The epidemiology of neck pain

Effect of Kinesio taping versus mechanical cervical traction combined with physiotherapy program on chronic neck pain in young female university students

Background

Mechanical neck pain is common among young female university students and can lead to disability and reduced physical activity.

Objectives

The aim of this study was to compare the effect of Kinesio taping (KT) to mechanical cervical traction (MCT) on young female university students with chronic neck pain.

Methods

Sixty young female university students with mechanical neck pain participated in this study; their ages ranged from 19 years to 23 years. They were assigned to three equal groups: the control group (A) received infrared, massage, stretching, and strengthening exercises three days per week for 6 weeks. Experimental group B received cervical traction in addition to the same program as the control, and experimental group C received KT in addition to the same program as the control group. Absolute pain intensity by the visual analogue scale (VAS) and neck disability index (NDI) were measured pre-and post-treatment intervention. Data were gathered at baseline, and after 6 weeks of intervention for three groups.

Results

The MANOVA test showed a significant reduction in NDI and pain level after 6 weeks between pre-and post-treatment intervention in group B (P < 0 . 001 and P < 0 . 001 , respectively). There was a significant reduction in pain after 6 weeks in group C. There was also a significant reduction in NDI and pain level after 6 weeks in group B versus control group (P < 0 . 001 and P = 0 . 001 , respectively). In addition, a significant reduction in pain level and NDI after 6 weeks was detected in group B compared to group C (P < 0 . 001 , P = 0 . 014 , respectively) while a significant reduction in pain level only between the control group (A) and group C was detected (P < 0 . 001 ).

Conclusion

In young female university students with mechanical neck pain, cervical traction combined with physiotherapy program was found to be more effective than KT with physiotherapy program or physiotherapy program alone in reducing pain and enhancing functional abilities after 6 weeks. This will help physiotherapists make more informed decisions concerning the clinical effects of MCT.

Physical work environment in an activity-based flex office: a longitudinal case study

OBJECTIVE

This study aimed to investigate and explore Occupational Health and Safety (OHS) management, office ergonomics, and musculoskeletal symptoms in a group of office workers relocating from cell offices to activity-based flex offices (AFOs).

METHODS

The analysis was based on qualitative interview data with 77 employees and longitudinal questionnaire data from 152 employees.

RESULTS

Results indicate that there was a need to clarify roles and processes related to the management of OHS. Self-rated sit comfort, working posture, and availability of daylight deteriorated and symptoms in neck and shoulders increased after the relocation and seemed to be influenced by many factors, such as difficulties adjusting the workstations, the availability of suitable workplaces, and age, sex, and individual needs.

CONCLUSION

Research on the long-term effects of physical work environments and management of (OHS) issues after implementing activity-based flex offices is sparse. This study demonstrates the importance of planning and organising OHS issue management when implementing an AFO, and to carefully implement office ergonomics among office workers.

Cross-Cultural Adaptation of the Neck Bournemouth Questionnaire: A Methodological Systematic Review

OBJECTIVE

Neck pain is a common musculoskeletal disorder, and it affects the quality of life of patients. As an effective and reliable multidimensional measurement tool for neck pain, the Neck Bournemouth Questionnaire (NBQ) has been cross-culturally adapted into multiple languages for clinical practice. The aim of this study was to evaluate the translation procedures and measurement properties of cross-cultural adaptations of the NBQ.

METHODS

Searches were conducted in the databases PubMed, Web of Science, Embase and Scopus using the keywords: "the Neck Bournemouth Questionnaire," "NBQ," "cross-cultural," and "adaptation." Methodological quality of cross-cultural adaptation processes and measurement properties were comprehensively assessed by the guidelines for Cross-cultural Adaptation Process of Self-Reporting Measures and the Consensus-based Standards for the Selection of Health Measurement Instruments.

RESULTS

There were 12 adaptations of NBQ in 10 different languages, including Dutch, simplified Chinese, and German. Among these studies, 11 adaptations completed all cross-cultural adaptation procedures. However, significant variations existed in the specific implementation plans, particularly regarding translator selection and expert committee composition. Most cross-cultural adaptations reported internal consistency, reliability, and construct validity. Only one study conducted factor analysis and hypothesis testing. Five adaptations examined floor and ceiling effects with one reporting a floor effect. A few studies reported protocol responsiveness and interpretability.

CONCLUSIONS

The Dutch, German, and Urdu adaptations demonstrate comparatively higher quality than other adaptations. Further research should comprehensively evaluate the measurement properties of the NBQ in the French, Portuguese-Brazilian, and Turkish adaptations.

The effects of neck exercise in comparison to passive or no intervention on quantitative sensory testing measurements in adults with chronic neck pain: A systematic review

BACKGROUND

Previous systematic reviews have identified the benefits of exercise for chronic neck pain on subjective reports of pain, but not with objective measures such as quantitative sensory testing (QST). A systematic review was conducted to identify the effects of neck specific exercise on QST measures in adults with chronic neck pain to synthesise existing literature and provide clinical recommendations.

METHODS

The study protocol was registered prospectively with PROSPERO (PROSPERO CRD42021297383). For both randomised and non-randomised trials, the following databases and trial registries were searched: AMED, CINAHL, Embase, Google Scholar, Medline, PEDro, PubMed, Scopus, SPORTDiscus, Science Citation Index and Social Science Citation Index from Web of Science Core Collection, clinicaltrials.gov, GreyOpen, and ISRCTN registry. These searches were conducted from inception to February 2022 and were updated until September 2023. Reference lists of eligible studies were screened. Study selection was performed independently by two reviewers, with data extraction and quality appraisal completed by one reviewer and independently ratified by a second reviewer. Due to high heterogeneity, narrative synthesis was performed with results grouped by exercise type.

FINDINGS

Three trials were included. Risk of bias was rated as moderate and the certainty of evidence as low or moderate for all studies. All exercise groups demonstrated statistically significant improvement at an intermediate-term follow-up, with progressive resistance training combined with graded physical training demonstrating the highest certainty of evidence. Fixed resistance training demonstrated statistically significant improvement in QST measures at a short-term assessment.

INTERPRETATION

Fixed resistance training is effective for short-term changes in pain sensitivity based on low-quality evidence, whilst moderate-quality evidence supports progressive resistance training combined with graded physical training for intermediate-term changes in pain sensitivity.

Impact of the COVID-19 pandemic on the productivity and career prospects of musculoskeletal researchers

Academic researchers faced a multitude of challenges posed by the COVID-19 pandemic, including widespread shelter-in-place orders, workplace closures, and cessation of in-person meetings and laboratory activities. The extent to which these challenges impacted musculoskeletal researchers, specifically, is unknown. We developed an anonymous web-based survey to determine the pandemic's impact on research productivity and career prospects among musculoskeletal research trainees and faculty. There were 116 musculoskeletal (MSK) researchers with varying demographic backgrounds who completed the survey. Of respondents, 48.3% (n = 56) believed that musculoskeletal funding opportunities decreased because of COVID-19, with faculty members more likely to hold this belief compared to nonfaculty researchers (p = 0.008). Amongst MSK researchers, 88.8% (n = 103) reported research activity was limited by COVID-19, and 92.2% (n = 107) of researchers reported their research was not able to be refocused on COVID-19-related topics, with basic science researchers less likely to be able to refocus their research compared to clinical researchers (p = 0.030). Additionally, 47.4% (n = 55) reported a decrease in manuscript submissions since the onset of the pandemic. Amongst 51 trainee researchers, 62.8% (n = 32) reported a decrease in job satisfaction directly attributable to the COVID-19 pandemic. In summary, study findings indicated that MSK researchers struggled to overcome challenges imposed by the pandemic, reporting declines in funding opportunities, research productivity, and manuscript submission. Trainee researchers experienced significant disruptions to critical research activities and worsening job satisfaction. Our findings motivate future efforts to support trainees in developing their careers and target the recovery of MSK research from the pandemic stall.

Causal associations of cognition, intelligence, education, health and lifestyle factors with cervical spondylosis: a mendelian randomization study

Background: Education, cognition, and intelligence are phenotypically and genetically related. Education has been shown to have a protective effect on the risk of developing cervical spondylosis. However, it is unclear whether cognition and intelligence have independent causal effects on cervical spondylosis, and whether health and lifestyle factors influence this association. Methods: We first assessed the independent effects of education, cognition, and intelligence on cervical spondylosis by two-sample Mendelian randomization and multivariable Mendelian randomization analysis, and evaluated 26 potential association mediators using two-step Mendelian randomization, and calculated the median proportion. Results: The results showed that only education had an independent causal effect on cervical spondylosis, and had a protective effect on the risk of cervical spondylosis (β: 0.3395; se: 0.166; p < 0.05; OR:0.71; [95%CI: 0.481-0.943]. Of the 26 potential associated mediators, a factor was identified: SHBG (mediated proportion: 2.5%). Univariable Mendelian randomization results showed that the risk factors for cervical spondylosis were time spent watching TV (OR:1.96; [95%CI: 1.39-2.76]), smoking (OR:2.56; [95%CI: 1.061-1.486]), body mass index (OR:1.26; [95%CI: 1.124-1.418]), percentage of body fat (OR:1.32; [95%CI: 1.097-1.593]), major depression (OR:1.27; [95%CI: 1.017-1.587]) and sitting height (OR:1.15; [95%CI: 1.025-1.291]). Protective factors include computer using (OR:0.65; [95%CI: 0.418-0.995]), sex hormone binding globulin (OR:0.87; [95%CI: 0.7955-0.951]) and high-density lipoprotein (OR:0.90; [95%CI: 0.826-0.990]). Conclusion: Our findings demonstrate the causal and independent effects of education on cervical spondylosis and suggest that lifestyle media may be a priority target for the prevention of cervical spondylosis due to low educational attainment.

Physiotherapists' awareness and use of red flags for the assessment of low back pain in Saudi Arabia

BACKGROUND

Physiotherapists must identify potential red flags that may impede recovery and function in individuals with low back pain (LBP) or put them at risk.

OBJECTIVES

This study aimed to (1) investigate physiotherapists' awareness and use of red flags for individuals with LBP in Saudi Arabia and (2) identify factors associated with their awareness and use of LBP red flags.

METHODS

This cross-sectional study collected data using an anonymous online questionnaire (February-July 2023). It included physiotherapists working in private/public hospitals in Saudi Arabia. The questionnaire asked about the participants' characteristics, their awareness of LBP red flags, and their use of red flags for LBP assessment.

RESULTS

A total of 643 participating physiotherapists (26.2 ± 3.8 years), 63.8% of whom were females, completed the survey. Most participants (94.4%) had adequate awareness of LBP red flags, and more than half (61%) had good utilization of red flags when assessing individuals with LBP. There was a positive correlation between the physiotherapists' awareness and use of LBP red flags.

CONCLUSION

The majority of the participating physiotherapists in Saudi Arabia were aware of LBP red flags, and many reported to have good use of red flags in clinical practice when assessing and managing individuals with LBP.

McKenzie neck exercise versus cranio-cervical flexion exercise on strength and endurance of deep neck flexor muscles, pain, disability, and craniovertebral angle in individuals with chronic neck pain: a randomized clinical trial

PURPOSE

To compare the effectiveness of McKenzie neck exercise and cranio-cervical flexion (CCF) exercise on strength and endurance of deep neck flexor (DNF) muscles, pain, disability, and craniovertebral angle (CVA) in individuals with chronic neck pain.

METHODS

Forty individuals with chronic neck pain were randomly allocated to the McKenzie neck or CCF exercise group. Each group performed exercises at home daily. The strength and endurance of DNF muscles were measured at baseline, immediately after the first exercise session, and each week follow-up for six weeks. Average pain over the past week was measured at baseline and each week follow-up for six weeks. Disability and CVA were measured at baseline and the end of six weeks.

RESULTS

At six weeks, both groups exhibited significant improvements across all outcome variables (p < 0.001) but there were no differences between groups (p > 0.05). The significant difference from baseline in the strength of DNF muscles was observed as early as the second week of each intervention (p ≤ 0.001). The significant difference from baseline in the endurance of DNF muscles was observed as early as the first week in the CCF exercise group (p < 0.05) and the second week in the McKenzie neck exercise group (p < 0.05). A significant decrease in pain intensity from baseline was observed after the first week in the McKenzie neck exercise group (p < 0.001) while it was after the second week in the CCF exercise group (p < 0.05).

CONCLUSION

Both the McKenzie neck exercise and CCF exercise produced similar effects in enhancing the strength and endurance of the DNF muscles, decreasing pain, alleviating neck disability, and improving the CVA.

Cervical muscle parameters and allodynia in migraine and cervical pain-A controlled study

BACKGROUND

Neck pain is common among individuals with migraine, but there is a lack of information of how this comorbidity can be associated with cervical muscle function. This controlled cross-sectional study aimed to compare cervical muscle function, activity, and sensitization in women with migraine, neck pain, both, and neither.

METHODS

This study included women, between 18 and 55 years old, with either episodic migraine with or without aura, without any concomitant headache diagnosis; chronic neck pain, with at least moderate intensity and mild disability; or neither headache nor neck pain. Pain pressure threshold, allodynia, muscle strength, and endurance and cervical muscles activity were evaluated.

RESULTS

One hundred subjects, with mean age of 30.4 years old, were stratified by diagnosis (n = 25 per group) and by self-reported pain during tests. Lower endurance during flexion was observed for migraine and neck pain (34s) relative to neck pain alone (45s), migraine (40s), and controls (58s) (p = 0.04). For extensor endurance, means were 142s, 166s, 215s, and 270s, respectively (p < 0.001). Endurance times were impacted by the presence of test-induced pain decreasing about 40%-53% of the performance. Diagnostic groups did not differ significantly in strength (p > 0.05), but all pain groups presented significantly higher proportion of test-induced pain, lower muscle activity during the maximal isometric voluntary contractions, and lower pressure pain thresholds.

CONCLUSION

Patients with migraine, chronic neck pain, and the association of both present altered cervical muscle function and activity. Also, test-induced pain impacts significantly on neck muscles endurance.

SIGNIFICANCE

The diagnosis of migraine and chronic neck pain is associated with altered function and activity of the cervical muscles. However, the test-induced pain had an important contribution to worse cervical muscle endurance. This suggests that the therapeutic approach should focus on de-sensitization of the trigeminal-cervical complex when dealing with the comorbidity of migraine and cervical pain.

Effect of osteopathic manipulative treatment and Bio-Electro-Magnetic Energy Regulation (BEMER) therapy on generalized musculoskeletal neck pain in adults

CONTEXT

General neck pain is a prevalent complaint made by patients to their physicians and is often of a suspected musculoskeletal origin. Osteopathic manipulative treatment (OMT) is a form of manual therapy utilized by osteopathic physicians and some allopathic physicians to treat a broad variety of musculoskeletal ailments, including neck pain. Bio-Electro-Magnetic Energy Regulation (BEMER) is an emerging therapeutic modality that deploys a biorhythmically defined stimulus through a pulsed electromagnetic field and has been shown to reduce musculoskeletal pain. Studies on these treatments have independently yielded promising results. Therefore, it is possible that the utility of OMT and BEMER can produce an additive improvement in the treatment of neck pain.

OBJECTIVES

The objectives of this study are to investigate the individual and combined effects of OMT and BEMER therapy on neck pain in adults.

METHODS

Adults with nonspecific neck pain were recruited for the study. A total of 44 participants met the study inclusion criteria and were randomized into one of four study groups: OMT-only, BEMER-only, OMT+BEMER, or CONTROL (light touch and sham). Forty subjects completed the study, and data for 38 participants were included in our analyses. An OMT and BEMER protocol were specifically designed for this study under the guidance of a licensed osteopathic physician. Participants underwent intervention for a duration of 3 weeks. Data were obtained through baseline and postintervention assessments utilizing three surveys: Neck Disability Index (NDI), Visual Analog Scale (VAS), and Short Form 12-item Health Survey (SF-12, divided into Mental and Physical). One-way analysis of variance (ANOVA) analysis was performed retrospectively on pre- and postintervention absolute means between study groups. Significance was set at p<0.05.

RESULTS

One-way ANOVA analysis demonstrated a statistically significant difference in pre- vs. postintervention mean scores between BEMER and CONTROL (p<0.05), BEMER compared to OMT (p<0.005), and BEMER compared to BEMER+OMT (p<0.05), in the NDI. The OMT+BEMER group reported an average reduction in pain on the VAS of 21.3 (±29.3) points, or a 65.0 % reduction of pain. A similarly substantial decrease in pain was reported in the BEMER study group, which showed a 46.2 % reduction in pain from baseline. The OMT and CONTROL study groups only reported a 2.9 and 23.9 % decrease, respectively. The BEMER and OMT+BEMER study groups also demonstrated a reduction in subjective reporting on the NDI, by 53.8 and 26.3 %, respectively. The BEMER study group also achieved the most substantial improvement in mental and physical well-being as reported by the SF-12.

CONCLUSIONS

Study arms that incorporated BEMER yielded improvements on the NDI, VAS, and SF-12, indicating benefits to BEMER regarding improved overall functionality in routine daily activities as well as a reduction in nonspecific neck pain. Perceived pain, as demonstrated on the VAS, was seemingly improved in an additive fashion from the BEMER group to the OMT+BEMER group, although the results did not achieve statistical significance. Further study with greater participation could provide additional insight.

Efficacy of capacitive-resistive therapy on the treatment of myofascial pain - A randomized control trial

BACKGROUND

Myofascial pain syndrome is a painful musculoskeletal condition with muscle spasm, referred pain, stiffness, restricted range of motion. Capacitive-resistive diathermy heats deep tissues by transferring energy through radiofrequency waves. Although this modality is used to treat various musculoskeletal disorders, there is no specific data on myofascial trigger points. Thus, we aimed to evaluate the effectiveness of capacitive-resistive diathermy on the myofascial trigger points.

METHODS

Thirty-six volunteers with active myofascial trigger points were included. Patients were randomly and equally allocated into two groups. Group-1 is the capacitive-resistive diathermy treatment group; Group-2 is the placebo capacitive-resistive diathermy (PG). Visual analog scale (VAS), pain pressure threshold (PPT), neck disability index (NDI), neck range of motion (nROM), Short form-36 (SF-36) were used as outcomes before and after the intervention.

RESULTS

In both groups, VAS, PPT, NDI score significantly improved within the groups (p < 0.05). The CRG showed a statistically significant improvement in nROM for flexion, extension, and rotation (p < 0.05). However, ROM increase in CRG is not superior to PG (p > 0.05).

CONCLUSIONS

There was no significant difference between the two groups. We thought positive results in the PG might attributed to doing exercise. As a result, capacitive-resistive diathermy is not superior to exercise, but can be used as an adjuvant modality in myofascial trigger points treatment.

Efficacy of chronic neck pain self-treatment using press needles: a randomized controlled clinical trial

Background

Chronic neck pain is common among Japanese individuals, but few receive treatment. This randomized controlled trial aimed to evaluate the efficacy of acupuncture using press needles in the self-treatment of chronic neck pain and preliminarily identify the characteristics of patients likely to benefit from this treatment.

Methods

Fifty participants with chronic neck pain were allocated to receive either press needle or placebo treatment for 3 weeks. The visual analogue scale (VAS) and motion-related VAS (M-VAS) scores for neck pain, Neck Disability Index score, and pressure pain threshold were measured at baseline, after the first session, at the end of the last session, and 1 week after the last session. Changes in the outcomes were analyzed using analysis of variance, and the relationships between the variables were evaluated using structural equation modeling.

Results

Intervention results as assessed by VAS score revealed no significant differences in the ANOVA. A between-groups comparison of M-VAS scores at the end of the last session and baseline showed a significant difference (press needle: -21.64 ± 4.47, placebo: -8.09 ± 3.81, p = 0.025, d = -0.65). Structural equation modeling revealed a significant pain-reducing effect of press needle treatment (β = -0.228, p = 0.049). Severity directly affected efficacy (β = -0.881, p < 0.001). Pain duration, baseline VAS and Neck Disability Index scores were variables explaining severity, while age and occupational computer use were factors affecting severity.

Conclusion

Self-treatment with press needles for chronic neck pain did not significantly reduce the VAS score compared to placebo but reduced the motion-related pain as assessed by M-VAS score. A direct association was observed between pain severity and the effectiveness of press needles, and the impact of age and computer were indirectly linked by pain severity.

Clinical Trial Registration

Identifier UMIN-CTR, UMIN000044078.

Effects of exercise combined with cervicothoracic spine self-mobilization on chronic non-specific neck pain

To investigate the short-term effects and differences between exercise alone and exercise combined with self-mobilization training on chronic non-specific neck pain (CNSNP). Thirty subjects who met the criteria were recruited and randomly assigned to the exercise training group, the exercise combined with cervical self-mobilization training group (ECCM), and the exercise combined with cervicothoracic self-mobilization training group (ECCTM). The exercise training group received 6 weeks of deep neck flexor under biofeedback and scapular stability training, and the other two groups received 6 weeks of cervical self-mobilization and cervicothoracic self-mobilization, respectively, in addition to exercise training. Neck pain, cervical range of motion (ROM), neck disability, strength and endurance of deep neck flexor and quality of life were assessed before and after 6 weeks of training. The study results showed that all the three training programs for 6 weeks increased the strength and endurance of deep neck flexor, increased cervical ROM, reduced pain, and improved neck function (P < 0.05). The exercise combined with self-mobilization two groups compared with only the exercise training group had better improvement in ROM of extension, lateral flexion, rotation and quality of life (P < 0.05). Compared with exercise alone and exercise combined with cervical self-mobilization training, the exercise combined with cervicothoracic self-mobilization training was the best in improving ROM of right lateral flexion (exercise training group vs ECCTM: P < 0.01, d = 1.61, ECCM vs ECCTM: P < 0.05, d = 1.14) and pain (exercise training group vs ECCTM: P < 0.05, d = 1.34, ECCM vs ECCTM: P < 0.05, d = 1.23). Deep flexor muscle and shoulder stability training can improve the endurance and strength of the deep flexor muscles of the neck and coordinate the movement patterns of the shoulder and neck. Self-mobilization techniques can promote improvements in cervical lateral flexion and rotation range of motion, alleviate neck disability and further improve quality of life. A combination of exercise and cervicothoracic self-mobilization training appears beneficial for the management of neck pain.

Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

Neck pain is a highly prevalent condition that leads to considerable pain, disability, and economic cost. We present the most current estimates of neck pain prevalence and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) by age, sex, and location, with forecasted prevalence to 2050.

METHODS

Systematic reviews identified population-representative surveys used to estimate the prevalence of and YLDs from neck pain in 204 countries and territories, spanning from 1990 to 2020, with additional data from opportunistic review. Medical claims data from Taiwan (province of China) were also included. Input data were pooled using DisMod-MR 2.1, a Bayesian meta-regression tool. Prevalence was forecast to 2050 using a mixed-effects model using Socio-demographic Index as a predictor and multiplying by projected population estimates. We present 95% UIs for every metric based on the 2·5th and 97·5th percentiles of 100 draws of the posterior distribution.

FINDINGS

Globally, in 2020, neck pain affected 203 million (95% uncertainty interval [UI] 163-253) people. The global age-standardised prevalence rate of neck pain was estimated to be 2450 (1960-3040) per 100 000 population and global age-standardised YLD rate was estimated to be 244 (165-346) per 100 000. The age-standardised prevalence rate remained stable between 1990 and 2020 (percentage change 0·2% [-1·3 to 1·7]). Globally, females had a higher age-standardised prevalence rate (2890 [2330-3620] per 100 000) than males (2000 [1600-2480] per 100 000), with the prevalence peaking between 45 years and 74 years in male and female sexes. By 2050, the estimated global number of neck pain cases is projected to be 269 million (219-322), with an increase of 32·5% (23·9-42·3) from 2020 to 2050. Decomposition analysis of the projections showed population growth was the primary contributing factor, followed by population ageing.

INTERPRETATION

Although age-standardised rates of neck pain have remained stable over the past three decades, by 2050 the projected case numbers are expected to rise. With the highest prevalence in older adults (higher in females than males), a larger effect expected in low-income and middle-income countries, and a rapidly ageing global population, neck pain continues to pose a challenge in terms of disability burden worldwide. For future planning, it is essential we improve our mechanistic understanding of the different causes and risk factors for neck pain and prioritise the consistent collection of global neck pain data and increase the number of countries with data on neck pain.

FUNDING

Bill & Melinda Gates Foundation and Global Alliance for Musculoskeletal Health.

Exercise-induced hypoalgesia in chronic neck pain: A narrative review

Chronic neck pain (CNP) is a worldwide health problem with several risk factors. One of the most widely used treatments for managing this condition is therapeutic exercise, which could generate a response called exercise-induced hypoalgesia (EIH). There is no consensus on the best exercise modality to induce hypoalgesia. Therefore, this review aims to analyze and synthesize the state-of-the-art about the hypoalgesic effect of exercise in subjects with CNP. We included articles on EIH and CNP in patients older than 18 years, with pain for more than three months, where the EIH response was measured. Articles that studied CNP associated with comorbidities or measured the response to treatments other than exercise were excluded. The studies reviewed reported variable results. Exercise in healthy subjects has been shown to reduce indicators of pain sensitivity; however, in people with chronic pain, the response is variable. Some investigations reported adverse effects with increased pain intensity and decreased pain sensitivity, others found no clinical response, and some even reported EIH with decreased pain and increased sensitivity. EIH is an identifiable, stimulable, and helpful therapeutic response in people with pain. More research is still needed on subjects with CNP to clarify the protocols and therapeutic variables that facilitate the EIH phenomenon. In addition, it is necessary to deepen the knowledge of the intrinsic and extrinsic factors that influence EIH in people with CNP.

The top 100 highly cited articles on neck pain: A bibliometric analysis

Objective

Neck pain has emerged as a significant public health concern. This study is to unveil the present state of neck pain research, thereby furnishing invaluable insights for prospective research endeavours and clinical applications.

Methods

The study was initiated by searching the Web of Science Core Collection database, focusing on "neck pain". From the amassed results, the top 100 most cited references were imported into CiteSpace and VOSviewer, enabling a rigorous bibliometric analysis. To ensure precision, synonymous terms conveying similar meanings were harmonized. The bibliometric study encompassed countries, research institutions, authors, journals, and keyword analysis.

Results

The investigation centered on a curated compilation of 100 articles, disseminated across a diverse array of 36 scholarly journals. These seminal articles originated from 24 distinct countries, reflecting contributions from a wide spectrum of 188 research institutions. Impressively, a collaborative effort involving 385 authors emerged. Noteworthy core research countries included the United States and Australia, with the University of Queensland and the University of Toronto asserting notable influence. Prolific authors such as J. David Cassidy and Pierre Cote garnered attention. Present research endeavours pivot around the incidence of neck pain, the identification of risk factors, the efficacy evaluation of treatment modalities, and a pronounced focus on high-quality randomized controlled trials and systematic reviews.

Conclusion

The study shines a light on key research countries, influential institutions, prominent authors, and prevalent trends, effectively contributing to comprehending the knowledge landscape and research dynamics in the field of neck pain.

Peripheral muscle oxygenation, pain, and disability indices in individuals with and without nonspecific neck pain, before and after myofascial reorganization®: A double-blind randomized controlled trial

To investigate whether myofascial reorganization® in the trapezius muscle (MRT) improves peripheral muscle oxygenation and pain tolerance and decreases neck disability index (NDI) scores in individuals with and without nonspecific neck pain (NP) using a double-blind randomized controlled trial. Seventy-five subjects were equally and randomly assigned to three groups: the intervention groups (experimental [EG] and sham sSG]) and the control group (CG). Several inclusion criteria were applied to the intervention groups: male or female, aged 18-32 years, self-reported NP in the last 3 months without a defined cause; at least "soft" pain in session 1 of the NDI, and at least a score of 1 on the Visual Analogue Scale (VAS). The CG was required to have NDI and VAS scores of 0 at recruitment. Intervention: The EG underwent MRT for 10 min, once a week for 6 weeks. Patients with NP in the SG underwent classical massage for the same duration and frequency. Patients in the CG had no pain and underwent no intervention. Data collection was performed using the NDI Questionnaire, a pressure algometer for pain evaluation, and near-infrared spectroscopy for muscle oxygenation measurements. It was registered as NCT03882515 at ClinicalTrials.gov. The NDI score in both the EG (p<0.001) and SG (p<0.001) decreased after 6 weeks of intervention compared to the CG. The CG demonstrated a lower basal tissue saturation (TSI) index than the EG (p<0.001) and SG (p = 0.02). The EG demonstrated higher oxyhemoglobin values than the SG (p<0.001) and CG (p = 0.03). The CG had higher pain tolerance than the EG (p = 0.01) and SG (p<0.001) post-intervention. MRT increased trapezius muscle oxygenation after 6 weeks of intervention.

Simplified Chinese version of the core outcome measures index (COMI) for patients with neck pain: cross-cultural adaptation and validation

PURPOSE

The aim of this study was to translate and cross-culturally adapt the Core Outcome Measures Index for (COMI) into a Simplified Chinese version (COMI-SC) and to evaluate the reliability and validity of COMI-SC in patients with neck pain.

METHODS

The COMI-neck was translated into Chinese according to established methods. The COMI-neck questionnaire was then completed by 122 patients with a hospital diagnosis of neck pain. Reliability was assessed by calculating Cronbach's alpha and intraclass correlation coefficient (ICC). Construct validity was assessed by correlating the COMI-neck with the Neck Pain and Disability Scale (NPDS), the Neck Disability Index (NDI), the VAS and the Short Form (36) Health Survey (SF-36). Using confirmatory factor analysis to validate the structural, convergent and discriminant validity of the questionnaire.

RESULTS

The COMI-neck total scores were well distributed, with no floor or ceiling effects. Internal consistency was excellent (Cronbach's alpha = 0.861). Moderate to substantial correlations were found between COMI-neck and NPDS (r = 0.420/0.416/0.437, P < 0.001), NDI (r = 0.890, P < 0.001), VAS (r = 0.845, P < 0.001), as well as physical function (r = - 0.989, P < 0.001), physical role (r = - 0.597, P < 0.001), bodily pain (r = - 0. 639, P < 0.001), general health (r = - 0.563, P < 0.001), vitality (r = - 0.702, P < 0.001), social functioning (r = - 0.764, P < 0.001), role emotional (r = - 0.675, P < 0.001) and mental health (r = - 0.507, P < 0.001) subscales of the SF-36. An exploratory factor analysis revealed that the 3-factor loading explained 71.558% of the total variance [Kaiser-Mayer-Olkin (KMO) = 0.780, C2 = 502.82, P < 0.001]. CMIN/DF = 1.813, Tucker-Lewis index (TLI) = 0.966 (> 0.9), Comparative Fit Index (CFI) = 0.982 (> 0.9), Normed Fit Index (NFI) = 0.961 (> 0.9), RMSEA = 0.082 (< 0.5) indicating that the model fits well.

CONCLUSION

COMI-neck was shown to have acceptable reliability and validity in patients with non-specific chronic neck pain and could be recommended for patients in mainland China.

LEVEL OF EVIDENCE

Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

The Fascial Distortion Model in Military Aircrew with Chronic Neck Pain: A Case Study

Musculoskeletal pain can be a significant safety risk to aircrew. Flight surgeons are the primary care providers for aircrew and are responsible for safely treating musculoskeletal pain. Certain medical interventions can be used to treat pain while maintaining the ability to fly safely. A previous F-18 Naval Flight Officer presented to the flight surgeon with chronic neck pain seeking noninvasive and nonpharmacological therapy. After one Osteopathic Manual Treatment session using the Fascial Distortion Model (FDM), the patient had improved pain and function. The aircrewman reported an 83% reduction in pain and a 200% improvement in cervical Range of Motion (ROM) immediately following treatment. Neck pain is a common complaint in aircrew. This pain can become an in-flight distraction, thus increasing the risk of aviation mishaps. FDM can decrease pain and increase ROM quickly, without equipment or a large amount of space and without the use of medications that may prohibit an aircrew member from flying. This case study shows the ability to treat a uniformed aircrewman with neck pain while onboard an aircraft. FDM is a technique that can be taught to all flight surgeons. Teaching future flight surgeons FDM techniques can improve the U.S. Navy's resources by decreasing time away from work along with decreasing medical costs. The use of osteopathic manipulation treatment significantly reduced an aircrewman's pain and increased ROM with one treatment while maintaining flight status per current aeromedical waiver guidelines.

Novel AI-Based Algorithm for the Automated Measurement of Cervical Sagittal Balance Parameters. A Validation Study on Pre- and Postoperative Radiographs of 129 Patients

STUDY DESIGN

Retrospective, mono-centric cohort research study.

OBJECTIVES

The analysis of cervical sagittal balance parameters is essential for preoperative planning and dependent on the physician's experience. A fully automated artificial intelligence-based algorithm could contribute to an objective analysis and save time. Therefore, this algorithm should be validated in this study.

METHODS

Two surgeons measured C2-C7 lordosis, C1-C7 Sagittal Vertical Axis (SVA), C2-C7-SVA, C7-slope and T1-slope in pre- and postoperative lateral cervical X-rays of 129 patients undergoing anterior cervical surgery. All parameters were measured twice by surgeons and compared to the measurements by the AI algorithm consisting of 4 deep convolutional neural networks. Agreement between raters was quantified, among other metrics, by mean errors and single measure intraclass correlation coefficients for absolute agreement.

RESULTS

ICC-values for intra- (range: .92-1.0) and inter-rater (.91-1.0) reliability reflect excellent agreement between human raters. The AI-algorithm could determine all parameters with excellent ICC-values (preop:0.80-1.0; postop:0.86-.99). For a comparison between the AI algorithm and 1 surgeon, mean errors were smallest for C1-C7 SVA (preop: -.3 mm (95% CI:-.6 to -.1 mm), post: .3 mm (.0-.7 mm)) and largest for C2-C7 lordosis (preop:-2.2° (-2.9 to -1.6°), postop: 2.3°(-3.0 to -1.7°)). The automatic measurement was possible in 99% and 98% of pre- and postoperative images for all parameters except T1 slope, which had a detection rate of 48% and 51% in pre- and postoperative images.

CONCLUSION

This study validates that an AI-algorithm can reliably measure cervical sagittal balance parameters automatically in patients suffering from degenerative spinal diseases. It may simplify manual measurements and autonomously analyze large-scale datasets. Further studies are required to validate the algorithm on a larger and more diverse patient cohort.

Translation, cross-cultural adaptation and psychometric properties of the Urdu version of the back pain functional scale in low back pain patients

BACKGROUND

Translation and validation of important scales in other languages reduce bias in reporting the functional status of the patient.

OBJECTIVE

To translate the Back Pain Functional Scale into Urdu (BPFSu), adapt it for use in other cultures, and evaluate its psychometric properties.

METHOD

According to Beaton guidelines, translation and cultural adaption was carried out. On 100 Urdu-literate men and women aged 18-60 years with lower back pain, the final BPFSu was assessed for psychometric qualities. First at baseline and again after 7 days, participants completed the BPFSu, the Functional Rating Index (FRI), and the Numeric Pain Rating Scale (NPRS).

RESULTS

Internal consistency of the BPFSu was excellent (Cronbach's alpha: 0.937). No floor and ceiling effects were found Excellent test-retest reliability (ICC = 0.882, CI 95%; 0.830-0.919) was achieved. Spearman correlation coefficient showed criterion validity with the NPRS (rho =â⁢⁢0.701, p⩽ 0.001) and Pearson correlation coefficient showed construct validity with the FRI (r=â⁢⁢0.740, p⩽ 0.001). The minimum detectable changes were 9.96, while the standard error of measurement was 3.6.

CONCLUSION

The BPFSu is a valid and reliable instrument for assessing physical function in individuals experiencing low back discomfort.

The impact of COVID-19 on neck pain intensity and onset: A systematic review

BACKGROUND

The COVID-19 pandemic has had significant impacts on most aspects of life, including physical and psychological wellbeing. Neck pain is a very common musculoskeletal complaint worldwide, and one that has been impacted by COVID-19. Such impacts have been studied by a few researchers, but not without inconstancies. Moreover, understanding those impacts in relation to rehabilitation is not fully comprehended.

OBJECTIVE

The aim of this study was to systematically examine the impacts of COVID-19 on neck pain intensity and onset pre and post the pandemic.

METHODS

This study was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A systematic literature search was conducted on PubMed-MEDLINE, EMBASE, and Cochrane Library. Keywords used were "COVID-19" and "Neck Pain". Risk of bias was assessed using the Joanna Briggs Institute Checklist for prevalence studies.

RESULTS

A total of five studies were included with an overall sample size of 2618 participants. Three studies were at moderate risk and two were at high risk of bias. Results from three studies reported an increase in neck pain intensity and onset, while the other two did not report an increase.

CONCLUSION

The impact of COVID-19 on neck pain is unclear. The inconsistency in results sheds the light on the importance of having future research (including longitudinal studies) to help guide us towards understanding the real impacts of COVID-19 on neck pain.

Atypical Presentation and Diagnosis of Multiple Myeloma: A Case Report

Chronic neck pain is a common, seemingly benign condition that typically does not warrant an urgent workup, in contrast to acute onset neck pain. Vertebral artery dissection (VAD) is a relatively rare presentation of acute onset neck pain and often presents in the context of blunt trauma. Due to the risk of subsequent clot formation and stroke, patients who present with symptoms suggestive of VAD must be promptly screened, most often first with computed tomography angiography (CTA) followed by magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA) for further evaluation. We present a case of a 69-year-old male with a history of chronic neck pain who was seen in the emergency department due to acute, severe neck pain with initial CTA imaging that suggested left VAD. However, follow-up MRI of his cervical spine identified that what seemed to be a left VAD was instead multiple myeloma. This case demonstrates the utility of using multiple imaging modalities, including CT, CTA, MRI, and MRA, in diagnosing an atypical presentation of multiple myeloma and the consequences of physician implicit biases that are often involved when treating patients with chronic pain.

Video interpretation in a medical spine clinic: A descriptive study of a diverse population and intervention

OBJECTIVES

Back pain is one of the most challenging health conditions to manage. Healthcare providers face additional challenges when managing back pain for patients with culturally diverse backgrounds including addressing linguistic barriers and understanding patients' cultural beliefs about pain and healthcare. Knowledge about patients with culturally diverse backgrounds experiencing back pain and the interventions available to them is limited. Therefore, this study aims to describe the characteristics of patients with culturally diverse backgrounds experiencing back pain and the video interpretation intervention offered to them and further to explore the clinician's perspective on this intervention.

METHODS

Data were collected from the electronic medical records and the Interpreter Gateway. Four clinicians participated in a group interview, where they described and evaluated the video interpretation intervention in detail inspired by the template for intervention description and replication (TIDieR) checklist and guide.

RESULTS

A total of 119 (68%) patients accepted the intervention (53% women, mean 44 years). These patients represent 24 different languages, with 50% having at least one hospital-registered diagnosis and a mean number of five outpatient contacts, 1 year before receiving the intervention. Fifty-seven patients did not accept the intervention and declined interpretation or opted to use relatives or through video conferencing equipment. The intervention was positively evaluated by the clinicians.

CONCLUSIONS

The detailed description of the population and the intervention together with the clinician perspective provides a valuable foundation for developing and refining similar interventions, allocating resources, and designing future research studies. The intervention consisted of a consultation lasting up to 2 h delivered by a rheumatologist and a physiotherapist, with a remote interpreter connected.

Rethinking neck-related arm pain: hypothetical clinical scenarios to differentiate the underlying IASP-defined pain mechanisms

Neck-related arm pain is frequently encountered in clinical settings, yet its underlying pain mechanisms remain elusive. While such pain radiating from the neck to the arm is often attributed to injuries or diseases of the nervous system (neuropathic pain), it can also arise from nociceptive (referred) or nociplastic sources. Regrettably, patients exhibiting this specific pain distribution are frequently diagnosed with varying terms, including 'cervicobrachialgia', 'cervicobrachial neuralgia', 'cervicobrachial pain syndrome', and 'cervical radiculopathy'. The ambiguity surrounding these diagnostic labels complicates the clinical reasoning process. It is imperative for clinicians to discern and comprehend the dominant pain mechanism. Three distinct hypothetical clinical scenarios depict patients with almost identical pain distribution but divergent dominant pain mechanisms. Within these scenarios, both subjective and objective examinations are employed to elucidate the dominant pain mechanism associated with neck-related arm pain: nociceptive, neuropathic, and nociplastic. Furthermore, clinicians must remain aware that the dominant pain mechanism can evolve over time.

An economic evaluation of pharmacopuncture versus usual care for chronic neck pain: a pragmatic randomized controlled trial

BACKGROUND

This study aimed to evaluate the cost utility of pharmacopuncture in comparison with usual care for patients with chronic neck pain.

METHODS

A 12-week, multicenter, pragmatic randomized controlled trial was conducted, and 101 patients suffering from chronic neck pain for more than six months were randomly placed into the pharmacopuncture and usual care groups to receive four weeks of treatment and 12 weeks of follow-up observations. The quality-adjusted life year (QALY) was calculated using EQ-5D and SF-6D. Concerning costs in 2019, a primary analysis was performed on societal perspective cost, and an additional analysis was performed on healthcare perspective cost.

RESULTS

Compared to usual care, pharmacopuncture was superior as it showed a slightly higher QALY and a lower incremental cost of $1,157 from a societal perspective. The probability that pharmacopuncture would be more cost-effective at a willingness-to-pay (WTP) of $26,374 was 100%. Pharmacopuncture was also superior from a healthcare perspective, with a lower incremental cost of $26. The probability that pharmacopuncture would be more cost-effective at a WTP of $26,374 was 83.7%.

CONCLUSIONS

Overall, pharmacopuncture for chronic neck pain was found to be more cost-effective compared to usual care, implying that clinicians and policy makers should consider new treatment options for neck pain.

TRIAL REGISTRATION

Number NCT04035018 (29/07/2019) Clinicaltrials.gov; Number KCT0004243 (26/08/2019) Clinical Research Information Service.

Spinal mobilization force-time characteristics: A scoping literature review

BACKGROUND

Spinal mobilization (SMob) is often included in the conservative management of spinal pain conditions as a recommended and effective treatment. While some studies quantify the biomechanical (kinetic) parameters of SMob, interpretation of findings is difficult due to poor reporting of methodological details. The aim of this study was to synthesise the literature describing force-time characteristics of manually applied SMob.

METHODS

This study is reported in accordance with the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) statement. Databases were searched from inception to October 2022: MEDLINE (Ovid), Embase, CINAHL, ICL, PEDro and Cochrane Library. Data were extracted and reported descriptively for the following domains: general study characteristics, number of and characteristics of individuals who delivered/received SMob, region treated, equipment used and force-time characteristics of SMob.

RESULTS

There were 7,607 records identified and of these, 36 (0.5%) were included in the analysis. SMob was delivered to the cervical spine in 13 (36.1%), the thoracic spine in 3 (8.3%) and the lumbopelvic spine in 18 (50.0%) studies. In 2 (5.6%) studies, spinal region was not specified. For SMob applied to all spinal regions, force-time characteristics were: peak force (0-128N); duration (10-120s); frequency (0.1-4.5Hz); and force amplitude (1-102N).

CONCLUSIONS

This study reports considerable variability of the force-time characteristics of SMob. In studies reporting force-time characteristics, SMob was most frequently delivered to the lumbar and cervical spine of humans and most commonly peak force was reported. Future studies should focus on the detailed reporting of force-time characteristics to facilitate the investigation of clinical dose-response effects.

Associations between exposure to common technology devices and reported neck pain among Iranian school-age adolescents: a cross sectional study

BACKGROUND

The advancement of technology has contributed to a more sedentary lifestyle, and the extensive use of handheld devices among adolescents may potentially result in neck pain. This study aimed to assess the association between exposure to common technology devices and self-reported neck pain in Iranian school-age adolescents.

METHODS

This cross-sectional study was conducted between June and October 2021, employing a randomized multi-stage cluster sampling approach. We enrolled 808 adolescent students aged 11 to 19 years old. We asked participants about any neck pain they experienced in the week leading up to the study. Additionally, we gathered demographic information and assessed participants' use of electronic devices using a questionnaire.

RESULTS

Our study comprised 73.5% female participants with an average age of 15.1 ± 1.7 years and 26.5% male participants with an average age of 14.5 ± 1.5 years. In the regression model, the female gender (p = 0.038), using mobile for more than 6 h (p = 0.04), and using electronic devices while sitting on the floor (p = 0.02) were associated with a higher prevalence of neck pain among participants.

CONCLUSION

In our study, we observed a relatively high prevalence of neck pain, which was linked to extended daily mobile phone usage and body posture during electronic device use. Policymakers may consider interventions aimed at reducing mobile phone usage and promoting proper body posture while using electronic devices as potential strategies to alleviate the burden of neck pain among Iranian adolescents.

Cross-Cultural Adaptation, Reliability, and Validity of the Polish Version of the Neck Outcome Score

This study aimed to translate and psychometrically validate the Neck Outcome Score (NOOS) in the Polish population according to the recommendations of the American Academy of Orthopedic Surgeons Participants completed online version of the NOOS, Neck Disability Index (NDI), and Visual Analogue Scale (VAS) for pain assessment (23 November 2021-9 April 2022). The questionnaires were completed by 57 women and 32 men with cervical spine ailments. A retest was performed after 48 h. The analysis confirmed the high internal consistency (Cronbach's alpha of 0.95) of the Polish NOOS. No floor/ceiling effects were observed. The Polish NOOS showed a significant Spearman's coefficient correlation with NDI (0.87; p < 0.001) and VAS (0.79; p < 0.001). The intraclass correlation coefficient (ICC) for the test-retest was found to be high (0.97). The Polish NOOS can be used for clinical and research purposes as an equivalent to the original version.

The efficacy of manual therapy on HRV in those with long-standing neck pain: a systematic review

OBJECTIVES

Long-standing neck pain (LNP) is a clinical condition frequently encountered in the physical therapy clinic. LNP is a complex, multifactorial condition affecting multiple body systems including the autonomic nervous system (ANS). Traditionally, research on the impact of physical therapy on LNP has focused on self-report measures and pain scales. Heart rate variability (HRV) is an objective measure of the ANS, allowing for quantification of effects of treatment. This systematic review is intended to evaluate if manual therapy acutely affects heart rate variability in adults with long-standing neck pain.

METHODS

Pubmed, Medline, CINAHL, Google Scholar, Web of Science, and Cochrane library were used to retrieve the randomized controlled trials for this review between the years 2010-2021. Search terms included: chronic neck pain, neck pain, cervical pain, manual therapy, mobilization, manipulation, osteopathy, osteopathic or chiropractic. Heart rate variability, HRV, heart rate variation, effects, outcomes, benefits, impacts or effectiveness.

RESULTS

Of 139 articles located and screened, three full-text articles were selected for full qualitative synthesis, with a combined population of 112 subjects, 91 of which were female, with an average age of 33.7 ± 6.8 years for all subjects. MT techniques in three studies were statistically significant in improving HRV in people with LNP; however, techniques were differed across studies, while one study showed no benefit. The studies were found to be of high quality with PEDro scores ≥6.

CONCLUSIONS

Although no clear cause and effect relationship can be established between improvement in HRV with manual therapy, results supported the use of MT for an acute reduction in HRV. No one particular method of MT has proven superior, MT has been found to produce a statistically significant change in HRV. These HRV changes are consistent with decreased sympathetic tone and subjective pain.

Longitudinal Care Patterns and Utilization Among Patients With New-Onset Neck Pain by Initial Provider Specialty

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To compare utilization patterns for patients with new-onset neck pain by initial provider specialty.

SUMMARY OF BACKGROUND DATA

Initial provider specialty has been associated with distinct care patterns among patients with acute back pain; little is known about care patterns among patients with acute neck pain.

METHODS

De-identified administrative claims and electronic health record data were derived from the Optum Labs Data Warehouse, which contains longitudinal health information on over 200M enrollees and patients representing a mixture of ages and geographical regions across the United States. Patients had outpatient visits for new-onset neck pain from October 1, 2016 to September 30, 2019, classified by initial provider specialty. Utilization was assessed during a 180-day follow-up period, including subsequent neck pain visits, diagnostic imaging, and therapeutic interventions.

RESULTS

The cohort included 770,326 patients with new-onset neck pain visits. The most common initial provider specialty was chiropractor (45.2%), followed by primary care (33.4%). Initial provider specialty was strongly associated with the receipt of subsequent neck pain visits with the same provider specialty. Rates and types of diagnostic imaging and therapeutic interventions during follow-up also varied widely by initial provider specialty. While uncommon after initial visits with chiropractors (≤2%), CT, or MRI scans occurred in over 30% of patients with initial visits with emergency physicians, orthopedists, or neurologists. Similarly, 6.8% and 3.4% of patients initially seen by orthopedists received therapeutic injections and major surgery, respectively, compared with 0.4% and 0.1% of patients initially seen by a chiropractor.

CONCLUSION

Within a large national cohort, chiropractors were the initial provider for a plurality of patients with new-onset neck pain. Compared with patients initially seen by physician providers, patients treated initially by chiropractors or therapists received fewer and less costly imaging services and were less likely to receive invasive therapeutic interventions during follow-up.

LEVEL OF EVIDENCE

3.

Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews

BACKGROUND

To date, no consensus exists as to whether one exercise type is more effective than another in chronic neck pain. This systematic review and meta-analysis of systematic reviews aimed to summarize the literature on the effect of various exercise types used in chronic neck pain and to assess the certainty of the evidence.

METHODS

We searched the databases Ovid MEDLINE, Embase, Cochrane Library, SportDiscus, and Web of Science (Core Collection) for systematic reviews and meta-analyses on adults between 18 and 70 years with chronic neck pain lasting ≥ 12 weeks which investigated the effects of exercises on pain and disability. The included reviews were grouped into motor control exercise (MCE), Pilates exercises, resistance training, traditional Chinese exercise (TCE), and yoga. Study quality was assessed with AMSTAR-2 and the level of certainty for the effects of the exercise through GRADE. A narrative analysis of the results was performed and in addition, meta-analyses when feasible.

RESULTS

Our database search resulted in 1,794 systematic reviews. We included 25 systematic reviews and meta-analyses including 17,321 participants (overlap not accounted for). The quality of the included reviews ranged from critically low to low (n = 13) to moderate to high (n = 12). We found low to high certainty of evidence that MCE, Pilates exercises, resistance training, TCE, and yoga have short-term positive effects on pain and that all exercise types except resistance training, show positive effects on disability compared to non-exercise controls. We found low to moderate certainty of evidence for conflicting results on pain and disability when the exercise types were compared to other exercise interventions in the short-term as well as in intermediate/long-term apart for yoga, as no long-term results were available.

CONCLUSION

Overall, our findings show low to high certainty of evidence for positive effects on pain and disability of the various exercise types used in chronic neck pain compared to non-exercise interventions, at least in the short-term. Based on our results, no optimal exercise intervention for patients with chronic neck pain can be recommended, since no large differences between the exercise types were shown here. Because the quality of the included systematic reviews varied greatly, future systematic reviews need to increase their methodological quality.

TRIAL REGISTRATION

Prospero CRD42022336014.

Effectiveness of Exercise Interventions for Preventing Neck Pain: A Systematic Review With Meta-analysis of Randomized Controlled Trials

OBJECTIVE: To update the evidence on the effectiveness of exercise interventions to prevent episodes of neck pain. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE, Embase, CENTRAL, CINAHL, SPORTDiscus, PEDro, and trial registries from inception to December 2, 2022. Forward and backward citation searches. STUDY SELECTION CRITERIA: Randomized controlled trials (RCTs) that enrolled adults without neck pain at baseline and compared exercise interventions to no intervention, placebo/sham, attention control, or minimal intervention. Military populations and astronauts were excluded. DATA SYNTHESIS: Random-effects meta-analysis. Risk of bias was assessed using the Cochrane RoB 2 tool. The certainty of evidence was judged according to the GRADE approach. RESULTS: Of 4703 records screened, 5 trials (1722 participants at baseline) were included and eligible for meta-analysis. Most (80%) participants were office workers. Risk of bias was rated as some concerns for 2 trials and high for 3 trials. There was moderate-certainty evidence that exercise interventions probably reduce the risk of a new episode of neck pain (OR, 0.49; 95% confidence interval: 0.31, 0.76) compared to no or minimal intervention in the short-term (≤12 months). The results were not robust to sensitivity analyses for missing outcome data. CONCLUSION: There was moderate-certainty evidence supporting exercise interventions for reducing the risk for an episode of neck pain in the next 12 months. The clinical significance of the effect is unclear. J Orthop Sports Phys Ther 2023;53(10):1-16. Epub: 8 September 2023. doi:10.2519/jospt.2023.12063.

Inter- and intra-rater-reliability of a clinical framework for spine-related neck-arm pain

OBJECTIVE

A mechanism-based clinical framework for spine-related pain differentiates (i) somatic referred pain, ii) heightened nerve mechanosensitivity, iii) radicular pain, iv) radiculopathy and mixed-pain. This study aimed to determine the reliability of proposed framework.

METHOD

Fifty-one people with unilateral spine-related neck-arm pain were assessed and categorized by examiner-1. The classifications were compared to those made by two other examiners, based on written documentation of examiner-1. Cohens kappa was calculated between examiner-pairs; Fleiss Kappa among all examiners to assess agreement in classifying subgroups and entire framework.

RESULT

Inter-rater-reliability showed moderate to almost perfect reliability (somatic: no variation, mechanosensitivity: 0.96 (95% CI 0.87-1.0) to 1.0 (95% CI: 1.0-1.0), radicular pain: 0.46 (95% CI: 0.19-0.69) to 0.62 (95% CI: 0.42-0.81), radiculopathy: 0.65 (95% CI: 0.43-0.84) to 0.80 (95% CI: 0.63-0.96) mixed-pain: 0.54 (95% CI: 0.21-0.81) to 0.75 (95% CI: 0.48-0.94). There was almost perfect to moderate reliability among all examiners (somatic: no variation, mechanosensitivity: 0.97 (95% CI: 0.82-1.0), radicular pain: 0.56 (95% CI: 0.40-0.71), radiculopathy: 0.74 (95% CI: 0.58-0.90), mixed-pain: 0.63 (95% CI: 0.47-0.79), entire framework: 0.64 (95% CI: 0.57-0.71)). Intra-rater-reliability showed substantial to almost perfect reliability (somatic: no variation, mechanosensitivity: 0.96 (95% CI: 0.87-1.0), radicular pain: 0.76 (95% CI: 0.57-0.92), radiculopathy: 0.84 (95% CI: 0.67-0.96), mixed-pain: 0.83 (95% CI: 0.60-1.0), entire framework: 0.80 (95% CI: 0.61-0.92).

CONCLUSION

Moderate to almost perfect reliability in subgrouping people with spine-related neck-arm pain and substantial reliability for entire framework support this classification's reliability.

Effect of a massage chair (BFM-M8040) on neck and shoulder pain in office workers: A randomized controlled clinical trial

Background

With the increasing work-related musculoskeletal disorders, neck and shoulder pain among office workers has also increased. That said, this randomized controlled trial aimed to seek the potential effects of a massage chair (BFR-M8040) on neck and shoulder pain among office workers.

Methods

This was conducted at the Wonkwang University Gwangju Medical Center from April 2022 to December 2022. Sixty adult participants were randomly allocated. The mean age of male participants was 39.63 ± 8.09 years while female participants was 43.52 ± 8.27; women participated the most (86.67%). The control group received basic physical treatments, including a 10-min heat treatment for deep regions and a 10-min hot pack for the areas on the neck and shoulder of the complained discomfort. The experimental group received the same treatment as the control group and added 20 min of the electric massage chair's PEMF Neck Mode (XD module 3) (BFR-M8040, Bodyfriend Co., Ltd.). The participants received treatments twice per week. The primary outcome was measured using the numerical rating scale and the Korean version of the neck disability index. And the secondary outcome was measured using pressure pain threshold, range of motion, the Korean occupational stress scale, the Korean version of the Euro-quality of life-5 dimension, and safety evaluation.

Results

Fifty-eight participants completed a 6-week follow-up and analyzed (29 in the control group and 29 in the experimental group). There was a significant decrease in the experiment group in both scales for primary outcome measures. For secondary outcome measures, statistically significant increases were observed in pressure pain threshold. The experimental group only showed a slight increase in the quality-of-life measures. There were no reported adverse events.

Conclusion

The benefit of using a massage chair (BFR-M8040) was verified to alleviate neck and shoulder pain among office workers; future studies could involve participants from other countries for further investigation.

YouTube online videos as a source for patient education of cervical spondylosis-a reliability and quality analysis

BACKGROUND

Given a prolonged course of Cervical spondylosis (CS) could cause irreversible neurological deficits, it is crucial to disseminate CS-related health information to the public to promote early diagnosis and treatment. YouTube has been widely used to search for medical information. However, the reliability and quality of videos on YouTube vary greatly. Thus, this study aimed to assess the reliability and educational quality of YouTube videos concerning CS and further explore strategies for optimization of patient education.

METHODS

We searched YouTube online library for the keywords "cervical spondylosis", "cervical radiculopathy" and "cervical myelopathy" on January 15, 2023. Ranked by "relevance", the first 50 videos of each string were recorded. After exclusions, a total of 108 videos were included. All videos were extracted for characteristics and classified based on different sources or contents. Two raters independently evaluated the videos using Journal of American Medical Association (JAMA) benchmark criteria, Modified DISCERN (mDISCERN) tool, Global Quality Scale (GQS) and Cervical-Spondylosis-Specific Scale (CSSS), followed by statistical analyses. All continuous data were described as median (interquartile range).

RESULTS

All videos had median values for JAMA, mDISCERN, GQS and CSSS scores of were 3.00 (1.00), 3.00 (2.00), 2.00 (1.00) and 7.00 (8.88), respectively. There were significant differences in VPI (P = 0.009) and JAMA (P = 0.001), mDISCERN (P < 0.001), GQS (P < 0.001) and CSSS (P < 0.001) scores among different sources. Videos from academic source had advantages in reliability and quality scores than other sources. VPI (P < 0.001), mDISCERN (P = 0.001), GQS (P < 0.001) and CSSS (P = 0.001) scores also significantly differed among videos of various contents. Spearman correlation analysis indicated VPI was not correlated with either reliability or quality. Multiple linear regression analysis showed a longer duration and an academic source were independent predictors of higher reliability and quality, while a clinical source also led to the higher video quality.

CONCLUSIONS

The reliability and educational quality of current CS-related videos on YouTube are unsatisfactory. Users face a high risk of encountering inaccurate and misleading information when searching for CS on YouTube. Longer duration, source of academic or clinician were closely correlated to higher video reliability and quality. Improving the holistic reliability and quality of online information requires the concerted effort from multiple parties, including uploaders, the platform and viewers.

The Use of Virtual Reality in the Rehabilitation of Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis

OBJECTIVES

There has been a major interest in using virtual reality (VR) as a pain-management tool. This systematic review evaluated the literature on the use of VR in the treatment of chronic nonspecific neck pain (CNNP).

METHODS

Electronic database searches were conducted in Cochrane, Medline, PubMed, Web of Science, Embase, and Scopus between inception and November 22, 2022. Search terms used were synonyms of "chronic neck pain" and "virtual reality." Inclusion criteria were as follows: chronic neck pain patients or pain lasting longer than 3 months; nonspecific neck pain; adult population; VR intervention; and functional and/or psychological outcomes. Study characteristics, quality, participant demographics, and results were independently extracted by 2 reviewers.

RESULTS

VR interventions demonstrated significant improvement in patients experiencing CNNP. Scores in the visual analogue scale, the Neck Disability Index, and range of motion were significantly improved compared with baseline but not better than gold standard kinematic treatments.

DISCUSSION

Our results suggest that VR is a promising tool for chronic pain management; however, there is a lack of VR intervention design consistency, objective outcome measures, follow-up reporting, and large sample sizes. Future research should focus on designing VR interventions to serve specific, individualized movement goals as well as combining quantifiable outcomes with existing self-report measures.

Protocol for a Parallel Group Randomized Clinical Trial Comparing a Culturally Adapted Cognitive Behavioral Telerehabilitation Intervention to Usual Physical Therapy for Latino Patients With Chronic Spine Pain

OBJECTIVE

Disparities exist in health care access, diagnosis, and treatment of chronic pain in Latino populations and other minority populations. Cognitive behavioral-based physical therapy (CBPT) interventions have been shown to be effective in predominantly non-Hispanic white populations with chronic spine pain. However, there is a need for culturally adapted CBPT interventions that focus on the conservative management of chronic spine pain. The primary purpose of the study described in this protocol is to test the efficacy of an adapted cognitive behavioral-based hybrid telerehabilitation intervention for Latino patients with chronic spine pain.

METHODS

A single-blind, 2-arm parallel group, superiority randomized clinical trial is planned to compare an adapted CBPT intervention to Usual Care physical therapy. Goal Oriented Activity for Latinos with chronic Spine pain (GOALS/Metas) is an 8-week hybrid telerehabilitation intervention that integrates guideline-based physical therapy and pain management interventions using cognitive behavioral approaches and has been adapted for Latino patients with chronic spine pain. Usual Care physical therapy will be administered based on institutional standards at the referring health center. Outcome measures will be evaluated preintervention and at 1-week, 3-months, and 6-months postintervention. The primary outcome is pain-related disability 1-week postintervention using the Brief Pain Inventory Pain Interference subscale. Secondary outcome measures include behavioral measures of functional activity, social participation, physical activity, and sleep. Determinants of treatment effect, including pain-related psychological measures, posture and movement, self-efficacy, treatment expectancy, and therapeutic alliance, will be included in the secondary moderation and mediation analyses.

IMPACT

This clinical trial will provide information on the extent to which an adapted CBPT hybrid telerehabilitation intervention is effective in reducing pain-related disability for Latino patients with chronic spine pain. This information will be useful for clinicians to integrate in their practice, given the growing population of Latino patients who experience disparities in health care management of chronic pain.

Clinical indicators for recommending continued care to patients with neck pain in chiropractic practice: a cohort study

BACKGROUND

Chiropractors' clinical indicators for recommending preventive continued care to patients with low back pain include previous pain episodes, a history of long pain duration and improvement after initial treatment. Our objectives were, in a cohort of patients with neck pain, to examine whether these clinical indicators were associated with being recommended continued care beyond 4 weeks, and if so whether this recommendation was dependent of chiropractor characteristics, as well as if the number of clinical indicators influenced this recommendation.

METHODS

In this multi-center observational study, 172 patients seeking care for a new episode of neck pain in chiropractic practice in Norway were included between September 2015 and May 2016. The chiropractors treated their patients as per usual, and for this study, baseline data and 4-week follow-up data were used. Patient data included the clinical indicators (1) previous episodes of neck pain, (2) a history of long duration neck pain and (3) improvement four weeks after initial treatment. The recruiting chiropractors were asked at 4-week follow-up if each patient was recommended continued care, defined as care planned beyond the first 4 weeks. Univariate and multivariable logistic regression models investigated the association between clinical indicators and the continued care recommendation, as well as the influence of chiropractor characteristics on this recommendation. Cross tabulations investigated the relationship between the number of indicators present and recommendation of continued care.

RESULTS

Long duration of neck pain was the strongest clinical indicator for being recommended continued care 4 weeks after the initial treatment. Chiropractor characteristics were not associated with this recommendation. In patients with all three clinical indicators present, 39% were recommended continued care. When two and one indicators were present, the percentages of those recommended continued care were 25% and 10%, respectively.

CONCLUSION

Chiropractors recommended continued care for patients experiencing neck pain based on their history of long pain duration, and this was not influenced by characteristics of the chiropractor. This differs from previous studies of indicators for maintenance care in patients with low back pain.

Risk factors for neck pain in college students: a systematic review and meta-analysis

BACKGROUND

During the COVID-19 epidemic, the prevalence of neck pain among college students has increased due to the shift from offline to online learning and increasing academic and employment pressures. Therefore, this systematic review aimed to identify the personal, occupational, and psychological factors associated with the development of neck pain to promote the development of preventive strategies and early intervention treatment.

METHODS

Seven electronic databases were searched from inception to December 2022 for cross-sectional studies, cohort studies, case----control studies, and randomized controlled trials (RCTs) on neck pain. The quality of the selected studies were assessed by American Agency for Healthcare Research and Quality (AHRQ) or the Newcastle-Ottawa Scale (NOS). Pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated to evaluate the effects of the included risk factors on neck pain.

RESULTS

Thirty studies were included, including 18,395 participants. And a total of 33 potentially associated risk factors were identified. Ultimately, 11 risk factors were included in the meta-analysis after assessing, and all results were statistically significant (P < 0.05). The factors supported by strong evidence mainly include the improper use of the pillow (OR = 2.20, 95% CI: 1.39 to 3.48), lack of exercise (OR = 1.88, 95% CI: 1.53 to 2.30), improper sitting posture (OR = 1.97, 95% CI: 1.39 to 2.78), history of neck and shoulder trauma (OR = 2.32, 95% CI: 1.79 to 3.01), senior grade (OR = 2.86, 95% CI: 2.07 to 3.95), staying up late (OR = 1.80, 95% CI: 1.35 to 2.41), long-time electronic product usage daily (OR = 1.53, 95% CI: 1.33 to 1.76), long-time to bow head (OR = 2.04, 95% CI: 1.58 to 2.64), and emotional problems (OR = 2.09; 95% CI: 1.66  to 2.63). Risk factors supported by moderate evidence were high stress (OR = 1.61, 95% CI: 1.02 to 2.52) and female gender (OR = 1.69, 95% CI: 1.52 to 1.87).

CONCLUSION

This study obtained 11 main risk factors affecting college students neck pain, including improper use of the pillow, lack of exercise, improper sitting posture, history of neck and shoulder trauma, senior grade, staying up late, long-term electronic product usage daily, long time to bow head, high stress, emotional problems and female gender.

Neck pain and headache: Pathophysiology, treatments and future directions

INTRODUCTION

Neck pain is a prevalent neurologic and musculoskeletal complaint in the general population and is often associated with primary headache disorders such as migraine and tension-type headache (TTH). A considerable proportion, ranging from 73% to 90%, of people with migraine or TTH also experience neck pain, and there is a positive correlation between headache frequency and neck pain. Furthermore, neck pain has been identified as a risk factor for migraine and TTH. Although the exact underlying mechanisms linking neck pain to migraine and TTH remain uncertain, pain sensitivity appears to play an important role. People with migraine or TTH exhibit lower pressure pain thresholds and higher total tenderness scores compared with healthy controls.

PURPOSE

This position paper aims to provide an overview of the current evidence on the relationship between neck pain and comorbid migraine or TTH. It will encompass the clinical presentation, epidemiology, pathophysiology, and management of neck pain in the context of migraine and TTH.

IMPLICATIONS

The relationship between neck pain and comorbid migraine or TTH is incompletely understood. In the absence of robust evidence, the management of neck pain in people with migraine or TTH relies mostly on expert opinion. A multidisciplinary approach is usually preferred, involving pharmacologic and non-pharmacologic strategies. Further research is necessary to fully dissect the linkage between neck pain and comorbid migraine or TTH. This includes the development of validated assessment tools, evaluation of treatment effectiveness, and exploration of genetic, imaging, and biochemical markers that might aid in diagnosis and treatment.

Variations in Concurrent Validity of Two Independent Inertial Measurement Units Compared to Gold Standard for Upper Body Posture during Computerised Device Use

Inertial measurement units (IMUs) may provide an objective method for measuring posture during computer use, but research is needed to validate IMUs' accuracy. We examine the concurrent validity of two different IMU systems in measuring three-dimensional (3D) upper body posture relative to a motion capture system (Mocap) as a potential device to assess postures outside a laboratory environment. We used 3D Mocap and two IMU systems (Wi-Fi and Bluetooth) to capture the upper body posture of twenty-six individuals during three physical computer working conditions (monitor correct, monitor raised, and laptop). Coefficient of determination (R2) and root-mean-square error (RMSE) compared IMUs to Mocap. Head/neck segment [HN], upper trunk segment [UTS], and joint angle [HN-UTS] were the primary variables. Wi-Fi IMUs demonstrated high validity for HN and UTS (sagittal plane) and HN-UTS (frontal plane) for all conditions, and for HN rotation movements (both for the monitor correct and monitor raised conditions), others moderate to poor. Bluetooth IMUs for HN, and UTS (sagittal plane) for the monitor correct, laptop, and monitor raised conditions were moderate. Frontal plane movements except UTS (monitor correct and laptop) and all rotation had poor validity. Both IMU systems were affected by gyroscopic drift with sporadic data loss in Bluetooth IMUs. Wi-Fi IMUs had more acceptable accuracy when measuring upper body posture during computer use compared to Mocap, except for trunk rotations. Variation in IMU systems' performance suggests validation in the task-specific movement(s) is essential.

Association of Cervical Spine Magnetic Resonance Imaging Abnormalities with Chronic Neck Pain in Southern Nigeria

Objective

This study was done to evaluate the relationship between cervical spine magnetic resonance imaging (MRI) findings and clinical features in adults with chronic neck pain (NP) at our tertiary hospital.

Materials and Methods

This was a prospective cross-sectional study of the cervical spine MRI of 90 adult patients with chronic NP. The clinical history, biodata, and cervical spine MRI findings were analysed. Statistical tests were considered significant at P ≤ 0.05.

Results

The mean age of the participants was 54.72 (13.51) years (range = 28-79 years). There were 52 (58%) males and 38 (42%) females. Cervical disc desiccation and disc herniation were the most prevalent MRI findings. C4/C5 and C5/C6 disc levels were most commonly affected. Disc height reduction correlated with shoulder pain (r = 0.23, P = 0.030), unsteady gait (r = 0.27, P = 0.010), and lower limb weakness (r = 0.23, P = 0.029). Vertebral collapse correlated with shoulder pain (r = 0.22, P = 0.036), upper limbs burning sensation (r = 0.33, P = 0.001), and loss of dexterity (r = 0.22, P = 0.037). Spondylolisthesis correlated significantly with unsteady gait (r = 0.34, P = 0.001), dizziness/vertigo (r = 0.29, P = 0.005), painful neck movement (r = 0.32, P = 0.002), loss of dexterity (r = 0.37, P < 0.001) and sphincteric dysfunction (r = 0.23, P = 0.031). Modic changes correlated with loss of dexterity (r = 0.39, P < 0.001) and upper limbs burning sensation (r = 0.21, P = 0.048). Cervical canal stenosis did not correlate significantly with any symptom.

Conclusion

Cervical disc disease (C4/C5 and C5/C6 levels) was the most prevalent finding on MRI. Disc height reduction, vertebral collapse, spondylolisthesis, and Modic changes correlated with various clinical symptoms.

Musculoskeletal pain in health professionals at the end of their studies and 1 year after entry into the profession: a multi-center longitudinal questionnaire study from Switzerland

BACKGROUND

Musculoskeletal pain, especially back pain, is common among health care professionals (HP). For prevention purposes, it is important to know whether HP develop their symptoms before or after entering the health care workforce. Cross-sectional studies among HP cannot answer this question. This follow-up study measures the prevalence and individual course of musculoskeletal pain among full-time HP students at the end of their studies and one year after entering the health care workforce.

METHOD

Self-reported one-year prevalence for low back pain, neck/shoulder pain, pain in arms/hands, and pain in legs/feet was collected at two timepoints from 1046 participating HP using an online questionnaire. Participants were asked whether their musculoskeletal pain was related to study or work conditions. Generalized estimating equation (GEE) models of the binomial family with log link were used to estimate adjusted prevalence and corresponding normal based 95% confidence intervals were derived using the bootstrap method with 1000 replications.

RESULTS

The prevalence of low back pain as well as neck and shoulder pain was very high at baseline and follow-up in all full-time students and later HP. Prevalence for pain in arms/hands, legs/feet was low and there were significant differences between the professions. HP clearly associated their low back pain and neck/shoulder pain with study and work conditions; HP strongly associated pain in arms/hands, legs/feet only with work conditions.

CONCLUSION

Many HP suffer from back/neck/shoulder pain already as students before starting their professional career. The prevention of back/neck/shoulder pain must be part of the education of all health professions at universities. As an example of best practice, universities should incorporate ergonomic measures and exercises into the daily routine of training health professionals. The effects of physically demanding professional tasks on the upper and lower extremities need to be investigated in further studies to take preventive measures.

Neck Pain Disability on Headache Impact and the Association between Sleep Disturbance and Neck Pain in Migraine

Neck pain (NP) is a prevalent symptom among migraine patients, but its disability on headache impact and the contributing factors for comorbid NP are poorly understood. This study aimed to investigate NP disability on the impact of headaches among migraineurs and factors linked to comorbid NP, including sleep-related variables. This cross-sectional study was conducted at a university hospital headache center, for headache patients at their first visits. Included in the study were 295 patients with migraines (217 females; 39.0  ±  10.8 years; 101 chronic migraine). Information on NP, history of physician-diagnosed cervical spine or disc disorders, detailed parameters of headache, and sleep and mood variables were collected. Logistic analysis of the severe impact of headache and contributing factors for NP were performed. NP was present in 153 participants (51.9%) with migraine, with high NP disability observed in 28 patients, and 125 patients had low NP disability. In multivariable analysis, NP disability, medication days per month, severe disability of migraine, and excessive daytime sleepiness were significant predictors for severe impact of headache. Thirty-seven patients with physician-diagnosed cervical spine or disc disorders were excluded from the NP analysis. Higher monthly headache days, female gender, and a high likelihood of obstructive sleep apnea were positively correlated with the presence of NP among migraineurs in multivariable analysis. Overall, the study highlights the potential impact of sleep-related variables and monthly headache days on NP in these patients. The high disability of NP was also associated with severe impact of headache.

Certainty of the Global Burden of Disease 2019 Modelled Prevalence Estimates for Musculoskeletal Conditions: A Meta-Epidemiological Study

Objectives: To describe and assess the risk of bias of the primary input studies that underpinned the Global Burden of Disease Study (GBD) 2019 modelled prevalence estimates of low back pain (LBP), neck pain (NP), and knee osteoarthritis (OA), from Australia, Brazil, Canada, Spain, and Switzerland. To evaluate the certainty of the GBD modelled prevalence evidence. Methods: Primary studies were identified using the GBD Data Input Sources Tool and their risk of bias was assessed using a validated tool. We rated the certainty of modelled prevalence estimates based on the GRADE Guidelines 30-the GRADE approach for modelled evidence. Results: Seventy-two primary studies (LBP: 67, NP: 2, knee OA: 3) underpinned the GBD estimates. Most studies had limited representativeness of their study populations, used suboptimal case definitions and applied assessment instruments with unknown psychometric properties. The certainty of modelled prevalence estimates was low, mainly due to risk of bias and indirectness. Conclusion: Beyond the risk of bias of primary input studies for LBP, NP, and knee OA in GBD 2019, the certainty of country-specific modelled prevalence estimates still have room for improvement.

A Case of Eagle Syndrome in a Chiropractic Patient

Eagle syndrome is a rare condition that is characterized by, among other things, pain in the face and neck, with the majority of cases being unilateral and isolated to the lower jaw. It is not uncommon for the pain to radiate to the ear. Symptoms can be constant or intermittent and may increase with yawning or rotation of the head, causing Eagle syndrome to be frequently misdiagnosed. The objective of this report is to summarize the symptoms, diagnostic workup, necessary imaging, and management of Eagle syndrome.

A Retrospective Evaluation and Review of Radiographic Outcomes for Anterior Cervical Discectomy and Fusion (ACDF) Procedures: Northern Ireland's Experience

Introduction Anterior Cervical Discectomy and Fusion (ACDF) is the gold standard treatment for symptomatic cervical spondylosis refractory to analgesic medical management. Currently, there are numerous approaches and devices used; however, there is no single implant that is preferred for this procedure. The aim of this study is to evaluate the radiological outcomes of ACDF procedures performed in the regional spinal surgery centre in Northern Ireland. The results of this study will aid surgical decision-making, specifically with regard to the choice of implant. The implants that will be assessed in this study are the stand-alone polyetheretherketone (PEEK) cage (Cage) and the Zero-profile augmented screw implant (Z-P). Methods A total of 420 ACDF cases were reviewed retrospectively. Following exclusion and inclusion criteria, 233 cases were reviewed. In the Z-P group, there were 117 patients, with 116 in the Cage group. Radiographic assessment was carried out at the pre-operative stage, day one post-operation, and follow-up (> three months). Measured parameters included segmental disc height, segmental Cobb angle, and spondylolisthesis displacement distance. Results Patient characteristic features showed no significant difference between the two groups (p>0.05) and no significant difference in mean follow-up time (p=0.146). The Z-P implant was superior in increasing and maintaining disc height post-operatively (+0.4±0.94mm, 5.20±0.66mm) compared to the Cage (+0.1±1.00mm, 4.40±0.95mm) (p<0.001). Z-P was also more successful in restoring and maintaining cervical lordosis in comparison to the Cage group, as it had a significantly smaller kyphosis incidence (0.85% vs. 34.5%) at follow-up (p<0.001). Conclusions Results of this study show a more advantageous outcome in the Zero-profile group as it restores and maintains both disc height and cervical lordosis; it is also more successful in treating spondylolisthesis. This study advocates cautious endorsement of the use of the Zero-profile implant in ACDF procedures for symptomatic cervical disc disease.

Interventional non-operative management of low back and neck pain

Background

Chronic neck and back pain are among the most commonly encountered health problems in neurosurgical practice. Many cases fail prolonged pharmacological and physical therapy and are not proper candidates for surgical interventions, or had refused proposed surgical treatment.

Objective

To provide an informative critical summary of the literature about the topic of interventional management of axial neck and low back pain and highlighting the new trends and pieces of evidence.

Methods

The English literature published over the last two decades was reviewed by the author for recent and relevant data about the principles of interventional management of chronic neck and low back pain. A PubMed search was performed through phrase searching and combined searching using Boolean operators. The articles thought to be most relevant to the study aim and the neurosurgeons’ practice were extracted.

Results

Neck and low back pain continue to be among the most common musculoskeletal health problems and the most common cause of disability worldwide. A detailed understanding of relevant spine anatomy is crucial for interventionists who should deal with the concept of “functional spine unit” with multiple potential pain generators. Chronic spinal pain is best managed through a dedicated multidisciplinary team in well-equipped healthcare facilities. An algorithmic approach for the diagnosis and management of spinal pain is the mainstay of providing the best patient care and should be based on the commonality and treatability of pain generators, values of patients and available resources.

Conclusion

Management of chronic neck and back pain can represent a clinical dilemma due to the multiplicity of pain generators that may coexist in the same individual resulting in a complex type and pattern of pain. Approach to these patients requires contributions from the members of a multidisciplinary team, implementing a standardized approach in a well-equipped healthcare facility.

The association between psychosocial factors and mental health symptoms in cervical spine pain with or without radiculopathy on health outcomes: a systematic review

BACKGROUND

Neck pain, with or without radiculopathy, can have significant negative effects on physical and mental wellbeing. Mental health symptoms are known to worsen prognosis across a range of musculoskeletal conditions. Understanding the association between mental health symptoms and health outcomes in this population has not been established. Our aim was to systematically review the association between psychosocial factors and/or mental health symptoms on health outcomes in adults with neck pain, with or without radiculopathy.

METHODS

A systematic review of published and unpublished literature databases was completed. Studies reporting mental health symptoms and health outcomes in adults with neck pain with or without radiculopathy were included. Due to significant clinical heterogeneity, a narrative synthesis was completed. Each outcome was assessed using GRADE.

RESULTS

Twenty-three studies were included (N = 21,968 participants). Sixteen studies assessed neck pain only (N = 17,604 participants); seven studies assessed neck pain with radiculopathy (N = 4,364 participants). Depressive symptoms were associated with poorer health outcomes in people with neck pain and neck pain with radiculopathy. These findings were from seven low-quality studies, and an additional six studies reported no association. Low-quality evidence reported that distress and anxiety symptoms were associated with poorer health outcomes in people with neck pain and radiculopathy and very low-quality evidence showed this in people with neck pain only. Stress and higher job strain were negatively associated with poorer health outcomes measured by the presence of pain in two studies of very low quality.

CONCLUSIONS

Across a small number of highly heterogenous, low quality studies mental health symptoms are negatively associated with health outcomes in people with neck pain with radiculopathy and neck pain without radiculopathy. Clinicians should continue to utilise robust clinical reasoning when assessing the complex factors impacting a person's presentation with neck pain with or without radiculopathy.

PROSPERO REGISTRATION NUMBER

CRD42020169497.