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Thermotherapy self-treatment for neck pain relief - A randomized controlled trial

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Abstract

Aim of the study To evaluate the potential of thermotherapy self-treatment in relieving pain and improving sensory function in patients with chronic mechanical neck pain. Materials and methods Fifty patients (74% female; mean age 57.18±12.3years) with chronic mechanical neck pain were randomized to either treatment group (n=25) or control group (n=25). Treatment group used a mud heat pad once a day for 20min over a period of 14days while the control group was left untreated. Both groups were allowed to continue self-directed usual care. Primary outcome measure was neck pain intensity as assessed by a 100mm visual analog scale (VAS) after 14days. Secondary outcome measures included a pain diary (daily measure of pain intensity on a 100mm VAS), functional disability (neck disability index; NDI) and health-related quality of life (short form-36; SF-36). Physiological measures included mechanical detection threshold (MDT), pressure pain threshold (PPT) and vibration detection threshold (VDT) at the site of maximal pain and in the adjacent region. Results Significant group differences occurred for pain intensity (mean difference −16.00mm; 95% confidence interval −26.07; −5.92; P=0.003) and pain diary (P=0.013). Group differences for MDT and VDT occurred at the site of maximal pain (MDT: P<0.001; VDT: P=0.035) and in the adjacent region (MDT: P=0.042; VDT: P=0.008). No group differences were found in NDI, SF-36 or PPT. Conclusions Thermotherapy self-treatment seems to be effective in relieving pain and improving sensory functioning in patients with chronic mechanical neck pain. Further research is needed to underpin these preliminary results.

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... [3] Conservative approaches may be listed as patient education, cognitive-behavioral therapy, exercise, electrotherapy, diathermia, acupuncture, laser therapy, ultrasound, manual therapy, heat therapy, and balneotherapy. [3][4][5][6][7][8] In the conservative approach, exercise reduces pain while increasing muscle strength, and improving motor functions and quality of life (QoL). [9] Administration of transcutaneous electrical nerve stimulation (TENS) in CNP has been shown to be more effective than placebo in reducing pain. ...
... Medicinal muds are usually applied when warm and are a perfect tool for heat transfer. [7,11,12] Many musculoskeletal discomforts are included among indications for hyperthermic medicinal mud application including back pain, fibromyalgia, lumbago, sprains/strains, and osteoarthritis (OA). [13] In the present study, we aimed to compare the short-term efficacy of MP and hot-pack (HP) treatments applied for the same duration at the same temperature for patients with CNNP. ...
... There are many studies in the literature about the efficacy of thermotherapeutic treatments for CNP. [7,27,28] A randomized-controlled study assessing the efficacy of naturopathic administrations in addition to local thermotherapy and acupuncture for CNP observed that complementary thermotherapy and acupuncture administered to patients supported reductions in pain and improvements in functionality. [27] A randomized-controlled study by Cramer et al. [7] compared the efficacy of heated MP with a treatmentfree control group for chronic mechanical neck pain (CMNP). ...
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Objectives: This study aims to compare the short-term efficacy of mud-pack (MP) and hot-pack (HP) treatments with the same temperature and duration on sleep, function, depression, and quality of life for chronic non-specific neck pain (CNNP) patients. Patients and methods: Between December 2018 and September 2019, a total of 70 patients with CNNP diagnosis (12 males, 58 females; mean age: 50.2±9.4 years; range, 24 to 65 years) were included. The patients were divided into two groups. The MP group (n=35) had a total of 15 sessions of MP for 20 min + transcutaneous electrical nerve stimulation (TENS) for 20 min + home exercise (HE) on five days per week for three weeks. The HP group (n=35) had 15 similar sessions of HP for 20 min + TENS for 20 min + HE. The patients were assessed with the Visual Analog Scale (VAS-pain), VAS physician’s and patient’s global assessments, modified Neck Disability Index (mNDI), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and Short Form-36 (SF-36) measures before treatment, at the end of post-treatment third week and one month later. Results: In the MP group, there were statistically significant improvements in all parameters at the end of treatment three-week and one-month follow-up (p<0.05), apart from SF-36 Vitality/Energy (SF-36V/E) at the end of treatment and SF-36 General Health (SF-36GH) at one month. In the HP group, there were statistically significant improvements observed for all parameters (p<0.05), apart from the SF-36 Physical Role and SF-36GH at the end of treatment third week and SF-36V/E at the first-month assessment. The VAS-pain(p<0.001), mNDI (p=0.019), BDI (p=0.002), SF-36GH (p<0.001), SF-36V/E (p<0.001) and SF-36 mental health (p<0.001) showed statistically significantly superior improvements in the MP group (p<0.05). Conclusion: In CNNP patients, both MP and HP treatments are effective. However, MP therapy has more positive effects on pain, function, depression, and quality of life parameters. The MP treatment may be used in addition to TENS treatment for CNNP patients. Keywords: Chronic neck pain, home exercise, hot pack, mud pack, thermotherapy
... Many studies of neck pain have been published in the past decade (3)(4)(5)(6)(7)(8)(9)(10)(11). Most studies have utilized self-reported outcomes, namely pain intensity on visual analogue or numeric rating scales, together with outcomes reflecting function and quality of life. ...
... This re-analysis used pooled data from 7 RCTs conducted at the Department of Complementary and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen in Essen, germany (3)(4)(5)(6)(7)(8)(9). All studies had been approved by the local ethics committee prior to patient recruitment and all patients had given written informed consent prior to inclusion in the study. ...
... however, patients who had had invasive treatments, such as injections or acupuncture within 4 weeks or surgery within 12 months prior to the trial, were excluded. More information on additional inclusion criteria can be found in the original reports (3)(4)(5)(6)(7)(8)(9). ...
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Objectives: To determine factors, including pain intensity, associated with pressure pain sensitivity in chronic non-specific neck pain and with changes after therapeutic interventions. Methods: This re-analysis used pooled data from 7 randomized controlled clinical trials. Pressure pain thresholds were assessed at the hand and at the site of maximal pain in the neck region before and after different non-pharmacological interventions. Age, gender, neck pain intensity and duration, mental health, expectancy and time interval between measurements were used to determine factors influencing pressure pain thresholds as well as pressure pain threshold changes. Results: A total of 346 patients (77 males, 269 females, mean age 52.6 years (standard deviation 12.0 years)) were included in study, 306 of whom provided a complete data-set for analysis. Pressure pain thresholds at the neck area or the hand did not correlate with pain intensity. Changes in pressure pain thresholds correlated with time between measurements, indicating time-sensitive changes. Discussion: No coherent correlations between pressure pain thresholds and pain intensity were found. Further research is needed to evaluate the relationship between pain intensity and pressure pain thresholds before its use as a valid substitute of pain rating can be supported. Until then, the results of trials with respect to using pressure pain thresholds as an outcome variable must be interpreted with care.
... Thermotherapy has been used to reduce chronic musculoskeletal pain and has been reported as a complementary intervention [11][12][13][14][15][16][17][18][19]. Since the application of thermotherapy to the skin increases the temperature and blood flow to the muscle and decreases muscle fatigue [14][15][16], it may be associated with an increase in muscle flexibility [17]. ...
... Previous studies have reported the effects of therapeutic exercise, including neck stabilization exercise, with or without thermotherapy on nonspecific musculoskeletal pain and disability [8][9][10][11][12]34,[37][38][39]. ...
... Interestingly, in comparison with neck stabilization exercise alone, the intervention group also showed significantly better neck pain control. In the study by Cramor et al. [12] both the thermotherapy and non-thermotherapy groups received their usual medication and physical therapy regimens during the study period, with the thermotherapy group receiving thermotherapy using mud packs; their findings suggested that the additional thermotherapy significantly alleviated nonspecific neck pain. Thermotherapy has been shown to effectively alleviate pain and improve somatosensory function in individuals with chronic neck pain [12]. ...
Article
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Neck pain is a serious problem for public health. This study aimed to compare the effects of thermotherapy plus neck stabilization exercise versus neck stabilization exercise alone on pain, neck disability, muscle properties, and alignment of the neck and shoulder in the elderly with chronic nonspecific neck pain. This study is a single-blinded randomized controlled trial. Thirty-five individuals with chronic nonspecific neck pain were randomly allocated to intervention (n = 18) or control (n = 17) groups. The intervention group received thermotherapy with a salt-pack for 30 min and performed a neck stabilization exercise for 40 min twice a day for 5 days (10 sessions). The control group performed a neck stabilization exercise at the same time points. Pain intensity, pain pressure threshold (PPT), neck disability index, muscle properties, and alignment of the neck and shoulder were evaluated before and after the intervention. Significant time and group interactions were observed for pain at rest (p < 0.001) and during movement (p < 0.001), and for PPT at the upper-trapezius (p < 0.001), levator-scapula (p = 0.003), and splenius-capitis (p = 0.001). The disability caused by neck pain also significantly changed between groups over time (p = 0.005). In comparison with the control group, the intervention group showed significant improvements in muscle properties for the upper-trapezius (tone, p = 0.021; stiffness, p = 0.017), levator-scapula (stiffness, p = 0.025; elasticity, p = 0.035), and splenius-capitis (stiffness, p = 0.012), and alignment of the neck (p = 0.016) and shoulder (p < 0.001) over time. These results recommend the clinical use of salt pack thermotherapy in addition to neck stabilization exercise as a complementary intervention for chronic nonspecific neck pain control.
... e systematic review of exercises used by LBP patients showed that a variety of exercises appeared to have beneficial effects for LBP and that exercise therapy for chronic LBP appears to be slightly effective in decreasing pain and improving function [10]. e therapeutic application of topical heat is used for the relief of musculoskeletal pain syndromes [11,12], and thermotherapy using mud can be also recommended to treat patients with chronic LBP [13], neck pain [14][15][16], or osteoarthritic pain [17]. An appropriate level of pain control by thermotherapy may be required before exercises for pain control in nonspecific LBP. ...
... To apply thermotherapy, moor mud was used in packs [14,17]; the moor mud was collected at the Chollipo Arboretum, Taean-gun, Chungcheongnam-do, Republic of Korea, in June 2018, and impurities were removed using a 5 mm and 90 μm sieve. Subsequently, 1.5 kg of the moor mud removed from impurities and 300 ml of deep sea water collected from Ulleungdo, East Sea of Korea, were mixed in a zipper bag (30 × 45 cm) and standardized to 1 cm in thickness. ...
... In addition, the intervention group was statistically superior to the control group in terms of personal care, lifting, and walking with decreased pain. Previous studies that demonstrated positive effects of mud intervention on chronic musculoskeletal pain, including LBP, support our results [13][14][15][16][17]. e results of our study showed the feasibility of the clinical use of mud-heat intervention for the management of chronic nonspecific LBP. ...
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Background: Low back pain (LBP) is common in the elderly and an appropriate intervention for LBP management should be investigated. The aim of this study is to investigate the potential of mud-heat intervention combined with core exercise as an alternative intervention for relieving pain and improving motor function in individuals with nonspecific chronic LBP. Methods: Thirty-one individuals with chronic nonspecific LBP were randomly allocated to either the intervention group (n = 16) or the control group (n = 15). The intervention group used a mud pack for 30 min and performed a core-exercise program for 50 min twice a day for 4 days (8 sessions). The control group performed the core-exercise program only, at the same time point as the intervention group. Pain intensity was assessed using a 100 mm visual analog scale and a pain pressure threshold (PPT) as the primary outcomes. The secondary outcome measures included functional disability by LBP (Oswestry Disability Index), muscle properties, and static/dynamic balance. Results: There was a significant group difference in pain intensity at rest (p=0.048) and in the PPT at the two sites assessed (2 cm lateral to L3 spinous process, p=0.045; 2 cm lateral to L5 spinous process, p=0.015). No group differences were found in terms of muscle properties. Compared to core exercise only, moor-heat therapy and core exercise showed a significant improvement in static balance (p=0.026) and dynamic balance (p=0.019). Conclusion: Mud therapy combined with core exercise is effective in relieving pain and improving motor function in patients with chronic nonspecific LBP. Further research is needed to underpin these preliminary results.
... In Western medicine, superficial heating using hot packs and heat wraps are frequently recommended by general practitioners and physiotherapists for instant pain relief in cLBP 29 via the increase of blood flow in deep muscles. 28,30 Nielsen et al. 14 has also reported the increase of the local microcirculation following the Gua sha treatment. 30 According to the theory of Chinese medicine, increasing the flow of blood and Qi would enhance the movement and physical activities. ...
... 28,30 Nielsen et al. 14 has also reported the increase of the local microcirculation following the Gua sha treatment. 30 According to the theory of Chinese medicine, increasing the flow of blood and Qi would enhance the movement and physical activities. Other researchers have proposed Gua sha is effective in stimulating the serotonergic, noradrenergic and opioid systems, which are relevant to the pain pathways. ...
... Correlations between the pain intensity, physical disability and biomarkers. [25][26][27][28][29][30][31][32] conditions, HO-1 is expressed at low levels in body tissues, 32 and can be induced by oxidative stress causing agents including hyperthermia 33 and inflammatory cytokines including TNF-α. 34 On the contrary, an acute induction of HO-1 has been shown to have beneficial effect because of the rapid removal of the undesired pro-oxidant heme and the attenuation of TNF-α mediated inflammation injury. ...
Article
Objective: To address the challenges for trialing with elderly and the lacking of valid sham/placebo control, a randomized crossover pilot study is designed and its feasibility on elderly subjects is evaluated. Design: A pilot randomized crossover study was conducted with hydrocollator-based hot pack therapy as active control. Pain intensity, physical disability, depression, general health status, and salivary biomarkers were assessed as outcome measures. Results: Despite there was no significant difference observed between any outcome measures attained by the two interventions, several important differences were noted during the one-week follow-up period. The magnitudes of pain reduction (21-25% versus 16-18%) and disability improvement (45-52% versus 39-42%) were greater in the Gua sha-treated group than the hot pack group. Both treatments were shown to improve flexion, extension and bending movements of the lower back, whereas areas of improvement varied between the two interventions. Decreasing trends were observed in both tumor necrosis factor-alpha (TNF-α) and heme-oxygenase-1 (HO-1) levels following Gua sha. However, rebounds of the biomarkers were observed one week following hot pack. Furthermore, in response to Gua sha, the decrease of TNF-α was strongly correlated with the improvement of physical disability, whereas the physical disability was correlated with the VAS pain intensity. Conclusion: It demonstrated a feasible clinical trial protocol for evaluating the effectiveness of Gua sha and other therapeutic modalities. Gua sha may exhibit a more long-lasting anti-inflammatory effect relative to hot pack for pain relief and improved mobility in elderly patients with chronic low back pain.
... The 14-day thermotherapy application has shown positive effects on pain reduction in the cervical region (Cramer, et al., 2012). After treating patients with different treatment methods including mobilization and manipulation, stretching, strength and flexibility, massage techniques and thermotherapy have shown functional improvement in patients with cervical disorders (Boissonnault & Badke, 2008). ...
... The role of dynamic exercises and deep transverse massages has shown to be more effective in treatment of cervical spondylosis, the same results reported by other authors who have concluded that the dynamic exercises are more effective in cervical spondylosis treatment can be comparative to our results (Wong, Shearer, Mior, Jacobs, & Cote, 2016) (Forbush, Cox, & Wilson, 2011), (Cramer, et al., 2012), (Lauche, et al., 2016) Based on the results of our research we can confirm that if we combine the exercises of both groups, the success of rehabilitation will be much more effective in cervical spondylosis. ...
Article
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Introduction: Spondylosis a presents of cervical degenerative disorder that appears in the cervical vertebrae. It is a very common issue since it appears among people older than 30, which leads to a higher numbers of problems connected with the cervical region. Purpose: The main purpose of this paper is to determine the effectiveness of physical therapy in the treatment of cervical spondylosis. Materials and methods: This research was a prospective study which was conducted at the Center for physical therapy and rehabilitation, in Kllokot, Kosovo, during 2013. To carry out the study according to the ethical medical standards a permission from the rehabilitation center was granted. The survey was short term, lasting 10 days. The total number of patients included in the study was 60 and they were of both sexes. Separation of patients in both groups (A and B) was done randomly. Group A was treated with: Thermotherapy, electrotherapy , dynamic exercises for the muscles of the cervical region against gravity, stretching and deep transverse massage, while group B was treated with: Thermotherapy, electrotherapy, isometric exercises. Range of motion was measured with goniometer while the pain was estimated by Numerical rating scale of pain. Evaluation of patients was done before and after ten days of treatment. Results: According to our results, we found significant improvement in group A regarding the mobility, pain and function. According to our results, the dynamic exercises combined with deep transversal massage are more effective than isometric exercises. Conclusion: This study confirms the hypothesis that short-term physiotherapy plays a significant role in the treatment of cervical spondylosis. Comparison between the two treatment techniques gives priority to dynamic exercises, contrary to isometric exercises. Our recommendation include: long-term study, the number of
... Patients from 10 randomized controlled trials on chronic non-specific neck pain were included in psychometric testing. The trials had been conducted at the Department of Complementary and Integrative Medicine, Kliniken Essen-Mitte, Germany [15][16][17][18][19][20][21][22] and at the Immanuel Hospital Berlin, Department of Internal and Integrative Medicine, Berlin, Germany [23,24]. All studies were conducted in accordance with the ethical standards of the responsible institutional committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 1983. ...
... All studies were conducted in accordance with the ethical standards of the responsible institutional committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 1983. All studies were approved by the institutional ethics committee of the medical institutions at the University of Duisburg-Essen, Germany [15][16][17][18][19][20][21][22] or by the Ethics Committee of the Charité-University Medical Center, Berlin, Germany [23,24] prior to patient recruitment and all patients gave written informed consent prior to inclusion in the study. ...
Article
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The Neck Disability Index (NDI) is the most commonly used outcome measure for neck pain. This study aimed to determine the psychometric properties of a German version of the NDI. Cross-cultural translation and psychometric testing of the NDI were performed. The 10-item NDI was translated into German and administered to 558 patients with chronic unspecific neck pain (Mean age 49.9 +/- 11.4 years, 76% female). The factor structure and reliability of the NDI were assessed using factor analysis, Cronbach's alpha, split-half reliability (Spearman-Brown coefficient), and intra-class correlation (ICC2,1). To determine convergent validity, pain intensity (visual analog scale; VAS), pain on movement (VAS), and quality of life (Short Form 36 Health Survey Questionnaire; SF-36) were correlated with the NDI. Correlation with range of motion and sensitivity to change were also assessed in a subsample of 49 patients. The mean NDI score was 32.75 +/- 13.09. Factor analysis revealed a single factor that explained 39.8% of the variance. Cronbach's alpha was 0.81; Spearman-Brown coefficient was 0.80; and intra-class correlation was 0.81 (95% confidence interval = 0.78, 0.83). Significant correlations were found for pain intensity (r = 0.22, p < 0.01), pain on movement (r = 0.39, p < 0.01), quality of life (r = -0.30 to -0.45, p < 0.01), and range of motion (r = -0.34, p = 0.02). Patients who reported global improvement of health after an exercise or yoga intervention showed a higher decrease on the NDI than patients who reported no global improvement (p < 0.01). The German version of the NDI has a comparable factor structure as the original version, acceptable psychometric properties, and is sensitive to change after physical activity. Neck disability is associated with other measures of neck pain.
... 3 Despite a high prevalence and the permanent risk of increasing chronicity few interventions for chronic neck pain have proven effective to date, 4,5 including acupuncture and chiropractic interventions alongside physical therapy. 6 Guidelines also recommend several self-help strategies such as the application of local heat via heat pads or pillows 7,8 and the use of non-specific relaxation techniques such as progressive muscle relaxation after Jacobson (PMR). 9 Few therapies address postural or habitual patterns that may cause muscular pain and/or restrict mobility. ...
... Previous studies have found the application of local heat an effective treatment for neck pain. 7,8 The guided imagery group This group was introduced to control for the potential effect of enhanced therapists' attention. Patients in this group were treated individually using a guided imagery relaxation technique. ...
Article
To test the efficacy of the Alexander Technique, local heat and guided imagery on pain and quality of life in patients with chronic non-specific neck pain. A randomized controlled trial with 3 parallel groups was conducted. Outpatient clinic, Department of Internal and Integrative Medicine. A total of 72 patients (65 females, 40.7±7.9 years) with chronic non-specific neck pain. Patients received 5 sessions of the Alexander Technique - an educational method which aims to modify dysfunctional posture, movement and thinking patterns associated with musculoskeletal disorders. Control groups were treated with local heat application or guided imagery. All interventions were conducted once a week for 45 minutes each. The primary outcome measure at week 5 was neck pain intensity on a 100-mm visual analogue scale; secondary outcomes included neck disability, quality of life, satisfaction and safety. Analyses of covariance were applied; testing ordered hypotheses. No group difference was found for pain intensity for the Alexander Technique compared to local heat (difference 4.5mm; 95%CI:-8.1;17.1;p=0.48), but exploratory analysis revealed the superiority of the Alexander Technique over guided imagery (difference -12.9mm; 95%CI:-22.6;-3.1,p=0.01). Significant group differences in favor of the Alexander Technique were also found for physical quality of life (P<0.05). Adverse events mainly included slightly increased pain and muscle soreness. The Alexander Technique was not superior to local heat application in treating chronic non-specific neck pain. It cannot be recommended as routine intervention at this time. Further trials are warranted for conclusive judgment. © The Author(s) 2015.
... 3 Despite a high prevalence and the permanent risk of increasing chronicity few interventions for chronic neck pain have proven effective to date, 4,5 including acupuncture and chiropractic interventions alongside physical therapy. 6 Guidelines also recommend several self-help strategies such as the application of local heat via heat pads or pillows 7,8 and the use of non-specific relaxation techniques such as progressive muscle relaxation after Jacobson (PMR). 9 Few therapies address postural or habitual patterns that may cause muscular pain and/or restrict mobility. ...
... Previous studies have found the application of local heat an effective treatment for neck pain. 7,8 The guided imagery group This group was introduced to control for the potential effect of enhanced therapists' attention. Patients in this group were treated individually using a guided imagery relaxation technique. ...
Article
Objective: To test the efficacy of the Alexander Technique, local heat and guided imagery on pain and quality of life in patients with chronic non-specific neck pain. Design: A randomized controlled trial with 3 parallel groups was conducted. Setting: Outpatient clinic, Department of Internal and Integrative Medicine. Subjects: A total of 72 patients (65 females, 40.7±7.9 years) with chronic non-specific neck pain. Interventions: Patients received 5 sessions of the Alexander Technique - an educational method which aims to modify dysfunctional posture, movement and thinking patterns associated with musculoskeletal disorders. Control groups were treated with local heat application or guided imagery. All interventions were conducted once a week for 45 minutes each. Main measures: The primary outcome measure at week 5 was neck pain intensity on a 100-mm visual analogue scale; secondary outcomes included neck disability, quality of life, satisfaction and safety. Statistics: Analyses of covariance were applied; testing ordered hypotheses. Results: No group difference was found for pain intensity for the Alexander Technique compared to local heat (difference 4.5mm; 95%CI:-8.1;17.1;p=0.48), but exploratory analysis revealed the superiority of the Alexander Technique over guided imagery (difference -12.9mm; 95%CI:-22.6;-3.1,p=0.01). Significant group differences in favor of the Alexander Technique were also found for physical quality of life (P<0.05). Adverse events mainly included slightly increased pain and muscle soreness. Conclusion: The Alexander Technique was not superior to local heat application in treating chronic non-specific neck pain. It cannot be recommended as routine intervention at this time. Further trials are warranted for conclusive judgment.
... Cramer i wsp. [22] obserwowali zmniejszenie natężenia dolegliwości bólowych szyjnej części kręgosłupa w następstwie stosowania okładów cieplnych przez okres 14 dni. W piśmiennictwie brakuje doniesień na temat wpływu lecznictwa uzdrowiskowego na dolegliwości bólowe i sprawność funkcjonalną osób ze zmianami zwyrodnieniowymi szyjnej części kręgosłupa. ...
... Jankowska et al. [21] in studies of 74 people with chronic nonspecific pain syndrome of the cervical spine, demonstrated the effectiveness of massage, TENS therapy and infrared radiation in reducing the frequency and intensity of pain, as well as improving mobility and functional capacity of the cervical spine. Cramer et al. [22] observed reduction of cervical spine pain following the use of heat compresses for a period of 14 days. There are no reports in the literature on the impact of spa treatment on pain and functional fitness of people with degenerative changes of the cervical spine. ...
Article
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Background. Back problems become a medical and social problem in the era of modern civilization. Wide variety of pain syndromes, their recurrent character and persisting pain in chronic cases prompts the search for effective diagnostic and therapeutic methods. The aim of the study was to compare the effectiveness of two spa therapy programs in alleviating pain and eliminating functional limitations in office workers with degenerative disease of the cervical spine. Material and methods. The study involved 144 office workers aged 45-55, staying on a rehabilitation stay due to pain in the cervical spine caused by degenerative changes. Patients were divided into two groups depending on the rehabilitation programme administered. Research tools was functional tests of the cervical spine (Valsalva, Kernig, compression test and traction test), linear measurements of ranges of cervical spine, NRS scale and NDI questionnaire. The data were analyzed based on the Chi-square test, Student t test, Mann Whitney U test, Wilcoxon test. Results. In both groups, after improvement, a statistically significant improvement was noted in terms of functional test results, cervical spine movement ranges, NRS scale values and NDI index. The differences in the results obtained in Test II in relation to I were significantly greater for patients from group I. The application of both therapeutic programs had an effect on alleviating pain and improving functional capacity. Conclusions. Application of both programs contributed to the relief intensity of pain and improved functional capacity, however, the extent of improvement was significantly greater in the case of patients subjected to a program containing mud therapy. Key words: cervical spine, pain, functional capacity, balneotherapy.
... The main challenge of physiotherapists is finding the best protocol to asses and to provide treatment for cervical pain, according the evidence there are many studies that have evaluated the different forms of physical therapy, including manual therapy, physical modalities, exercise protocols, thermotherapy, acupuncture etc. They all plays an important role in reducing pain, increasing muscular strength and flexibility in the cervical region (Egwu, Ajao, & Mbada, 2009), (Boyles, Toy, Mellon, Hayes, & Hammer, 2011) (Hirpara, Butller, Dolan, O'Byrne, & Poynton, 2012) (Leaver, Refshauge, Maher, & McAuley, 2010) (Lauche, et al., 2016) application of thermotherapy (Cramer, et al., 2012). ...
... Applying strengthening exercise in cervical region has a positive impact in reducing pain, increasing muscular strength and flexibility, these data are consistent with other authors (Lauche, et al., 2016) (Boyles, Toy, Mellon, Hayes, & Hammer, 2011) (Hirpara, Butller, Dolan, O'Byrne, & Poynton, 2012) (Leaver, Refshauge, Maher, & McAuley, 2010). (Wong, Shearer, Mior, Jacobs, & Cote, 2016) (Forbush, Cox, & Wilson, 2011), (Cramer, et al., 2012), Based on the results of our research we can confirm once again the significant role of physical therapy treatment in management of chronic neck pain which can be radiated or not in both shoulders. ...
Article
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Neck pain among most patients is considered as simple neck pain without a specific cause, contributing factors in neck pain are considered poor posture, occupational activities, mechanical changes in spine, also anxiety and depression. The purpose of this research was to evaluate the effectiveness of short term physical therapy for treatment of neck pain. This research was carried out at the Diagnostic Therapeutic Centre "Rezonanca" in Pristina, this research was conducted during March-June in year 2017 at physiotherapy department, the study was prospective and short term. The total number of patients incorporated in the study was 25 out of 75, 30-80 years old of both sexes with pain in cervical region lasting more than three months. The survey was short term, lasting 21 days. Patients were treated with physical therapy protocol for 10 sessions. The evaluation of patients was done before and after treatment by Visual Analogue Scale of pain from 0-10. After statistical analysis with t-test we found important statistical significance assessing the degree of pain before and after treatment (t = 7.201, P>0.05). Regarding the age group in relation with diagnoses we can notice that age group 47-52 years was the most influenced age and the frequency of patients was higher with diagnosed cervical pain radiated in the left arm. The combination of physical exercises and modalities of physical therapy plays a significant role in the treatment of cervical pain
... The open literature reports conflicting outcomes on heat-wrap efficacy: Shaheed et al. [17] found no immediate evidence of analgesic effect; other works suggest that application of heat onto the skin surface yields pain relief, decreases local muscle spasms and reduces disability rate [12,[18][19][20][21] . Most of, if not all, the available studies on heat therapy describe in vivo performance and clinical significance [18][19][20][22][23][24][25] , thus emphasizing a general lack of solid, quantitative approaches to assess and compare heat-wrap thermal transient trend. Notably, in vivo investigations are inherently related to patients' clinical conditions, which include the type of pain they endure (e.g., lumbar, neck, knee) and their physiological status with the associated variability. ...
Article
Among the numerous thermotherapy methods, heat wraps have been largely used over the last 2 decades as a self-administered practice for pain relief. Therefore, understanding their performance has become instrumental within the healthcare industry. However, the majority of the available studies have been focused on in vivo clinical performance, whereas a standardized, quantitative approach to evaluate and compare the various heat-wrap types against each other is lacking. An experimental methodology is proposed to carry out a comparative assessment between heat wraps in terms of their transient thermal behavior. A simple setup was developed to measure wrap/substrate interface temperature trend. The approach was validated by a preliminary infrared-thermography assessment and statistical analysis on the extensive dataset acquired on commercial heat-wrap types for low-back and neck pain relief. The heat-release trend was found to be qualitatively similar over all the investigated types, consisting of rapid growth, stationary phase, decay and end of the reactions. A set of parameters is also proposed to summarize heat-wrap thermal performance.
... Reduced muscle tension might relieve pain and fatigue (50). Cramer et al. (51) found that heat pad is effective in relieving pain and improve somatosensory function in patients suffering from chronic idiopathic neck pain. Our study did not allow us to determine whether the heating effect of US was affected by the application of superficial heat. ...
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Objective: The purpose of this study was to evaluate the effect of continuous ultrasound [US] compared with placebo US combined with conventional physiotherapy program for patients with cervical spondylosis.Methods: This was a randomized placebo-controlled trial. Patients, diagnosed with cervical spondylosis, were randomly assigned to one of two groups in an orthopedic physical therapy clinic: a group that received electrotherapy, exercise, hot packs, and therapeutic US [True US group] and a group that received electrotherapy, exercise, hot packs, and sham US [Sham US group]. Patients were treated, on average, three times per week for 4 weeks. Outcome measurements were collected at baseline and after 4 weeks using the Numeric Pain Rating Scale, Patient-Specific Functional Scale, and Neck Disability Index.Results: Analysis of variance showed that both groups had improved regarding Numeric Pain Rating Scale, Patient-Specific Functional Scale, and Neck Disability Index [p p > 0.05] for all measures.Conclusions: The addition of US to conventional physiotherapy program of electrotherapy, exercise, and hot packs yields no additional benefit to neck pain, function, or disability in patients with cervical spondylosis.
... Self treatment using a mud heat pack (thermotherapy) for chronic neck pain was tested in a small German trial [10]. This resulted in significant reduction in pain intensity and improved sensory functioning and has implications for self care. ...
... Nineteen studies included participants with chronic neck pain [14,15,18,38,43,44,46,47,53,54,68,72,76,77] and chronic WAD [19,39,40,62,75]. Sample sizes ranged from 22 to 151, with 1043 total participants from all studies. ...
Article
Sensitization of the nervous system can present as pain hypersensitivity that may contribute to clinical pain. In spinal pain, however, the relationship between sensory hypersensitivity and clinical pain remains unclear. This systematic review examined the relationship between pain sensitivity measured via quantitative sensory testing (QST) and self-reported pain or pain-related disability in people with spinal pain. Electronic databases and reference lists were searched. Correlation coefficients for the relationship between QST and pain intensity or disability were pooled using random effects models. Subgroup analyses and mixed effects meta-regression were used to assess whether the strength of the relationship was moderated by variables related to the QST method or pain condition. One hundred seventy-four effect sizes from 40 studies were included in the metaanalysis. Pooled estimates for the correlation between pain threshold and pain intensity were -0.15 (95% CI: -0.18 to -0.11) and for disability -0.16 (95% CI: -0.22 to -0.10). Subgroup analyses and meta-regression did not provide evidence that these relationships were moderated by the QST testing site (primary pain/remote), pain condition (back/neck pain), pain type (acute/chronic), or type of pain induction stimulus (e.g., mechanical/thermal). Fair correlations were found for the relationship between pain intensity and thermal temporal summation (0.26, 95% CI: 0.09 to 0.42) or pain tolerance (0.30, 95% CI: -0.45 to -0.13), but only a few studies were available. Our study indicates that pain threshold is either a poor marker of central sensitisation or sensitisation does not play a major role in patients' reporting of pain and disability. Future research prospects are discussed.
... This might include the application of therapeutic heat (e.g. heat pads [7], balneotherapy) or the use of progressive muscle relaxation after Jacobson (PMR) [8], a technique used to teach patients to relax muscles through a two-step process. In PMR, patients start to deliberately contract muscles and hold the tension; secondly they release all tension and focus on the sensation of relaxation. ...
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Chronic neck pain is a major public health problem with very few evidence-based complementary treatment options. This study aimed to test the efficacy of 12 weeks of a partner-delivered home-based cupping massage, compared to the same period of progressive muscle relaxation in patients with chronic non-specific neck pain. Patients were randomly assigned to self-directed cupping massage or progressive muscle relaxation. They were trained and asked to undertake the assigned treatment twice weekly for 12 weeks. Primary outcome measure was the current neck pain intensity (0-100 mm visual analog scale; VAS) after 12 weeks. Secondary outcome measures included pain on motion, affective pain perception, functional disability, psychological distress, wellbeing, health-related quality of life, pressure pain thresholds and adverse events. Sixty one patients (54.1±12.7 years; 73.8%female) were randomized to cupping massage (n = 30) or progressive muscle relaxation (n = 31). After treatment, both groups showed significantly less pain compared to baseline however without significant group differences. Significant effects in favor of cupping massage were only found for wellbeing and pressure pain thresholds. In conclusion, cupping massage is no more effective than progressive muscle relaxation in reducing chronic non-specific neck pain. Both therapies can be easily used at home and can reduce pain to a minimal clinically relevant extent. Cupping massage may however be better than PMR in improving well-being and decreasing pressure pain sensitivity but more studies with larger samples and longer follow-up periods are needed to confirm these results. ClinicalTrials.gov NCT01500330.
... 2 Benefits are particularly manifest in the field of rheumatology, 3 with reduced pain, less joint soreness, and increased grip strength. Aquatic therapy also has positive effects on respiratory diseases (facilitating expiration 4 ), cardiovascular illnesses (less pain, swelling, and limping in individuals with varicose veins 5,6 ), and psychosomatic diseases, 7,8 and has an analgesic effect on the musculoskeletal system (neck pain, back pain, fibromyalgia, rheumatoid arthritis or osteoarthritis, 9 and management of postoperative rehabilitation). ...
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Objective Aquatic osteopathy (AO) is a recent discipline that has not yet demonstrated its value compared with existing therapies. This study compared AO with aquatic therapy (AT)—that is, thermoneutral water immersion—using infrared thermography on healthy individuals to assess differences in cutaneous body temperature. Methods Fifty-five healthy individuals were immersed in thermoneutral water for 1 hour and then underwent AO treatment, with application of a classic diagnosis routine and subsequent manual therapy. Thermograms were recorded to measure the distribution of skin surface temperature throughout the entire body after 1 hour of immersion in thermoneutral water (AT) and compared with thermograms taken after AO. Results Visual analysis of the thermograms showed that there were thermographic differences between the 2 groups. A statistical analysis revealed significant differences between post-AT and post-AO thermograms (P = .002): the mean variance in cutaneous body temperature was significantly lower in the post-AO group than in the post-AT group. Therefore, cutaneous body temperatures were more homogeneous after AO than after AT. Conclusion Cutaneous thermal reactions were more homogenous after AO than after AT alone, with cutaneous temperatures returning closer to normal than after AT alone. These reactions may be related to physiological reactions due to a decrease in vasoconstriction or trigger points. Further studies are needed to clarify these physiological reactions to establish the mechanisms of AO and thus better define its indications.
... One constituent of caraway oil, +(-)-carvone, however, has been investigated; and it could be shown that the intact abdominal skin of mice was able to absorb it within 35 min [36] . Beside the pharmacological mechanisms, the tested poultices may further act through topical heat, which leads to an increased temperature in the deep muscle tissue [37,38] . This is ac-companied by an increase of muscle extensibility, causing relaxation of abdominal muscles and associated pain [9,10,[39][40][41] . ...
Article
Irritable bowel syndrome (IBS) is a frequent gastrointestinal disorder, with only limited evidence regarding self-management approaches. This study tested the efficacy of caraway oil poultices (CarO) for treating IBS. This randomized controlled open-label cross-over trial included three treatment periods with hot CarO and hot olive oil poultice (OlivH) or nonheated poultices (OlivC) with olive oil as control interventions. Patients applied each intervention daily for 3 weeks. The primary outcome was symptom severity (IBS-SSS); secondary outcomes included responder rates (improvement ≥50 IBS-SSS), quality of life (EQ-5D, IBS-QOL), psychological distress (HADS), adequate relief, and safety. 48 patients with IBS were included (40 females, 53.9 ± 14.4 years). A significant difference was found for symptom severity in favor of CarO compared to OlivC (difference -38.4, 95% CI -73.6, -3.1, p = 0.033), but not compared to OlivH (difference -24.3, 95% CI -56.5, 7.9, p = 0.139). Responder rates were highest for CarO compared to OlivH and OlivC (43.9, 20.0, 18.9%, respectively). Within the CarO, 51.8% reported adequate relief compared to 23.5% (OlivH) and 25.8% (OlivC). One adverse event (gastrointestinal infection) was reported during CarO. Hot caraway oil poultices appear effective and safe, although their effects may be a result of the heat application. Patients reported highest levels of subjective benefit from caraway oil poultices, making their use appropriate in the self-management of IBS. © 2015 S. Karger AG, Basel.
... This analysis used pooled data from nine randomized controlled clinical trials conducted at the Department of Complementary and Integrative Medicine in Essen, Germany between 2008 and 2013 [5,[14][15][16][17][18][19]21,22]. All studies had been approved by the local ethics committee prior to patient recruitment, and all patients had given written informed consent prior to inclusion in the study. ...
Article
Objective This analysis aimed to determine reliability, validity, and responsiveness of the pain on movement (POM) questionnaire, an instrument developed to determine pain intensity induced by head movement.DesignData from nine randomized controlled trials for the treatment of chronic nonspecific neck pain were reanalyzed to determine reliability and validity of the POM questionnaire.MethodsPOM was assessed as ratings of pain intensity induced by head movement in six different directions. The instrument's structure was assessed using a factor analysis. Reliability (internal consistency) was determined using Cronbach's alpha, and validity (convergent validity) was determined by correlating the POM with pain at rest on a visual analog scale (VAS), the neck disability index (NDI), quality of life (short-form 36 health survey questionnaire [SF-36]) and range of motion. Responsiveness was indicated by sensitivity to changes over time in a subsample of 49 patients.ResultsOverall, 482 patients (mean age 50.3 ± 12.4 years, 72.3% female) were included in the analysis, and 458 of them provided complete data set for the POM. Average POM was 43.9 ± 20.8 mm on the VAS. The POM showed very good reliability as indicated by high internal consistency and moderate validity as indicated by significant correlations with the pain at rest, the NDI, and the SF-36. No correlations were found for POM with range of motion. The POM further proved to be responsive as it was sensitive to changes over time, and those changes were correlated to changes in pain intensity and NDI.Conclusions The POM seems to be a reliable and valid instrument to assess POM in patients with chronic nonspecific neck pain.
... These include the use of diathermia and radiofrequency [2], microwaves [3], ultrasound [4], laser [5], magnetic nanoparticles [6], muds and peloids [7,8], etc. Its use may be destructive or ablative (tumour lesions), inhibitory (cancer) or for the rehabilitation of osteo-muscular, sports and degenerative lesions, and chronic pain [9][10][11]. ...
Article
Mixtures of clays and waters of different mineralization have been used for thermotherapy therapies since ancient times. These mixtures are the basis of the most so-called thermal peloids, which are used for therapeutic purposes in the main thermal centres of the world. The thermal properties of peloids are very important to establish their applicability and determine whether they are appropriate for use in thermotherapy. This work focuses on the study of the behaviour of the specific heat capacity of different mixtures of kaolin with sea water or distilled water as a function of water concentration. Sea water is equivalent to high mineralized water, and distilled water corresponds to zero mineralization. Specific heat capacity was measured at atmospheric pressure and in the temperature interval from 293.15 to 317.15 K, using a commercial SETARAM BT 2.15 calorimeter. This device is based on the principle of Calvet calorimetry with temperature control. Furthermore, experimental results were compared to those obtained from mixtures with other clays.
... The latter two studies show a two to threefold increase in deep tissue blood flow with moderate levels of conductive topical heat treatment applied directly to the skin. In addition, it was reported that a significant increase in trapezius muscle conduction velocity, most likely due to increased tissue blood flow, occurred with hot pack treatment at moderate temperatures (Cramer, et al., 2012). Continuous application of low-level heat therapy (LLHT) directly on the skin has been shown to be safe and therapeutically effective in treating musculoskeletal disorders. ...
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the same university. He is also a Registered Engineer in Nigeria. His main areas of specialisation are biomedical modelling and simulations, and biomedical devices; he has produced many portable cost-effective medical devices. He also specialises on renewable energy as an alternative and viable source of energy, and other energy related issues such as witricity. He has published widely both in national and international journals.
... Quantitative sensory testing (QST) is a well-established procedure and is predominantly used for the analysis of the somatosensory phenotype of patients suffering from neuropathic pain [28, 29]. However, subtests of the test battery, especially the pressure pain threshold (PPT), have been utilized as outcome measures in treatment studies on chronic pain [30–41]. ...
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Objectives. The objective was to investigate whether a treatment with a needle stimulation pad (NSP) changes perceived pain and/or sensory thresholds in patients with chronic neck (NP) and lower back pain (BP). Methods. 40 patients with chronic NP and 42 patients with chronic BP were equally randomized to either treatment or waiting list control group. The treatment group self-administered a NSP over a period of 14 days. Pain ratings were recorded on numerical rating scales (NRSs). Mechanical detection thresholds (MDTs) and pressure pain thresholds (PPTs) were determined at the site of maximal pain and in the adjacent region, vibration detection thresholds (VDT) were measured at close spinal processes. The Northwick Park Neck Pain Questionnaire (NPQ) and the Oswestry Disability Index (ODI) were utilized for the NP and BP study, respectively. Results. NRS ratings were significantly reduced for the treatment groups compared to the control groups (NP: P = .021 and BP: P < .001), accompanied by a significant increase of PPT at pain maximum (NP: P = .032 and BP: P = .013). There was no effect on VDT and MDT. The NPQ showed also a significant improvement, but not the ODI. Conclusions. The mechanical NSP seems to be an effective treatment method for chronic NP and BP.
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Index of published papers on thermology or temperature measurement Volume 4: 2011 to 2013
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Unprecedented 800% stretchable, non-polymeric, widely used, low-cost, naturally rigid, metallic thin-film copper (Cu)-based flexible and non-invasive, spatially tunable, mobile thermal patch with wireless controllability, adaptability (tunes the amount of heat based on the temperature of the swollen portion), reusability, and affordability due to low-cost complementary metal oxide semiconductor (CMOS) compatible integration. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
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Musculoskeletal conditions are the leading contributors to disability worldwide, typically characterized by pain, decreased mobility, dexterity, and functional ability. After back pain, neck pain is the most frequent musculoskeletal cause of consultation in primary care worldwide. Cervical spondylosis is a chronic degenerative process of the cervical spine characterized by pain in the neck, degenerative changes in the intervertebral disc, and osteophyte formation. This condition is known as wajaʹur raqaba in the Unānī system of medicine. Its rate is 3.3 patients per 1000 people in the general population. Its increasing prevalence is drawing the attention of the medical fraternity. Due to the limited efficacy of conventional treatment and potential side effects of long-term use, patients seek alternative treatment options. Unānī physicians claimed the management of various joint disorders with the help of several tadābīr. The objective of this critical review is to address the claims of Unānī physicians and clinical studies conducted on the efficacy of various Regimenal modalities in the management of joint pain. Classical Unānī literature, peer-reviewed journal articles, and RCTs that predominantly focused on the use of Regimenal modalities in joint pain were included in this review. It was extracted that several Regimenal modalities are effective in the management of various joint disorders including cervical spondylosis. Despite the long history of the use of various Regimenal modalities in several painful conditions, more systematic, well designed, rigorous, randomized, controlled clinical trials are needed to determine which approaches have merit.
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Published papers on thermology or temperature measurement, between 2011 and 2012,
Article
Naturopathic reflex therapies such as massage, Gua Sha massage, cupping, wet packs etc. are likely able to influence chronic pain at different levels of the nociceptive system. Since naturopathic reflex therapies have been shown to reduce symptoms of chronic pain and often utilize intense manipulation of the environment of the nociceptor (e.g. Gua Sha massage or cupping), it can be hypothesized that they unfold part of their effect at the level of the peripheral nociceptor and the spinal cord. However, these hypotheses have to date not been tested systematically. Standardized sensory testing, e.g., as performed by 'quantitative sensory testing' (QST), a comprehensive battery of tests for clinical trials, may offer additional information about the mechanisms of naturopathic reflex therapies since it provides a measure for the mechanisms of nociceptive pain on all levels of the pain processing system. This method paper describes the potential role of QST in research on the neurobiological mechanisms of naturopathic reflex therapies. © 2013 S. Karger GmbH, Freiburg.
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Transparent heaters (TH) have attracted intense attention from both scientific and industrial sectors due to the key role they play in many technologies, including smart windows, deicers, defoggers, displays, actuators, and sensors. While transparent conductive oxides have dominated the field for the past five decades, a new generation of THs based on nanomaterials has led to new paradigms in terms of applications and prospects in the past years. Here, the most recent developments and strategies to improve the properties, stability, and integration of these new THs are reviewed.
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Introduction. A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of low back pain. Methods. Evidence from randomized controlled trials (RCTs) and observational studies was identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and data synthesis. Meta-analysis was conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized studies. Developing Recommendations. An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater relative to a control based on panel expertise and empiric results) in patient-important outcomes was required for a recommendation. Statistical significance was also required, but was insufficient alone. Patient-important outcomes were decided by consensus as being pain, function, patient global assessment, quality of life, and return to work, providing that these outcomes were assessed with a scale for which measurement reliability and validity have been established. Validating the Recommendations. A feedback survey questionnaire was sent to 324 practitioners from 6 professional organizations. The response rate was 51%. Results. Four positive recommendations of clinical benefit were developed. Therapeutic exercises were found to be beneficial for chronic, subacute, and postsurgery low back pain. Continuation of normal activities was the only intervention with beneficial effects for acute low back pain. These recommendations were mainly in agreement with previous EBCPGs, although some were not covered by other EBCPGs. There was wide agreement with these recommendations from practitioners (greater than 85%). For several interventions and indications (eg, thermotherapy, therapeutic ultrasound, massage, electrical stimulation), there was a lack of evidence regarding efficacy. Conclusions. This methodology of developing EBCPGs provides a structured approach to assessing the literature and developing guidelines that incorporates clinicians' feedback and is widely acceptable to practicing clinicians. Further well-designed RCTs are warranted regarding the use of several interventions for patients with low back pain where evidence was insufficient to make recommendations.
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Background: Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. Objective: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. Design: Randomized, controlled trial. Setting: Outpatient care setting in the Netherlands. Patients: 183 patients, 18 to 70 years of age, who had had nonspecific neck pain for at least 2 weeks. Intervention: 6 weeks of manual therapy (specific mobilization techniques) once per week, physical therapy (exercise therapy) twice per week, or continued care by a general practitioner (analgesics, counseling, and education). Measurements: Treatment was considered successful if the patient reported being "completely recovered" or "much improved" on an ordinal six-point scale. Physical dysfunction, pain intensity, and disability were also measured. Results: At 7 weeks, the success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued care. Statistically significant differences in pain intensity with manual therapy compared with continued care or physical therapy ranged from 0.9 to 1.5 on a scale of 0 to 10. Disability scores also favored manual therapy, but the differences among groups were small. Manual therapy scored consistently better than the other two interventions on most outcome measures. Physical therapy scored better than continued care on some outcome measures, but the differences were not statistically significant. Conclusion: in daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.
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Introduction: A common treatment for low back pain is topical heat therapy involving sustained contact of the lower back with a temperature source in the 38 to 40 C range (1). The mechanism of pain relief from topical heat treatment involves presynaptic inhibition of nociception in the dorsal horn of the spinal cord, i.e. "gate control" (2). In addition, the temperature distribution among muscles in the lower back will play an important role in relieving muscle spasms and increasing blood flow to enhance the healing response. Magnetic Resonance Thermometry (MRT), which uses the sensitivity of the water resonant frequency to temperature (3) appears well-suited to non-invasively measure temperature distribution changes among muscles in the lower back during topical heat therapy. As such, MRT may prove useful as a tool for studying mechanisms underlying successful1 topical heat therapy. Here we explore the feasibility of monitoring changes in the temperature distribution among the lower back muscles of volunteers subjected to mild topical heating during MRT studies. Materials and Methods: Nine studies with 6 healthy adult volunteers were performed during the course of this study. Volunteers were placed supine in a 1.5 T scanner (General Electric Medical Systems, Milwaukee, WI) with their lower backs resting on a water flow-through rubber pad. Water temperature was controlled with two heat pumps circulating water through the pad. Two constantan-copper thermocouples were placed under the lower back and used to monitor local pad/skin temperatures at two locations. A gradient echo sequence with FAITRITE = 30/100128 ms, FOV of 38 cm, and slice thickness 10 mm, was used to collect axial images through the lower back at three separate slices in 18 s scan times. Volunteers were instructed to breathe shallowly and, if possible, maintain breatholds during the 18 s acquisitions. The three slice acquisitions were repeated every minute for 30 to 40 minutes as the water temperature was cycled to obtain skin/pad temperatures between approximately 32 C to 40 C and then back down to 32 C. Phase and magnitude images were reconstructed from the data and subtraction of phase images acquired at high temperatures from pre-heating baseline images were used to generate temperature difference images assuming a -0.008 ppm/C water frequency shift (4,5).
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Chronic neck pain results in significant costs to individuals because of pain, suffering, and personal losses; and to society due to increased health care costs, disability payments, and loss of work productivity. Many people have an episode of acute neck pain, but only in a few does the pain become chronic. This chapter will examine chronic neck pain, particularly whiplash, with an emphasis on the potential predictors of chronic pain and long-term disability. In order to accomplish this, we will briefly discuss the structural causes for chronic neck pain after trauma and the results of the most important evidence-based treatments.
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Introduction. Cupping has been used since antiquity in the treatment of pain conditions. In this pilot study, we investigated the effect of traditional cupping therapy on chronic nonspecific neck pain (CNP) and mechanical sensory thresholds. Methods. Fifty CNP patients were randomly assigned to treatment (TG, n = 25) or waiting list control group (WL, n = 25). TG received a single cupping treatment. Pain at rest (PR), pain related to movement (PM), quality of life (SF-36), Neck Disability Index (NDI), mechanical detection (MDT), vibration detection (MDT), and pressure pain thresholds (PPT) were measured before and three days after a single cupping treatment. Patients also kept a pain and medication diary (PaDi, MeDi) during the study. Results. Baseline characteristics were similar in the two groups. After cupping TG reported significantly less pain (PR: -17.9 mm VAS, 95%CI -29.2 to -6.6; PM: -19.7, 95%CI -32.2 to -7.2; PaDi: -1.5 points on NRS, 95%CI -2.5 to -0.4; all P < 0.05) and higher quality of life than WL (SF-36, Physical Functioning: 7.5, 95%CI 1.4 to 13.5; Bodily Pain: 14.9, 95%CI 4.4 to 25.4; Physical Component Score: 5.0, 95%CI 1.4 to 8.5; all P < 0.05). No significant effect was found for NDI, MDT, or VDT, but TG showed significantly higher PPT at pain-areas than WL (in lg(kPa); pain-maximum: 0.088, 95%CI 0.029 to 0.148, pain-adjacent: 0.118, 95%CI 0.038 to 0.199; both P < 0.01). Conclusion. A single application of traditional cupping might be an effective treatment for improving pain, quality of life, and hyperalgesia in CNP.
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In this preliminary trial we investigated the effects of dry cupping, an ancient method for treating pain syndromes, on patients with chronic non-specific neck pain. Sensory mechanical thresholds and the participants' self-reported outcome measures of pain and quality of life were evaluated. Fifty patients (50.5 ± 11.9 years) were randomised to a treatment group (TG) or a waiting-list control group (WL). Patients in the TG received a series of 5 cupping treatments over a period of 2 weeks; the control group did not. Self-reported outcome measures before and after the cupping series included the following: Pain at rest (PR) and maximal pain related to movement (PM) on a 100-mm visual analogue scale (VAS), pain diary (PD) data on a 0-10 numeric rating scale (NRS), Neck Disability Index (NDI), and health-related quality of life (SF-36). In addition, the mechanical-detection thresholds (MDT), vibration-detection thresholds (VDT), and pressure-pain thresholds (PPT) were determined at pain-related and control areas. Patients of the TG had significantly less pain after cupping therapy than patients of the WL group (PR: Δ-22.5 mm, p = 0.00002; PM: Δ-17.8 mm, p = 0.01). Pain diaries (PD) revealed that neck pain decreased gradually in the TG patients and that pain reported by the two groups differed significantly after the fifth cupping session (Δ-1.1, p = 0.001). There were also significant differences in the SF-36 subscales for bodily pain (Δ13.8, p = 0.006) and vitality (Δ10.2, p = 0.006). Group differences in PPT were significant at pain-related and control areas (all p < 0.05), but were not significant for MDT or VDT. A series of five dry cupping treatments appeared to be effective in relieving chronic non-specific neck pain. Not only subjective measures improved, but also mechanical pain sensitivity differed significantly between the two groups, suggesting that cupping has an influence on functional pain processing. The trial was registered at clinicaltrials.gov (NCT01289964).
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Synopsis: Neck pain is a common and episodic condition that is treated using a spectrum of interventions known to be moderately effective but is associated with a significant incidence of chronic pain. Recently, there has been increased focus on defining biological aspects of neck pain. Studies have indicated that neurophysiological, biomechanical, and motor control abnormalities are present and may be useful either in prognosis or classification. We review some of these findings in the context of our own work defining biological markers that may form the basis for clinical tests that can be used for prognosis, classification, or outcome evaluation in patients with neck pain. We have identified abnormalities in neurophysiology using quantitative sensory testing (vibration, touch, and current perception) and response to cold provocation that are related to neck disability. We have identified altered muscle biochemistry by measuring circulating muscle proteins in a lumbar surgery model and are now applying those methods to whiplash injury. We have incorporated capnography into treatment to address central physiological changes present in some patients by monitoring and training CO2 levels. We have developed an innovative new test, the Neck Walk Index, that captures abnormal control of head movement during slow gait as a means of differentiating patients with neck pain from either unaffected controls or individuals with other pathologies. We have used time-varying 3-dimensional joint orientation kinematics to assess deficits in motor control during an upper extremity reach task, the results showing that poor coordination and control of the shoulder girdle leads to shoulder guarding and inconsistencies in elbow joint movement. Despite some promising early results, future research is needed to determine how these measures help clinicians to diagnose, evaluate, and forecast future outcome for patients who present with neck pain. Level of evidence: Diagnosis, level 5.
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To describe the management in patients with chronic non-specific neck pain in general practice. A descriptive, questionnaire-based retrospective study. General practices in the Netherlands. 517 patients with chronic non-specific neck pain. Nature and frequency of diagnostic procedures, therapeutic interventions and referrals by the general practitioner (GP). Forty-four per cent visited the GP for neck pain in the previous year. Of the patients who did visit the GP in the previous year, 32% did not receive a diagnostic modality, 31% did not receive therapy and 43% were not referred. The most frequently applied diagnostic and therapeutic modalities were physical examination (66%) and pain medication (58%), respectively. The GPs most frequently referred to a physiotherapist (51%). Once neck pain has become chronic, the minority (44%) of patients do seek help from their GP on a yearly base. In spite of the fact that the patients' conditions are non-specific and chronic, GPs still find indications for further diagnostics in two-thirds of patients. The GPs were rather consistent in their management, as the nature of the diagnostic/therapeutic modalities and referrals was similar in more than 50% of the patients.
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We describe those sensations that are unpleasant, intense, or distressing as painful. Pain is not homogeneous, however, and comprises three categories: physiological, inflammatory, and neuropathic pain. Multiple mechanisms contribute, each of which is subject to or an expression of neural plasticity-the capacity of neurons to change their function, chemical profile, or structure. Here, we develop a conceptual framework for the contribution of plasticity in primary sensory and dorsal horn neurons to the pathogenesis of pain, identifying distinct forms of plasticity, which we term activation, modulation, and modification, that by increasing gain, elicit pain hypersensitivity.
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Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. Randomized, controlled trial. Outpatient care setting in the Netherlands. 183 patients, 18 to 70 years of age, who had had nonspecific neck pain for at least 2 weeks. 6 weeks of manual therapy (specific mobilization techniques) once per week, physical therapy (exercise therapy) twice per week, or continued care by a general practitioner (analgesics, counseling, and education). Treatment was considered successful if the patient reported being "completely recovered" or "much improved" on an ordinal six-point scale. Physical dysfunction, pain intensity, and disability were also measured. At 7 weeks, the success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued care. Statistically significant differences in pain intensity with manual therapy compared with continued care or physical therapy ranged from 0.9 to 1.5 on a scale of 0 to 10. Disability scores also favored manual therapy, but the differences among groups were small. Manual therapy scored consistently better than the other two interventions on most outcome measures. Physical therapy scored better than continued care on some outcome measures, but the differences were not statistically significant. In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.
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The objective of this study was to determine the prevalence of neck pain (NP) in the world population and to identify areas of methodological variation between studies. A systematic search was conducted in five databases (MEDLINE, EMBASE, CINAHL, OSH-ROM, and PsycINFO), followed by a screening of reference lists of relevant papers. Included papers were extracted for information and each paper was given a quality score. Mean prevalence estimates were calculated for six prevalence periods (point, week, month, 6 months, year, and lifetime), and considered separately for age, gender, quality score, response rate, sample size, anatomical definition, geography, and publication year. Fifty-six papers were included. The six most commonly reported types of prevalence were point, week, month, 6 months, year, and lifetime. Except for lifetime prevalence, women reported more NP than men. For 1-year prevalence, Scandinavian countries reported more NP than the rest of Europe and Asia. Prevalence estimates were not affected by age, quality score, sample size, response rate, and different anatomical definitions of NP. NP is a common symptom in the population. As expected, the prevalence increases with longer prevalence periods and generally women have more NP than men. At least for 1-year prevalence Scandinavian countries report higher mean estimates than the rest of Europe and Asia. The quality of studies varies greatly but is not correlated with the prevalence estimates. Design varies considerably and standardisation is needed in future studies.
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The nationwide multicenter trials of the German Research Network on Neuropathic Pain (DFNS) aim to characterize the somatosensory phenotype of patients with neuropathic pain. For this purpose, we have implemented a standardized quantitative sensory testing (QST) protocol giving a complete profile for one region within 30 min. To judge plus or minus signs in patients we have now established age- and gender-matched absolute and relative QST reference values from 180 healthy subjects, assessed bilaterally over face, hand and foot. We determined thermal detection and pain thresholds including a test for paradoxical heat sensations, mechanical detection thresholds to von Frey filaments and a 64 Hz tuning fork, mechanical pain thresholds to pinprick stimuli and blunt pressure, stimulus/response-functions for pinprick and dynamic mechanical allodynia, and pain summation (wind-up ratio). QST parameters were region specific and age dependent. Pain thresholds were significantly lower in women than men. Detection thresholds were generally independent of gender. Reference data were normalized to the specific group means and variances (region, age, gender) by calculating z-scores. Due to confidence limits close to the respective limits of the possible data range, heat hypoalgesia, cold hypoalgesia, and mechanical hyperesthesia can hardly be diagnosed. Nevertheless, these parameters can be used for group comparisons. Sensitivity is enhanced by side-to-side comparisons by a factor ranging from 1.1 to 2.5. Relative comparisons across body regions do not offer advantages over absolute reference values. Application of this standardized QST protocol in patients and human surrogate models will allow to infer underlying mechanisms from somatosensory phenotypes.
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Chronic neck pain is highly prevalent in Western societies, with about 15% of females and 10% of males suffering with it at any time. The course of untreated chronic neck pain patients in clinical trials has not been well-defined and the placebo effect has not been clarified. A systematic review of RCT's of conservative treatments for chronic mechanical neck pain was conducted. Studies were excluded if they did not include a control group, if they involved subjects with whiplash injuries, a predominance of headache or arm pain associated with chronic neck pain and if only one treatment was reported. Only studies scoring 3-5 out of 5 on the Jadad Scale for quality were included in the final analysis. Data on change in pain scores of subjects in both placebo (PL) as well as no-treatment (NT) control groups were analyzed. Mean changes in pain scores as well as effect sizes were calculated, summarized and compared between these groups. Twenty (20) studies, 5 in the NT group and 15 in the PL group, with outcome intervals ranging from 1-52 weeks were included in the final analysis. The mean [95% CI] effect size of change in pain ratings in the no-treatment control studies at outcome points up to 10 weeks was 0.18 [-0.05, 0.41] and for outcomes from 12-52 weeks it was 0.4 [0.12, 0.68]. In the placebo control groups it was 0.50 [0.10, 0.90] at up to 10 weeks and 0.33. [-1.97, 2.66] at 12-24 weeks. None of the comparisons between the no-treatment and placebo groups were statistically significant. It appears that the changes in pain scores in subjects with chronic neck pain not due to whiplash who are enrolled in no-treatment and placebo control groups were similarly small and not significantly different. As well, they do not appear to increase over longer-term follow-up.
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Cryotherapy and thermotherapy are useful adjuncts for the treatment of musculoskeletal injuries. Clinicians treating these conditions should be aware of current research findings regarding these modalities, because their choice of modality may affect the ultimate outcome of the patient being treated. Through a better understanding of these modalities, clinicians can optimize their present treatment strategies. Although cold and hot treatment modalities both decrease pain and muscle spasm, they have opposite effects on tissue metabolism, blood flow, inflammation, edema, and connective tissue extensibility. Cryotherapy decreases these effects while thermotherapy increases them. Continuous low-level cryotherapy and thermotherapy are newer concepts in therapeutic modalities. Both modalities provide significant pain relief with a low side-effect profile. Contrast therapy, which alternates between hot and cold treatment modalities, provides no additional therapeutic benefits compared with cryotherapy or thermotherapy alone. Complications of cryotherapy include nerve damage, frostbite, Raynaud's phenomenon, cold-induced urticaria, and slowed wound healing. With thermotherapy, skin burns may occur, especially in patients with diabetes mellitus, multiple sclerosis, poor circulation, and spinal cord injuries. In individuals with rheumatoid arthritis, deep-heating modalities should be used with caution because increased inflammation may occur. Whirlpool and other types of hydrotherapy have caused infections of the skin, urogenital, and pulmonary systems. Additionally, ultrasound should not be used in patients with joint prostheses.
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Study Design. Best evidence synthesis. Objective. To identify, critically appraise, and synthesize literature from 1880 through 2006 on noninvasive interventions fer neck pain and its associated disorders. of Background Data. No comprehensive systematic literature reviews have been published on interventions for neck pain and its associated disorders in the past decade. Methods. We systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of non-invasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our best evidence synthesis. Results. Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 (47%) were accepted as scientifically admissible, and 139 of these related to non-invasive interventions (including health care utilization, costs, and safety). For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus. Conclusion, Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies.
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Pneumatic pulsation therapy may combine the effects of cupping therapy and massage. This study investigated the effect of pneumatic pulsation therapy on chronic neck pain compared to standard medical care. 50 patients (79.15% female; 46.17 ± 12.21 years) with chronic nonspecific neck pain were randomized to treatment group (TG; n = 25) or control group (CG; n = 25). The TG received 5 pneumatic pulsation treatments over a period of 2 weeks utilizing a mechanical device. Treatment was applied as a combination of moving and stationary pulsating cupping. Main outcome measure was pain intensity in pain diaries (numerical rating scale). Secondary outcome measures included functional disability (NDI), quality of life (SF-36), and pain at motion. Sensory thresholds, including pressure pain threshold, were measured at pain-related sites. After the intervention, significant group differences occurred regarding pain intensity (baseline: 4.12 ± 1.45 in TG and 4.20 ± 1.57 in CG; post-intervention: 2.72 ± 1.62 in TG and 4.44 ± 1.96 in CG; analysis of covariance: p = 0.001), NDI (baseline: 25.92 ± 8.23 and 29.83; post-intervention: 20.44 ± 10.17 and 28.83; p = 0.025), and physical quality of life (baseline: 43.85 ± 7.65 and 41.66 ± 7.09; post-intervention: 47.60 ± 7.93 and 40.49 ± 8.03; p = 0.002). Further significant group differences were found for pain at motion (p = 0.004) and pressure pain threshold (p = 0.002). No serious adverse events were reported. Pneumatic pulsation therapy appears to be a safe and effective method to relieve pain and to improve function and quality of life in patients with chronic neck pain.
Article
Objectives: Chronic neck pain is a significant public health problem with only very few evidence-based treatment options. There is growing evidence for the effectiveness of yoga for relieving musculoskeletal disorders. The aim of this study was to evaluate the effect of Iyengar yoga compared with exercise on chronic nonspecific neck pain. Methods: Patients were randomly assigned to either yoga or exercise. The yoga group attended a 9-week yoga course and the exercise group received a self-care manual on home-based exercises for neck pain relief. The main outcome measure was the present neck pain intensity (100 mm visual analog scale). Secondary outcome measures included functional disability (Neck Disability Index), pain at motion (visual analog scale), health-related quality of life (Short Form-36 questionnaire), cervical range of motion, proprioceptive acuity, and pressure pain threshold. Results: Fifty-one patients (mean age 47.8 y ; 82.4% female) were randomized to yoga (n=25) and exercise (n=26) intervention. After the study period, patients in the yoga group reported significantly less neck pain intensity compared with the exercise group [mean difference: -13.9 mm (95% CI, -26.4 to -1.4), P=0.03]. The yoga group reported less disability and better mental quality of life. Range of motion and proprioceptive acuity were improved and the pressure pain threshold was elevated in the yoga group. Discussion: Yoga was more effective in relieving chronic nonspecific neck pain than a home-based exercise program. Yoga reduced neck pain intensity and disability and improved health-related quality of life. Moreover, yoga seems to influence the functional status of neck muscles, as indicated by improvement of physiological measures of neck pain.
Article
Study Design. Best evidence synthesis. Objective. To undertake a best evidence synthesis on the burden and determinants of whiplash-associated disorders (WAD) after traffic collisions. Summary of Background Data. Previous best evidence synthesis on WAD has noted a lack of evidence regarding incidence of and risk factors for WAD. Therefore there was a warrant of a reanalyze of this body of research. Methods. A systematic search of Medline was conducted. The reviewers looked for studies on neck pain and its associated disorders published 1980–2006. Each relevant study was independently and critically reviewed by rotating pairs of reviewers. Data from studies judged to have acceptable internal validity (scientifically admissible) were abstracted into evidence tables, and provide the body of the best evidence synthesis. Results. The authors found 32 scientifically admissible studies related to the burden and determinants of WAD. In the Western world, visits to emergency rooms due to WAD have increased over the past 30 years. The annual cumulative incidence of WAD differed substantially between countries. They found that occupant seat position and collision impact direction were associated with WAD in one study. Eliminating insurance payments for pain and suffering were associated with a lower incidence of WAD injury claims in one study. Younger ages and being a female were both associated with filing claims or seeking care for WAD, although the evidence is not consistent. Preliminary evidence suggested that headrests/car seats, aimed to limiting head extension during rear-end collisions had a preventive effect on reporting WAD, especially in females. Conclusion. WAD after traffic collisions affects many people. Despite many years of research, the evidence regarding risk factors for WAD is sparse but seems to include personal, societal, and environmental factors. More research including, well-defined studies with accurate denominators for calculating risk, and better consideration of confounding factors, are needed.
Article
Acute back and neck strains are very common. In addition to administering analgesics, these strains are often treated with either heat or cold packs. The objective of this study was to compare the analgesic efficacy of heat and cold in relieving pain from back and neck strains. The authors hypothesized that pain relief would not differ between hot and cold packs. This was a randomized, controlled trial conducted at a university-based emergency department (ED) with an annual census of 90,000 visits. ED patients >18 years old with acute back or neck strains were eligible for inclusion. All patients received 400 mg of ibuprofen orally and then were randomized to 30 minutes of heating pad or cold pack applied to the strained area. Outcomes of interest were pain severity before and after pack application on a validated 100-mm visual analog scale (VAS) from 0 (no pain) to 100 (worst pain), percentage of patients requiring rescue analgesia, subjective report of pain relief on a verbal rating scale (VRS), and future desire for similar packs. Outcomes were compared with t-tests and chi-square tests. A sample of 60 patients had 80% power to detect a 15-mm difference in pain scores. Sixty patients were randomized to heat (n = 31) or cold (n = 29) therapy. Mean (+/-standard deviation [SD]) age was 37.8 (+/-14.7) years, 51.6% were female, and 66.7% were white. Groups were similar in baseline patient and pain characteristics. There were no differences between the heat and cold groups in the severity of pain before (75 mm [95% CI = 66 to 83] vs. 72 mm [95% CI = 65 to 78]; p = 0.56) or after (66 mm [95% CI = 57 to 75] vs. 64 mm [95% CI = 56 to 73]; p = 0.75) therapy. Pain was rated better or much better in 16/31 (51.6%) and 18/29 (62.1%) patients in the heat and cold groups, respectively (p = 0.27). There were no between-group differences in the desire for and administration of additional analgesia. Twenty-five of 31 (80.6%) patients in the heat group and 22 of 29 (75.9%) patients in the cold group would use the same therapy if injured in the future (p = 0.65). The addition of a 30-minute topical application of a heating pad or cold pack to ibuprofen therapy for the treatment of acute neck or back strain results in a mild yet similar improvement in the pain severity. However, it is possible that pain relief is mainly the result of ibuprofen therapy. Choice of heat or cold therapy should be based on patient and practitioner preferences and availability.
Article
Systematic review and best evidence synthesis. To describe the prevalence and incidence of neck pain and disability in workers; to identify risk factors for neck pain in workers; to propose an etiological diagram; and to make recommendations for future research. Previous reviews of the etiology of neck pain in workers relied on cross-sectional evidence. Recently published cohorts and randomized trials warrant a re-analysis of this body of research. We systematically searched Medline for literature published from 1980-2006. Retrieved articles were reviewed for relevance. Relevant articles were critically appraised. Articles judged to have adequate internal validity were included in our best evidence synthesis. One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible. The annual prevalence of neck pain varied from 27.1% in Norway to 47.8% in Québec, Canada. Each year, between 11% and 14.1% of workers were limited in their activities because of neck pain. Risk factors associated with neck pain in workers include age, previous musculoskeletal pain, high quantitative job demands, low social support at work, job insecurity, low physical capacity, poor computer workstation design and work posture, sedentary work position, repetitive work and precision work. We found preliminary evidence that gender, occupation, headaches, emotional problems, smoking, poor job satisfaction, awkward work postures, poor physical work environment, and workers' ethnicity may be associated with neck pain. There is evidence that interventions aimed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers. Neck disorders are a significant source of pain and activity limitations in workers. Most neck pain results from complex relationships between individual and workplace risk factors. No prevention strategies have been shown to reduce the incidence of neck pain in workers.
Article
Best evidence synthesis. To undertake a best evidence synthesis of the published evidence on the burden and determinants of neck pain and its associated disorders in the general population. The evidence on burden and determinants of neck has not previously been summarized. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders performed a systematic search and critical review of literature published between 1980 and 2006 to assemble the best evidence on neck pain. Studies meeting criteria for scientific validity were included in a best evidence synthesis. We identified 469 studies on burden and determinants of neck pain, and judged 249 to be scientifically admissible; 101 articles related to the burden and determinants of neck pain in the general population. Incidence ranged from 0.055 per 1000 person years (disc herniation with radiculopathy) to 213 per 1000 persons (self-reported neck pain). Incidence of neck injuries during competitive sports ranged from 0.02 to 21 per 1000 exposures. The 12-month prevalence of pain typically ranged between 30% and 50%; the 12-month prevalence of activity-limiting pain was 1.7% to 11.5%. Neck pain was more prevalent among women and prevalence peaked in middle age. Risk factors for neck pain included genetics, poor psychological health, and exposure to tobacco. Disc degeneration was not identified as a risk factor. The use of sporting gear (helmets, face shields) to prevent other types of injury was not associated with increased neck injuries in bicycling, hockey, or skiing. Neck pain is common. Nonmodifiable risk factors for neck pain included age, gender, and genetics. Modifiable factors included smoking, exposure to tobacco, and psychological health. Disc degeneration was not identified as a risk factor. Future research should concentrate on longitudinal designs exploring preventive strategies and modifiable risk factors for neck pain.
Article
Best evidence synthesis. To identify, critically appraise, and synthesize literature from 1980 through 2006 on noninvasive interventions for neck pain and its associated disorders. No comprehensive systematic literature reviews have been published on interventions for neck pain and its associated disorders in the past decade. We systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of noninvasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our best evidence synthesis. Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 (47%) were accepted as scientifically admissible, and 139 of these related to noninvasive interventions (including health care utilization, costs, and safety). For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus. Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies.
Article
Background: Sensory hypersensitivity is a recently recognized yet common feature of some neck pain conditions, particularly those with higher levels of pain and disability. It is generally acknowledged that the presence of widespread sensory hypersensitivity provides indication of augmented central pain processing mechanisms or central hyperexcitability. Sensory hypersensitivity may be able to differentiate various neck pain conditions, provide an indication of prognosis after whiplash injury, and show potential to recognize poor responders to physical interventions. Special features: Various tests may be used to determine the presence of sensory hypersensitivity. This article outlines and discusses 3 tests that have been used in the investigation of processes underlying neck pain as follows: pressure pain thresholds (PPT); thermal pain thresholds, and the brachial plexus provocation test. Summary: Although there are some data available on the psychometric properties of these tests, particularly PPT, much more information is required before these tests can be comprehensively used in the clinical environment.
Article
Injuries to the cervical spine, especially those involving the soft tissues, represent a significant source of chronic disability. Methods of assessment for such disability, especially those targeted at activities of daily living which are most affected by neck pain, are few in number. A modification of the Oswestry Low Back Pain Index was conducted producing a 10-item scaled questionnaire entitled the Neck Disability Index (NDI). Face validity was ensured through peer-review and patient feedback sessions. Test-retest reliability was conducted on an initial sample of 17 consecutive "whiplash"-injured patients in an outpatient clinic, resulting in good statistical significance (Pearson's r = 0.89, p less than or equal to .05). The alpha coefficients were calculated from a pool of questionnaires completed by 52 such subjects resulting in a total index alpha of 0.80, with all items having individual alpha scores above 0.75. Concurrent validity was assessed in two ways. First, on a smaller subset of 10 patients who completed a course of conservative care, the percentage of change on NDI scores before and after treatment was compared to visual analogue scale scores of percent of perceived improvement in activity levels. These scores correlated at 0.60. Secondly, in a larger subset of 30 subjects, NDI scores were compared to scores on the McGill Pain Questionnaire, with similar moderately high correlations (0.69-0.70). While the sample size of some of the analyses is somewhat small, this study demonstrated that the NDI achieved a high degree of reliability and internal consistency.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
This study investigated the effects of passive warming on the biomechanical properties of the musculotendi nous unit. Paired tibialis anterior (TA) and extensor digitorum longus (EDL) muscles in the rabbit hindlimb were passively heated to different temperatures and then subjected to controlled strain injury. The parame ters examined were: 1) percent increase in length to failure, 2) force to failure, 3) energy absorbed by the musculotendinous unit to failure, and 4) site of failure. Warmed (39°C ± 0.5°C) TA ( P ≤ 0.01) and EDL ( P ≤ 0.05) muscles achieved a greater increase in length from rest before failing than did their contralateral con trols at 35°C ± 0.5°C. In both the TA and EDL the force at failure was greater at 35°C than at 39°C, although the difference was significant for only the EDL ( P ≤ 0.05). The energy absorbed (area beneath the length-tension curve) by both the TA and EDL was greater at 39°C, but these differences were not signif icant. All muscles failed at the distal musculotendinous junction. These data suggest that passive warming increases the extensibility of the musculotendinous unit and may thereby reduce its susceptibility to strain in jury.
Article
The aim was to study the characteristics of pain drawings in the neck, shoulders, and upper-back regions among the general working population. Pain drawings of the rear view of the neck, shoulders, and upper back were made by 125 middle-aged subjects from the general working population suffering from symptoms, mainly ache and pain, in the neck or shoulder regions. The locations of the markings in each pain drawing were coded to computer files using a transparent grid (878 pixels). The total area, the number of separate loci, and the left-right symmetry were recorded. Symptoms and signs were assessed at a medical examination. The most frequently marked locations in the resulting aggregated topographical diagram covered two palm-sized areas in the neck-shoulder angles, with a symmetrical and even distribution occurring between the left and right sides. Subjects with more chronic or severe symptoms made pain drawings with larger areas. The presence of tenderness in the neck-trapezius region was associated with larger areas and more bilateral and multiple loci. Larger areas with multiple bilateral loci and a more symmetric distribution characterized pain drawings made by women as compared with those made by men. No substantial difference was noted in connection with age or educational level. Pain drawings of neck and shoulder symptoms among the middle-aged general working population most usually focused on the neck-shoulder angles with a symmetrical left-right distribution. The number of separate symptom loci and their total area, left-right distribution, and symmetry were characteristics associated with symptom chronicity and severity or signs of tenderness in the neck-trapezius region.
Article
In an attempt to explain how and why some individuals with musculoskeletal pain develop a chronic pain syndrome, Lethem et al. (Lethem J, Slade PD, Troup JDG, Bentley G. Outline of fear-avoidance model of exaggerated pain perceptions. Behav Res Ther 1983; 21: 401-408).ntroduced a so-called 'fear-avoidance' model. The central concept of their model is fear of pain. 'Confrontation' and 'avoidance' are postulated as the two extreme responses to this fear, of which the former leads to the reduction of fear over time. The latter, however, leads to the maintenance or exacerbation of fear, possibly generating a phobic state. In the last decade, an increasing number of investigations have corroborated and refined the fear-avoidance model. The aim of this paper is to review the existing evidence for the mediating role of pain-related fear, and its immediate and long-term consequences in the initiation and maintenance of chronic pain disability. We first highlight possible precursors of pain-related fear including the role negative appraisal of internal and external stimuli, negative affectivity and anxiety sensitivity may play. Subsequently, a number of fear-related processes will be discussed including escape and avoidance behaviors resulting in poor behavioral performance, hypervigilance to internal and external illness information, muscular reactivity, and physical disuse in terms of deconditioning and guarded movement. We also review the available assessment methods for the quantification of pain-related fear and avoidance. Finally, we discuss the implications of the recent findings for the prevention and treatment of chronic musculoskeletal pain. Although there are still a number of unresolved issues which merit future research attention, pain-related fear and avoidance appear to be an essential feature of the development of a chronic problem for a substantial number of patients with musculoskeletal pain.
Article
The literature on psychological factors in neck and back pain was systematically searched and reviewed. To summarize current knowledge concerning the role of psychological variables in the etiology and development of neck and back pain. Recent conceptions of spinal pain, especially chronic back pain, have highlighted the role of psychological factors. Numerous studies subsequently have examined the effects of various psychological factors in neck and back pain. There is a need to review this material to ascertain what conclusions may be drawn. Medical and psychological databases and cross-referencing were used to locate 913 potentially relevant articles. A table of 37 studies was constructed, consisting only of studies with prospective designs to ensure quality. Each study was reviewed for the population studied, the psychological predictor variables, and the outcome. The available literature indicated a clear link between psychological variables and neck and back pain. The prospective studies indicated that psychological variables were related to the onset of pain, and to acute, subacute, and chronic pain. Stress, distress, or anxiety as well as mood and emotions, cognitive functioning, and pain behavior all were found to be significant factors. Personality factors produced mixed results. Although the level of evidence was low, abuse also was found to be a potentially significant factor. Psychological factors play a significant role not only in chronic pain, but also in the etiology of acute pain, particularly in the transition to chronic problems. Specific types of psychological variables emerge and may be important in distinct developmental time frames, also implying that assessment and intervention need to reflect these variables. Still, psychological factors account for only a portion of the variance, thereby highlighting the multidimensional view. Because the methodologic quality of the studies varied considerably, future research should focus on improving quality and addressing new questions such as the mechanism, the developmental time factor, and the relevance that these risk factors have for intervention.
Article
In many randomised trials researchers measure a continuous variable at baseline and again as an outcome assessed at follow up. Baseline measurements are common in trials of chronic conditions where researchers want to see whether a treatment can reduce pre-existing levels of pain, anxiety, hypertension, and the like. Statistical comparisons in such trials can be made in several ways. Comparison of follow up (post-treatment) scores will give a result such as “at the end of the trial, mean pain scores were 15 mm (95% confidence interval 10 to 20 mm) lower in the treatment group.” Alternatively a change score can be calculated by subtracting the follow up score from the baseline score, leading to a statement such as “pain reductions were 20 mm (16 to 24 mm) greater on treatment than control.” If the average baseline scores are the same in each group the estimated treatment effect will be the same using these two simple approaches. If the treatment is effective the statistical significance of the treatment effect by the two methods will depend on the correlation between baseline and follow up scores. If the correlation is low using the change score will …
Article
Reliable and valid measures of pain are needed to advance research initiatives on appropriate and effective use of analgesia in the emergency department (ED). The reliability of visual analog scale (VAS) scores has not been demonstrated in the acute setting where pain fluctuation might be greater than for chronic pain. The objective of the study was to assess the reliability of the VAS for measurement of acute pain. This was a prospective convenience sample of adults with acute pain presenting to two EDs. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (95% CIs) and a Bland-Altman analysis were used to assess reliability of paired VAS measurements obtained 1 minute apart every 30 minutes over two hours. The summary ICC for all paired VAS scores was 0.97 [95% CI = 0.96 to 0.98]. The Bland-Altman analysis showed that 50% of the paired measurements were within 2 mm of one another, 90% were within 9 mm, and 95% were within 16 mm. The paired measurements were more reproducible at the extremes of pain intensity than at moderate levels of pain. Reliability of the VAS for acute pain measurement as assessed by the ICC appears to be high. Ninety percent of the pain ratings were reproducible within 9 mm. These data suggest that the VAS is sufficiently reliable to be used to assess acute pain.
Article
Background: Heat and cold therapy are often used as adjuncts in the treatment of rheumatoid arthritis by rehabilitation specialists. Objectives: To evaluate the effects of heat and cold on objective and subjective measures of disease activity in patients with rheumatoid arthritis. Search strategy: We searched Medline, Embase, PEDro, Current Contents, Sports Discus and CINAHL up to June 2000. The Cochrane Field of Rehabilitation and related therapies and the Cochrane Musculoskeletal Review Group were also contacted for a search of their specialized registers. Handsearching was conducted on all retrieved articles for additional articles. Selection criteria: Randomized or controlled clinical trials of ice or heat compared to placebo or active interventions in patients with rheumatoid arthritis and case-control and cohort studies were eligible. No language restrictions were applied. Abstracts were accepted. Data collection and analysis: Two independent reviewers identified potential articles from the literature search. These reviewers extracted data using pre-defined extraction forms. Consensus was reached on all data extraction. Quality was assessed by two reviewers using a 5 point scale that measured the quality of randomization, double-blinding and description of withdrawals. Main results: Three studies (79 subjects) met the inclusion criteria. There was no effect on objective measures of disease activity (including inflammation, pain and x-ray measured joint destruction) of either ice versus control or heat versus control. Patients reported that they preferred heat therapy to no therapy (94% prefer heat therapy to no therapy). There was no difference in patient preference for heat or ice. No harmful effects of ice or heat were reported. Reviewer's conclusions: Since patients preferred thermotherapy to no therapy, thermotherapy can be used as a palliative therapy which can be applied at home as needed to relieve pain. These results are limited by the poor methodological quality of the trials.
Article
We conducted a nationally representative random household telephone survey to assess therapies used to treat back or neck pain. The main outcome was complementary therapies used in the last year to treat back or neck pain. Back pain and neck pain are common medical conditions that cause substantial morbidity. Despite the presumed importance of complementary therapies for these conditions, studies of care for back and neck pain have not gathered information about the use of complementary therapies. Our nationally representative survey sampled 2055 adults. The survey gathered detailed information about medical conditions, conventional and complementary therapies used to treat those conditions, and the perceived helpfulness of those therapies. We found that of those reporting back or neck pain in the last 12 months, 37% had seen a conventional provider and 54% had used complementary therapies to treat their condition. Chiropractic, massage, and relaxation techniques were the most commonly used complementary treatments for back or neck pain (20%, 14%, and 12%, respectively, of those with back or neck pain). Chiropractic, massage, and relaxation techniques were rated as "very helpful" for back or neck pain among users (61%, 65%, and 43%, respectively), whereas conventional providers were rated as "very helpful" by 27% of users. We estimate that nearly one-third of all complementary provider visits in 1997 (203 million of 629 million) were made specifically for the treatment of back or neck pain. Chiropractic, massage, relaxation techniques, and other complementary methods all play an important role in the care of patients with back or neck pain. Treatment for back and neck pain was responsible for a large proportion of all complementary provider visits made in 1997. The frequent use and perceived helpfulness of commonly used complementary methods for these conditions warrant further investigation.
Article
Evaluation of patients for rehabilitation after musculoskeletal injury involves identifying, grading and assessing the injury and its impact on the patient's normal activities. Management is guided by a multidisciplinary team, comprising the patient, doctor and physical therapist, with other health professionals recruited as required. Parallel interventions involving the various team members are specified in a customised management plan. The key component of the plan is active mobilisation utilising strengthening, flexibility and endurance exercise programs. Passive physical treatments (heat, ice, and manual therapy), as well as drug therapy and psychological interventions, are used as adjunctive therapy. Biomechanical devices or techniques (eg, orthotic devices) may also be helpful. Coexisting conditions such as depression and drug dependence are treated at the same time as the injury. Effective team communication, simulated environmental testing and, for those employed, contact with the employer facilitate a staged return to normal living, sports and occupational activities.
Article
To evaluate of the efficacy and safety of 8 hours of continuous, low-level heatwrap therapy administered during sleep. Prospective, randomized, parallel, single-blind (investigator), placebo-controlled, multicenter clinical trial. Two community-based research facilities. Seventy-six patients, aged 18 to 55 years, with acute, nonspecific low back pain. Subjects were stratified by baseline pain intensity and gender and randomized to one of the following treatments: evaluation of efficacy (heatwrap, n=33; oral placebo, n=34) or blinding (unheated wrap, n=5; oral ibuprofen, n=4). All treatments were administered for 3 consecutive nights with 2 days of follow-up. Primary: morning pain relief (hour 0) on days 2 through 4 (0-5-point verbal response scale). Secondary: mean daytime pain relief score (days 2-4, hours 0-8), mean extended pain relief score (day 4, hour 0; day 5, hour 0), muscle stiffness, lateral trunk flexibility, and disability (Roland-Morris Disability Questionnaire). Heatwrap therapy was significantly better than placebo at hour 0 on days 2 through 4 for mean pain relief (P=.00005); at hours 0 through 8 on days 2 through 4 for pain relief (P<.001); at hour 0 on day 4 and at hour 0 on day 5 for mean pain relief (P<.001); on day 4 in reduction of morning muscle stiffness (P<.001); for increased lateral trunk flexibility on day 4 (P<.002); and for decreased low back disability on day 4 (P=.005). Adverse events were mild and infrequent. Overnight use of heatwrap therapy provided effective pain relief throughout the next day, reduced muscle stiffness and disability, and improved trunk flexibility. Positive effects were sustained more than 48 hours after treatments were completed.
Article
To evaluate the efficacy of 8 hours of continuous low-level heatwrap therapy for the treatment of acute nonspecific low back pain (LBP). Prospective, randomized, parallel, single-blind (investigator), placebo-controlled, multicenter clinical trial. Five community-based research facilities. Two-hundred nineteen subjects, aged 18 to 55 years, with acute nonspecific LBP. Subjects were stratified by baseline pain intensity and gender and randomized to one of the following groups: evaluation of efficacy (heatwrap, n=95; oral placebo, n=96) and blinding (oral ibuprofen, n=12; unheated back, wrap n=16). All treatments were administered for 3 consecutive days with 2 days of follow-up. Primary: day 1 mean pain relief (0- to 5-point verbal response scale). Secondary: muscle stiffness (101-point numeric rating scale), lateral trunk flexibility (fingertip-floor distance), and Roland-Morris Disability Questionnaire over 3 days of treatment and 2 days of follow-up. Heatwrap therapy was shown to provide significant therapeutic benefits when compared with placebo during both the treatment and follow-up period. On day 1, the heatwrap group had greater pain relief (1.76+/-.10 vs 1.05+/-.11, P <.001), less muscle stiffness (43.1+/-1.21 vs 47.6+/-1.21, P=.008), and increased flexibility (18.6+/-.44 cm vs 16.5+/-.45 cm, P=.001) compared with placebo. Disability was also reduced in the heatwrap group (5.3 vs 7.4, P=.0002). Adverse events were mild and infrequent. Continuous low-level heatwrap therapy was shown to be effective for the treatment of acute, nonspecific LBP.
Article
This article carefully itemizes the various anatomic structures that can evoke neck pain, putting in perspective what clinicians know, what they assume, and what they need to understand better about neck pain and pain referred from the neck. The critique of many of the accepted entities in the differential diagnosis of neck pain is crucial to an understanding of the causes of neck pain and an ability to implement appropriate therapies.
Article
A prospective, multicenter, cross-sectional analysis of data from the National Spine Network database. To compare the relative impact of radicular and axial symptoms associated with disease of the cervical spine on general health as measured by the SF-36 Health Survey, and to compare the impact of these symptoms among patients of varying age and symptom duration. Degenerative disorders of the cervical spine can cause debilitating symptoms of neck and arm pain. Physicians generally treat radiculopathy more aggressively than axial neck pain alone, although it has never been shown that the presence of radiculopathy leads to a greater impairment of physical and mental function. SF-36 Health Survey data were collected from all consenting patients seen within the National Spine Network. Patients with symptoms referable to the cervical spine (as per their physician) were included (n = 1,809). SF-36 scores for all eight scales (bodily pain (BP), vitality (VT), general health (GH), mental health (MH), physical function (PF), role physical (RP), role emotional (RE), and social function (SF), and two summary scales (Physical Component Summary [PCS] and Mental Component Summary [MCS]) were calculated. Age/gender normative scores were subtracted from the scale scores to produce a negative "impact" score, which reflected how far below normal health status these patients were. Patients were grouped according to location of symptoms (axial only, radicular only, or axial and radicular), age (younger than 40, 40 to 60, and older than 60 years), and symptom duration (acute: <6 wk; subacute: 6 wk-6 mo; and chronic: >6 mo). SF-36 scores were compared between all groups using analysis of variance and multiple comparisons with Bonferroni adjustment. Patients who presented with both axial and radicular symptoms had the lowest SF-36 scores relative to age and gender norms. These scores were significantly lower than those for patients with only axial or only radicular symptoms across all eight subscales (P < 0.05- P < 0.0001). Scores for patients with only axial pain were significantly lower than for patients with only radicular pain for VT (P < 0.04) and GH (P < 0.004). Patients younger than 40 and those between ages 40 to 60 years were significantly more impacted by their symptoms than patients older than 60 years for all eight scales (P < 0.01). PCS scores were similar for acute, subacute, and chronic groups, whereas MCS scores were significantly worse for patients with chronic pain. Combined neck and arm pain were much more disabling than either symptom alone. Younger patients (younger than 40 or 40-60) were more affected by these symptoms than patients older than 60 years. In addition, as symptom duration increased, a negative impact on mental health was observed, although chronic symptoms did not affect physical health. This study suggests that patients with a significant component of axial pain in conjunction with cervical radiculopathy should be considered the most affected of all patients with cervical spondylosis. Given the evidence that the treatment methods at the disposal of physicians are effective, this study suggests that prompt treatment of these patients may help avoid the harmful effects of chronic symptoms on mental functioning, especially among younger patients who were found to be more impacted by the symptoms.
Article
A number of theories of pathogenesis of entrapment neuropathy, due to repeated loading, have been proposed and these theories are being actively explored with animal models. Tubes placed loosely around peripheral nerves cause delayed onset, chronic pain and changes in nerve morphology including nerve sprouting. Balloons placed around or adjacent to the nerve and inflated to low pressures, rapidly produce endoneurial edema and a persistent increase in intraneural pressure. The same models demonstrate long-term changes such as demyelination and fibrosis. The applied pressure causes a decrement in nerve function and abnormal morphology in a dose-dependent manner that appears to be linked to the amount of endoneurial edema. A new model involving involuntary, repetitive fingertip loading for 6 h per week for 4 weeks has caused slowing of nerve function at the wrist similar to that seen in patients with carpal tunnel syndrome. These models have the potential to reveal the mechanisms of injury at the cellular and biochemical level and address questions about the relative importance of various biomechanical factors (e.g. peak force, mean force, force rate, duty cycle, etc.). In addition, these models will allow us to evaluate various prevention, treatment and rehabilitation protocols.
Article
Acupuncture has been promoted for the treatment of chronic pain. Though many randomized trials have been conducted, these have been criticized for deficiencies of methodology, acupuncture technique, and sample size. Somewhat less emphasis has been placed on methods of statistical analysis. This paper describes 4 recent randomized trials of acupuncture for musculoskeletal or headache pain. Each trial used statistical methods that did not adjust for baseline pain scores and were thus of suboptimal power. The objective of this study is to reanalyze the trials using analysis of covariance (ANCOVA). Raw data for the 4 trials were obtained from the original authors. Data were reanalyzed by ANCOVA. For 2 trials--acupuncture versus placebo for chronic headache and acupuncture versus transcutaneous electric nerve stimulation for back pain--reanalysis did not change the conclusion of no difference between groups, but showed that clinically significant differences between groups could not ruled out. Reanalysis of a trial of acupuncture versus placebo for shoulder pain slightly strengthened the evidence of acupuncture effectiveness. Reanalysis of the fourth trial, which compared acupuncture to placebo acupuncture and massage for neck pain, reversed the results of the original paper: reanalysis found acupuncture to be effective and that its effectiveness could not be ascribed to a placebo effect. Future trials of acupuncture and other modalities for pain should use efficient statistical methods. ANCOVA is more efficient than unadjusted analysis where used appropriately.
Article
Heat and cold are commonly utilised in the treatment of low-back pain by both health care professionals and people with low-back pain. To assess the effects of superficial heat and cold therapy for low-back pain in adults. We searched the Cochrane Back Review Group Specialised register, the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to October 2005), EMBASE (1980 to October 2005) and other relevant databases. We included randomised controlled trials and non-randomised controlled trials that examined superficial heat or cold therapies in people with low-back pain. Two authors independently assessed methodological quality and extracted data, using the criteria recommended by the Cochrane Back Review Group. Nine trials involving 1117 participants were included. In two trials of 258 participants with a mix of acute and sub-acute low-back pain, heat wrap therapy significantly reduced pain after five days (weighted mean difference (WMD) 1.06, 95% confidence interval (CI) 0.68 to 1.45, scale range 0 to 5) compared to oral placebo. One trial of 90 participants with acute low-back pain found that a heated blanket significantly decreased acute low-back pain immediately after application (WMD -32.20, 95%CI -38.69 to -25.71, scale range 0 to 100). One trial of 100 participants with a mix of acute and sub-acute low-back pain examined the additional effects of adding exercise to heat wrap, and found that it reduced pain after seven days. There is insufficient evidence to evaluate the effects of cold for low-back pain, and conflicting evidence for any differences between heat and cold for low-back pain. The evidence base to support the common practice of superficial heat and cold for low back pain is limited and there is a need for future higher-quality randomised controlled trials. There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and sub-acute low-back pain, and that the addition of exercise further reduces pain and improves function. The evidence for the application of cold treatment to low-back pain is even more limited, with only three poor quality studies located. No conclusions can be drawn about the use of cold for low-back pain. There is conflicting evidence to determine the differences between heat and cold for low-back pain.
Article
Cochrane systematic review. To assess the effects of superficial heat and cold therapy for low back pain in adults. Heat and cold are commonly used in the treatment of low back pain. We searched electronic databases from inception to October 2005. Two authors independently assessed inclusion, methodologic quality, and extracted data, using the criteria recommended by the Cochrane Back Review Group. Nine trials involving 1,117 participants were included. In two trials of 258 participants with a mix of acute and subacute low back pain, heat wrap therapy significantly reduced pain after 5 days (weighted mean difference [WMD], 1.06; 95% confidence interval [CI], 0.68-1.45, scale range, 0-5) compared with oral placebo. One trial of 90 participants with acute low back pain found that a heated blanket significantly decreased pain immediately after application (WMD, -32.20; 95% CI, -38.69 to -25.71; scale range, 0-100). One trial of 100 participants with a mix of acute and subacute low back pain examined the additional effects of adding exercise to heat wrap and found that it reduced pain after 7 days. The evidence base to support the common practice of superficial heat and cold for low back pain is limited, and there is a need for future higher-quality randomized controlled trials. There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and subacute low back pain, and that the addition of exercise further reduces pain and improves function. There is insufficient evidence to evaluate the effects of cold for low back pain and conflicting evidence for any differences between heat and cold for low back pain.
Article
This study was undertaken to investigate any relationship between sensory features and neck pain in female office workers using quantitative sensory measures to better understand neck pain in this group. Office workers who used a visual display monitor for more than four hours per day with varying levels of neck pain and disability were eligible for inclusion. There were 85 participants categorized according to their scores on the neck disability index (NDI): 33 with no pain (NDI<8); 38 with mild levels of pain and disability (NDI 9-29); 14 with moderate levels of pain (NDI30). A fourth group of women without neck pain (n=22) who did not work formed the control group. Measures included: thermal pain thresholds over the posterior cervical spine; pressure pain thresholds over the posterior neck, trapezius, levator scapulae and tibialis anterior muscles, and the median nerve trunk; sensitivity to vibrotactile stimulus over areas of the hand innervated by the median, ulnar and radial nerves; sympathetic vasoconstrictor response. All tests were conducted bilaterally. ANCOVA models were used to determine group differences between the means for each sensory measure. Office workers with greater self-reported neck pain demonstrated hyperalgesia to thermal stimuli over the neck, hyperalgesia to pressure stimulation over several sites tested; hypoaesthesia to vibration stimulation but no changes in the sympathetic vasoconstrictor response. There is evidence of multiple peripheral nerve dysfunction with widespread sensitivity most likely due to altered central nociceptive processing initiated and sustained by nociceptive input from the periphery.
Article
Unlabelled: A consensus meeting was convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to provide recommendations for interpreting clinical importance of treatment outcomes in clinical trials of the efficacy and effectiveness of chronic pain treatments. A group of 40 participants from universities, governmental agencies, a patient self-help organization, and the pharmaceutical industry considered methodologic issues and research results relevant to determining the clinical importance of changes in the specific outcome measures previously recommended by IMMPACT for 4 core chronic pain outcome domains: (1) Pain intensity, assessed by a 0 to 10 numerical rating scale; (2) physical functioning, assessed by the Multidimensional Pain Inventory and Brief Pain Inventory interference scales; (3) emotional functioning, assessed by the Beck Depression Inventory and Profile of Mood States; and (4) participant ratings of overall improvement, assessed by the Patient Global Impression of Change scale. It is recommended that 2 or more different methods be used to evaluate the clinical importance of improvement or worsening for chronic pain clinical trial outcome measures. Provisional benchmarks for identifying clinically important changes in specific outcome measures that can be used for outcome studies of treatments for chronic pain are proposed. Perspective: Systematically collecting and reporting the recommended information needed to evaluate the clinical importance of treatment outcomes of chronic pain clinical trials will allow additional validation of proposed benchmarks and provide more meaningful comparisons of chronic pain treatments.
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