motion, while the Ergon Technique group had significantly better results in terms of improvement of neck pain and reduction in functional disability. In conclusion, the upper thoracic spine mobilization was effective at increasing the range of motion of the cervical region, while the Ergon technique was effective at relieving pain and dysfunction in the cervical spine in patients with mechanical neck pain.

Neck pain clinical practice guidelines: a systematic review of the quality and quantity of complementary and alternative medicine recommendations.

Individuals with neck pain frequently turn to complementary and alternative medicine (CAM) to seek relief. However, conventional healthcare providers often lack adequate CAM therapy knowledge to deliver informed recommendations to patients. The purpose of this study was to identify mention of CAM in neck pain clinical practice guidelines (CPG) and assess the quality of CAM recommendations using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. MEDLINE, EMBASE and CINAHL were systematically searched from 2009 to 2020 in addition to the Guidelines International Network and National Center for Complementary and Integrative Health websites. Eligible CPGs providing CAM recommendations were assessed twicewith the AGREE II instrument, onceto assess the overall CPG and then onceto assess the CAM sections specifically. From 643 unique search results, 15 CPGs on the treatment and/or management of neck pain were identified, and 8 made recommendations on CAM therapy. Regarding scaled domain percentages, the overall CPG scored higher than the CAM section for 5 of 6 domains (overall, CAM): (1) scope and purpose (93.4%, 93.1%), (2) stakeholder involvement (81.6%, 81.9%), (3) rigour of development (70.8%, 66.3%), (4) clarity of presentation (64.9%, 60.8%), (5) applicability (39.3%, 33.6%), and (6) editorial independence (47.9%, 45.3%). Most neck pain CPGs made CAM recommendations. The quality of CAM recommendations is lower than overall recommendations across all domains with the exception of stakeholder involvement. This disparity highlights the need for CAM recommendations quality improvement. Although many patients with neck pain seek CAM therapies, few CPGs are available for healthcare providers and patients.

Is brace necessary after cervical surgery: A meta-analysis of randomized controlled trials.

Background:Currently, there are increasing surgical treatments for neck pain. However, whether to use cervical brace after operation remains poorly defined. We aim to clear the clinical efficacy of the use of cervical brace after cervical surgery.Methods:We searched for relevant studies in 8 electronic databases up to March 2021. The mean difference and 95% confidence intervals were used for continuous data. Cochrane Collaboration’s tool was used to assess the risk of bias. The data were collected and input into the Review Manager 5.3 software (The Cochrane Collaboration, Copenhagen, Denmark).Results:Four randomized controlled trials were finally included in our study. For pain, the pooled analysis showed that postoperative neck brace compared with no brace can relieve neck pain at all follow-up periods except 6 months. For neck disability index, the result showed that postoperative neck brace compared with no brace can improve neck disability index during the 3 to 12 month follow-up period. However, no significant difference was identified between 2 groups within the follow-up of 6 weeks after surgery. In addition, the result tends to get the opposite at follow-up of 24 months. For 36-Short form health survey Physical Component Summary, there was no significant difference between 2 groups in the early 3 weeks after surgery, but the results were changed after 3 weeks. For 36-short form health survey Mental Component Summary, there appears to be no significant change between 2 groups at all time intervals.Conclusion:Wearing a cervical brace after cervical surgery is conducive to improving symptoms after cervical surgery at different stages. However, there is no relevant evidence indicating it can improve the mental health of postoperative patients. Higher quality, large prospective randomized studies are needed to verify the current conclusions.

Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation

BackgroundCervical spine manipulation (CSM) is a frequently used treatment for neck pain. Despite its demonstrated efficacy, concerns regarding the potential of stretch damage to vertebral arteries (VA) during CSM remain. The purpose of this study was to quantify the angular displacements of the head relative to the sternum and the associated VA length changes during the thrust phase of CSM.MethodsRotation and lateral flexion CSM procedures were delivered bilaterally from C1 to C7 to three male cadaveric donors (Jan 2016–Dec 2019). For each CSM the force–time profile was recorded using a thin, flexible pressure pad (100–200 Hz), to determine the timing of the thrust. Three dimensional displacements of the head relative to the sternum were recorded using an eight-camera motion analysis system (120–240 Hz) and angular displacements of the head relative to the sternum were computed in Matlab. Positive kinematic values indicate flexion, left lateral flexion, and left rotation. Ipsilateral refers to the same side as the clinician's contact and contralateral, the opposite. Length changes of the VA were recorded using eight piezoelectric ultrasound crystals (260–557 Hz), inserted along the entire vessel. VA length changes were calculated as D = (L1 − L0)/L0, where L0 = length of the whole VA (sum of segmental lengths) or the V3 segment at CSM thrust onset; L1 = whole VA or V3 length at peak force during the CSM thrust.ResultsIrrespective of the type of CSM, the side or level of CSM application, angular displacements of the head and associated VA length changes during the thrust phase of CSM were small. VA length changes during the thrust phase were largest with ipsilateral rotation CSM (producing contralateral head rotation): [mean ± SD (range)] whole artery [1.3 ± 1.0 (− 0.4 to 3.3%)]; and V3 segment [2.6 ± 3.6 (− 0.4 to 11.6%)].ConclusionsMean head angular displacements and VA length changes were small during CSM thrusts. Of the four different CSM measured, mean VA length changes were largest during rotation procedures. This suggests that if clinicians wish to limit VA length changes during the thrust phase of CSM, consideration should be given to the type of CSM used.

The Effect of Muscle Energy Technique and Posture Correction Exercises on Pain and Function in Patients with Non-specific Chronic Neck Pain Having Forward Head Posture-a Randomized Controlled Trail.

BackgroundNeck pain is a common problem in individuals despite different types of working patterns. Forward head posture is a common identified cause of chronic neck pain in patients. The effect of long-term forward head posture can be loss of function which can limit individuals’ capacity to work or do activities of daily living; hence it becomes necessary to intervene with muscle strengthening to improve neck stability, as well as mobility.PurposeTo assess effectiveness of muscle energy technique (MET) and posture correction exercises on pain and function in patients with non-specific chronic neck pain having forward head posture.Study SettingOutpatient department of Dr. D. Y. Patil College of Physiotherapy, Pune, India.ParticipantsBoth males and females between the ages of 21–60 years with a cranio-vertebral angle of less than 48° were included in study.Research DesignA randomized clinical trial.MethodologyMET group received muscle energy treatment + posture correction exercises, and control group receiving neck range of motion treatment. Outcomes measures were pain (Numerical Pain Rating Scale), function (Neck Disability Index), and cranio-vertebral angle (MB ruler).ResultsForty-eight subjects were included in the analysis, with 23 participants in Group A (MET) and 25 in Group B (Control). While both groups showed within-group improvements, Group A had significantly greater decreases in neck pain (p < .001), Neck Disability Index scores (p < .001), and significantly greater improvements in cranio-vertebral angles (p < .025) compared to group B.ConclusionThe combined effect of MET and posture correction exercises provides significantly greater results than neck range of motion treatment, and muscle energy technique should be included in the treatment of non-specific chronic neck pain in individuals with forward head posture.

Prevalence of Neck pain and its effects on Quality of life of Software Engineers in Lahore

Background: Neck pain is a sensation of discomfort in the dorsal and lateral side of cervical spine due to postural or mechanical faults. It affects health - status, work productivity and multiple interventions are used to treat neck pain. Aim: To check the prevalence of neck pain, its effects on quality of life of software engineers of Lahore city. Methodology: This was an observational study Cross-sectional survey. Three hundred and thirty eight participants with minimum one year of job experience in software house were included in the study. Neck pain disability and quality of life were observed by using NDI and SF-12 respectively. Data was entered and analyzed by SSS 22.0.s Results: Results showed the prevalence as mild, moderate, severe and complete neck pain disability in software engineers was 150(44.38%), 68(20.12%), 19(5.62%) and 3(0.89%) respectively and 98(28.99%) participants were without neck pain. There are more male participants 86(25.44%) without neck pain than female participants 12(3.55%) without neck pain. Neck pain showed no significant association with age of software engineers because p &gt; 0.05 in chi-square test. There were fewer participants with excellent and poor physical health 8.28% and 10.36% respectively. Conclusion: Neck pain is common in software engineers of Lahore city. Neck pain is more prevalent in female software engineers as compared to male. Severe neck pain declined their Physical health and complete neck pain caused disability. They are facing the physical health issues with resulting limitations in their routine office work, physical activities and social activities. Neck pain is associated with gender and physical health of software engineers. Keywords: Neck pain, quality of life, software engineers, Lahore city

Effects of Muscle Energy Technique vs Bruegger’s Relief Exercise on Forward Head Posture among electronic gadget users

Background: Neck pain due to Forward Head Posture (FHP) caused by prolongs flexion of head and neck while using electronic gadgets. It causes different musculoskeletal complaints particularly affecting upper limb and neck region. Muscle Energy Technique is an efficient method to reduce the tightness and improve strength of muscles. Bruegger’s Relief Exercise is helpful in improving posture. Aim: To compare the effects of Muscle Energy Technique (MET) and Bruegger’s Relief Exercise on pain, range of motion and function in patients of cervicalgia due to FHP. Method: A pilot study was performed. 24 subjects were recruited according to sample selection criteria and were assigned to Group A and B. Assessment of pain, function, Cervical ROM and Craniovertebral angle was taken using NPRS, NDI, Goniometer and photogrammetry. Group A received treatment with hot pack and Muscle Energy Technique. Group B received hot pack and Bruegger’s Relief Exercise. Total 20 sessions were given to each patient in 4 weeks with 5 sessions per week. Both groups were reassessed after 4 weeks of treatment. Data was analyzed by using SPSS 23. Results: There was statistically significant changes within both groups in the NPRS, NDI, CROM and Craniovertebral angle with p- value of &lt; 0.05 Both were effective but using Bruegger’s Relief Exercise showed more improvement. Conclusion: Both treatment strategies were effective in decreasing pain, improving movement, regaining functional status, and correcting posture but using Bruegger’s Relief Exercise is more efficient for treating neck pain due to FHP. Key words: Forward head posture, Muscle energy techniques, Bruegger’s relief exercise

Consideration in Randomized Placebo-Controlled Trial on Neck Pain to Avoid the Placebo Effect in Analgesic Action.

Background: In neck pain treatment, many therapies are focused on etiology, while it is well-known that placebo analgesia is also present in these therapies. The specific efficacy for etiology may be underestimated by ignoring their actual placebo effect. In this study, a logistic regression analysis is used to explore the risk factors causing different placebo responses in patients with neck pain among two RCTs. The probability of the placebo effect is predicted based on these risk factors. Methods: Trial A and Trial B were similarly designed, randomized, double-/single-blind, placebo-controlled trials in patients treating neck pain with Qishe pill or Shi-style manipulation. Both studies set a placebo pill twice a day or traction for every other day as control. For further analyses on the placebo effect in neck pain management, logistic regression was used to assess subgroup-placebo interactions. The odds ratio assessed a significant influence on the placebo effect. Results: In this pooled analysis, the total number of patients recruited for these two studies was 284, of which 162 patients received placebo treatment (placebo drug or traction for every other day). No statistically significant differences are found at baseline between the participants with placebo effect and non-placebo effect in the gender, age, and disease duration except in VAS and NDI at the initial time. There are numerically more patients with placebo effect in the shorter disease duration subgroup (< 4 months [76%]), higher initial VAS subgroup (>60 mm [90%]), and worse initial NDI subgroup (>24 [72%]) compared with the gender and age subgroup. An ROC curve is established to assess the model-data fit, which shows an area under the curve of 0.755 and a 95% confidence interval of 0.677–0.830. Participants who show placebo effect after 2 weeks have significantly lower VAS scores after 4 weeks, while there is no significant difference in NDI improvement between the two groups after 4 weeks. Conclusion: Neck pain patients with shorter disease duration are more likely to overscore their pain severity, because of their less experience in pain perception, tolerance, and analgesia expectation.

What is success of treatment? Expected outcome scores in cervical radiculopathy patients were much higher than the previously reported cut-off values for success

PurposeTreatment success can be defined by asking a patient how they perceive their condition compared to prior to treatment, but it can also be defined by establishing success criteria in advance. We evaluated treatment outcome expectations in patients undergoing surgery or non-operative treatment for cervical radiculopathy.MethodsThe first 100 consecutive patients from an ongoing randomized controlled trial (NCT03674619) comparing the effectiveness of surgical and nonsurgical treatment for cervical radiculopathy were included. Patient-reported outcome measures and expected outcome and improvement were obtained before treatment. We compared these with previously published cut-off values for success. Arm pain, neck pain and headache were measured by a numeric rating scale. Neck disability index (NDI) was used to record pain-related disability. We applied Wilcoxon signed-rank test to compare the expected outcome scores for the two treatments.ResultsPatients reported mean NDI of 42.2 (95% CI 39.6–44.7) at baseline. The expected mean NDI one year after the treatment was 4 (95% CI 3.0–5.1). The expected mean reduction in NDI was 38.3 (95% CI 35.8–40.8). Calculated as a percentage change score, the patients expected a mean reduction of 91.2% (95% CI 89.2–93.2). Patient expectations were higher regarding surgical treatment for arm pain, neck pain and working ability, P < 0.001, but not for headache.ConclusionsThe expected improvement after treatment of cervical radiculopathy was much higher than the previously reported cut-off values for success. Patients with cervical radiculopathy had higher expectations to surgical treatment.

The effect of McKenzie protocol vs. deep neck flexor and scapulothoracic exercises in subjects with chronic neck pain - a randomized controlled study.

This study investigated the impact of McKenzie exercises against deep neck flexor (DNF) combined with scapulothoracic exercises on improving pain severity, cervical mobility, and functional disability. Fifty-five subjects suffering from chronic neck pain participated in this randomized controlled study. They were randomly assigned to three groups; the DNF group, which was treated by traditional physical therapy (i.e., physical therapy agents, stretching, and isometric exercises), combined with DNF, and scapulothoracic exercises; the McKenzie group, treated by traditional physical therapy, combined with McKenzie exercises; and finally, a control group, treated by traditional physical therapy. Before and after 6 weeks of treatment, they were assessed for neck pain severity, cervical range of motion (ROM), and functional disability using a visual analog scale (VAS), a gravity-reference goniometer, and the Copenhagen neck functional disability scale (CNFDS), respectively. Compared to baseline, all groups showed a significant decrease in neck pain severity and disability (p <0.05), and there was a significant increase in neck flexion/extension, lateral right flexion/left flexion, and right/left rotation ROMs (p<0.05). The improvement of the McKenzie group was significantly higher than the DNF group, and control group. Moreover, the improvement of the DNF group was significantly higher than the control group (p<0.05). The McKenzie exercises were better than DNF combined with scapulothoracic exercises to treat neck pain, functional disability, and mobility.