The age- and sex-specific occurrence of bothersome neck pain in the general population--results from the Stockholm public health cohort

Occupational exposure to whole-body vibration and neck pain in the Swedish general population

The primary aim of this study was to determine if occupational exposure to whole-body vibration (WBV) was associated with reporting neck pain. A cross-sectional study was conducted on a sample of the general population living in northern Sweden, aged 24-76 years. Data was retrieved through a digital survey that collected subjectively reported information on exposure to WBV and biomechanical exposures as well as neck pain. The study included 5,017 participants (response rate 44%). Neck pain was reported by 269 men (11.8%) and 536 women (20.2%). There was a statistically significant association between reporting occupational exposure to WBV half the time or more (adjusted OR 1.91; 95% CI 1.22-3.00) and reporting neck pain. In gender-stratified analyses, the same pattern was observed in men, while there were too few women to determine any association. We conclude that occupational exposure to whole-body vibration was associated with neck pain in men.Practitioner summary: This cross-sectional, survey-based study investigated associations between self-reported occupational whole-body vibration and neck pain. It showed significant associations between frequent exposure to whole-body vibration and neck pain among men but not women. In occupational health care settings, whole-body vibration could be considered as a possible risk factor for neck pain.

A randomized controlled trial on the effects of "Global Postural Re-education" versus neck specific exercise on pain, disability, postural control, and neuromuscular features in women with chronic non-specific neck pain

BACKGROUND

Neck pain is associated with decreased health-related quality of life, decreased work productivity, and increased visits to health care providers.

AIM

The aim of this study was to assess the effectiveness of "Global Postural Re-education" (GPR) versus a neck specific exercise (SE) program on neck pain, disability, cervical range of movement, postural stability, and activity of the superficial cervical flexor muscles.

DESIGN

A parallel-group and single-blinded clinical trial.

SETTING

Community interventions.

POPULATION

Fifty women with non-specific chronic neck pain (NSCNP).

METHODS

Participants were randomly assigned to one of the two intervention groups (GPR [N.=25] or SE [N.=25]). Both interventions consisted of eight sessions of ~40 minutes duration, performed twice a week, for four weeks. Outcomes included neck pain intensity and disability, cervical range of motion (CROM), postural sway, and activity of the superficial neck flexor muscles during a cranio-cervical flexion test (CCFT). All outcomes were assessed twice before the intervention and immediately following eight treatment sessions over four weeks.

RESULTS

Both interventions were equally effective in reducing neck pain (P<0.001, ŋp²=0.770) and disability (P<0.001, ŋp²=0.306), improving neck mobility (P<0.001, 0.385≤ŋp²≤0.623, for all measurements) and decreasing the activity of the superficial cervical flexor muscles (P>0.001). Neither intervention altered postural sway.

CONCLUSIONS

Our results revealed that GPR and SE induced significant positive results in all measures apart from postural stability but with no difference between the interventions.

CLINICAL REHABILITATION IMPACT

"Global Postural Re-education" (GPR) and neck SE interventions are equally effective in reducing neck pain and disability, and improving neck mobility in women with NSCNP. Overall, this study indicates that GPR and SE interventions can be used to effectively manage patients with NSCNP.

Impact of Gender on Postsurgical Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion

BACKGROUND

Prior studies associate male gender with higher complication rates following anterior cervical discectomy and fusion (ACDF), but none has investigated gender influence on patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) following single-level ACDF.

METHODS

Patients undergoing primary, single-level ACDF were divided into female and male groups. Visual analog scale (VAS) neck/arm, Neck Disability Index (NDI), 12-item short form (SF-12) physical composite score (PCS), PROM information system physical function (PROMIS-PF), and veterans RAND 12-item (VR-12) health survey PCS were collected preoperatively and postoperatively. Simple linear regression analysis evaluated the predictive capability of gender on PROMs. Multiple regression analysis was performed to determine the effects of gender on mean PROMs while accounting for insurance type. Established MCID values determined achievement rates across PROMs. χ ² analysis compared MCID achievement by gender.

RESULTS

A total of 179 women and 134 men were included. Cohorts differed in insurance type, length of stay, and discharge day (P ≤ 0.017, all). Women improved in PROMs at all timepoints (P ≤ 0.049, all) except SF-12 PCS 6 weeks and PROMIS-PF 6 weeks. Men improved in PROMs at all timepoints (P ≤ 0.042) except VAS arm 2 years, SF-12 PCS 6 weeks and 2 years, PROMIS-PF 6 weeks, and VR-12 PCS 6 weeks. Women demonstrated higher SF-12 PCS (P = 0.043) and VR-12 PCS (P = 0.035) 2 years. Multiple regression determined that VAS neck and arm from 6 weeks to 6 months, NDI from preoperative to 6 months, SF-12 PCS and VR-12 PCS from preoperative to 12 weeks, and PROMIS-PF preoperative, 6 weeks, and 6 months were significantly affected by gender and insurance status (P ≤ 0.031, all). MCID achievement rate did not differ for any PROM between genders.

CONCLUSION

Women reported significantly higher long-term physical function health (SF-12 PCS and VR-12 PCS) compared with men, while disability and pain did not differ. Nevertheless, no significant differences in MCID achievement were observed for any PROM studied. Gender does not appear to play a significant role in clinically meaningful recovery following single-level ACDF.

CLINICAL RELEVANCE

Gender has little value in prognostication for determining clinically meaningful recovery after single-level ACDF.

LEVEL OF EVIDENCE: 3

Manual therapy versus advice to stay active for nonspecific back and/or neck pain: a cost-effectiveness analysis

BACKGROUND

Low back and neck pain are the most common musculoskeletal disorders worldwide, and imply suffering and substantial societal costs, hence effective interventions are crucial. The aim of this study was to evaluate the cost-effectiveness of manual therapy compared with advice to stay active for working age persons with nonspecific back and/or neck pain.

METHODS

The two interventions were: a maximum of 6 manual therapy sessions within 6 weeks, including spinal manipulation/mobilization, massage and stretching, performed by a naprapath (index group), respectively information from a physician on the importance to stay active and on how to cope with pain, according to evidence-based advice, at 2 occasions within 3 weeks (control group). A cost-effectiveness analysis with a societal perspective was performed alongside a randomized controlled trial including 409 persons followed for one year, in 2005. The outcomes were health-related Quality of Life (QoL) encoded from the SF-36 and pain intensity. Direct and indirect costs were calculated based on intervention and medication costs and sickness absence data. An incremental cost per health related QoL was calculated, and sensitivity analyses were performed.

RESULTS

The difference in QoL gains was 0.007 (95% CI - 0.010 to 0.023) and the mean improvement in pain intensity was 0.6 (95% CI 0.068-1.065) in favor of manual therapy after one year. Concerning the QoL outcome, the differences in mean cost per person was estimated at - 437 EUR (95% CI - 1302 to 371) and for the pain outcome the difference was - 635 EUR (95% CI - 1587 to 246) in favor of manual therapy. The results indicate that manual therapy achieves better outcomes at lower costs compared with advice to stay active. The sensitivity analyses were consistent with the main results.

CONCLUSIONS

Our results indicate that manual therapy for nonspecific back and/or neck pain is slightly less costly and more beneficial than advice to stay active for this sample of working age persons. Since manual therapy treatment is at least as cost-effective as evidence-based advice from a physician, it may be recommended for neck and low back pain. Further health economic studies that may confirm those findings are warranted. Trial registration Current Controlled Trials ISRCTN56954776. Retrospectively registered 12 September 2006, http://www.isrctn.com/ISRCTN56954776 .

Association between back and neck pain and workplace absenteeism in the USA: the role played by walking, standing, and sitting difficulties

PURPOSE

There is a paucity of literature identifying factors that influence the back and neck pain (BNP)-workplace absenteeism relationship. Therefore, this study aimed to investigate the association between BNP and workplace absenteeism and potential mediating variables in a large sample of the US population.

METHODS

Nationally representative data collected in 2019 from the RAND American Life Panel (ALP) were used for this retrospective study. Workplace absenteeism was defined as the number of days of absence in the past 12 months for health-related reasons (count variable), while BNP corresponded to the presence of back pain due to spinal stenosis, back pain due to other causes, or neck pain (dichotomous variable). Control variables included sex, age, ethnicity, marital status, education, occupation, annual family income, health insurance, obesity, and diabetes. There were eight influential variables (depression, anxiety, sleep disorder, alcohol dependence, opioid dependence, walking difficulty, standing difficulty, and sitting difficulty). The association between BNP and workplace absenteeism was analyzed using a negative binomial regression model.

RESULTS

There were 1,471 adults aged 22-83 years included in this study (52.9% of men; mean [standard deviation] age 44.5 [13.0] years). After adjusting for control variables, BNP was positively and significantly associated with workplace absenteeism (incidence rate ratio = 1.40, 95% confidence interval: 1.07-1.83). Walking, standing, and sitting difficulties individually explained between 24 and 43% of this association.

CONCLUSIONS

Workplace interventions focusing on the management of BNP and overcoming difficulties in walking, standing, and sitting, potentially utilizing exercise, therapy, and ergonomic interventions, may prevent absenteeism.

The burden of neck pain in Brazil: estimates from the global burden of disease study 2019

Background

This study analyzed neck pain estimates in Brazil and its states between 2000 and 2019, in view of the country’s lacking epidemiological data.

Methods

An analysis was performed of the GBD 2019 estimates by location, sex, and age, per 100,000 population, with uncertainty intervals (95% UI). Brazilian estimates were compared to global, Mexican, English, and American rates.

Results

Global, Brazilian, and Mexican prevalence numbers were statistically homogeneous and stable in the period. Throughout the period analyzed in the study, Brazilian neck pain prevalence (2241.9; 95%UI 1770.5–2870.6) did not show statistical differences when compared to global (2696.5; 95%UI 2177.0–3375.2) or Mexican (1595.9; 95%UI 1258.9–2058.8) estimates. Estimates observed in the USA (5123.29; 95%UI 4268.35–6170.35) and England (4612.5; 95%UI 3668.8–5830.3) were significantly higher. In 2019, when compared to the USA and England, age-standardized prevalences were lower globally, in Brazil, and in Mexico. Prevalences in Brazilian states were similar, being that Roraima (1915.9; 95%UI 1506.5–2443.1) and the Federal District (1932.05; 95%UI 1515.1–2462.7) presented the lowest and highest values respectively. The exception was the state of São Paulo (3326.5; 95%UI 2609.6–4275.5). There was no statistical difference by sex, but the prevalence tended to increase with aging. In 2019, the Brazilian prevalence was 2478.6 (95% UI 1791.0–3503.8), 5017.2 (95%UI 3257.26–7483.8), and 4293.4 (95% UI 2898,8–6343.9), for those aged 15 to 49, 50 to 69, and 70+ years. There was no statistical difference among the YLDs in all locations and times.

Conclusions

Brazil is going through a fast-paced process of populational aging; a higher prevalence of neck pain in middle-aged individuals and the elderly highlights the need for lifelong prevention initiatives. The higher rates observed among higher-income populations and the homogeneity of the Brazilian estimates suggest a lack of robust epidemiological data in lower-income countries.

Biomechanical Evaluation of a Novel S-Type, Dynamic Zero-Profile Cage Design for Anterior Cervical Discectomy and Fusion with Variations in Bone Graft Shape: A Finite Element Analysis

BACKGROUND

Variations in cage design, material, and graft shape can affect osteointegration and adjacent segment range of motion (ROM) and stress after anterior cervical discectomy and fusion (ACDF) surgery. This study aimed to evaluate the biomechanical properties of a novel dynamic cervical cage design in both titanium (Ti) and polyether ether ketone (PEEK) with variations in bone graft shape using a single level ACDF (FE) model.

METHODS

A 3-dimensional C3-C6 FE model was developed using computed tomography scan data from a healthy male subject. The novel S-shaped dynamic interbody fusion cage with a zero-profile fixation was inserted at the C4-C5 level with 4 different bone graft shapes (square, circular, rectangular, and elliptical). Changes in segmental ROM and maximum von Mises stresses at the fusion and adjacent segments were analyzed.

RESULTS

Both Ti and PEEK cages showed decreased ROM at the fusion and adjacent levels for all shapes of bone graft when compared with the intact spine model. The elliptical graft, for both Ti and PEEK cages, showed a lower percentage of reduction in segmental ROM at the fusion and adjacent levels (0%-5.6%) when compared with other graft shapes (0%-12%). Maximum stresses at the fusion level were lowest in Ti cage with elliptical graft (229.8-347.6 MPa) when compared with other shapes (241.2-476.2 MPa) in flexion, extension, and lateral bending. For the bone graft, maximum stresses were highest on the elliptical-shaped bone graft in flexion and extension in the Ti cage, and in flexion and lateral bending in the PEEK cage.

CONCLUSIONS

Both Ti and PEEK cages showed decreased ROM at the fusion and adjacent levels for all shapes of bone graft when compared with the intact spine model. In the Ti and PEEK dynamic cages, the elliptical shape bone graft showed decreased stress on the cage and increased stress on the bone graft. Further experimental and clinical studies are needed to confirm these encouraging biomechanical results of this novel dynamic, zero-profile fusion device with elliptical bone graft in ACDF surgery.

Forward flexed posture: reliability and determinants of tragus-to-wall measurement

INTRODUCTION

Forward flexed posture is an impairment in body structure commonly seen among older adults and those with pathologies such as ankylosing spondylitis and osteoporosis. Accurate measurement of forward flexed posture is important as it is related to pain, mobility limitations, and falls. Our purpose was to examine the reliability and determinants of forward flexed posture as indicated by tragus-to-wall (TTW) distance.

METHODS

Twenty healthy younger and 20 healthy older adults were included in this secondary analysis of data from a neck strength study. Measurements included the linear distance of TTW standing naturally and with neck retraction, age, gender, body mass index (BMI), and neck retraction strength. Measurements were performed initially by 2 investigators and by the primary investigator 1 week later. Intraclass correlation coefficients (ICCs) (model 3,1) described relative reliability and Bland-Altman plots characterized absolute reliability. A mixed general linear model examined the determinants for TTW distance.

RESULTS

Good inter-rater (ICC = 0.811-0.878) and test-retest reliability (ICC = 0.853-0.862) were found in both positions. Bland-Altman plots showed that absolute limits of agreement ranged from - 1.9 to +3.8 cm for inter-rater reliability and -2.4 to +2.6 cm for test-retest reliability. Analysis of TTW determinants demonstrated significant differences between neck positions, dichotomous age groups, and BMI groups (p ≤ 0.001). There was no significant difference based on neck strength.

CONCLUSIONS

Our results indicate that TTW distance, measured using a standardized procedure, is a reliable method of quantifying forward flexed posture. TTW distance is greater in relaxed standing, older individuals, and those with greater BMI.

Important work demands for reducing sickness absence among workers with neck or upper back pain: a prospective cohort study

BACKGROUND

The aim of this study was to investigate what exposure to work demands, physical and psychosocial, is associated with lower levels of sickness absence among workers with neck or upper back pain in different groups, by age, gender, duration of sickness absence and work ability score.

METHODS

This study was a prospective study of 4567 workers with neck or upper back pain. Data on neck or upper back pain, work demand and work ability were obtained from the Swedish Work Environment survey over a 3-year period (2009-2013). Register data on sickness absence, 1 year after each survey was conducted, were obtained from the Swedish health insurance database. Analyses were performed to estimate the association between self-reported work demands and registered sick days > 14 days. The analyses were stratified for gender, age group and work ability score.

RESULTS

Lower numbers of sick days were found for workers reporting low exposure to lifting ≥15 kg and twisted or forward-leaning work postures. Lower numbers of sick days were found for workers reporting high work control and seated work. The associations were generally stronger in the older age groups for the physical work demands.

CONCLUSIONS

The findings in this study suggest that certain physical work demands and having high control over one's work can result in lower sickness absence, especially among middle-aged and older workers with neck or upper back pain.

Gender and posture are significant risk factors to musculoskeletal symptoms during touchscreen tablet computer use

[Purpose] To investigate the prevalence of neck and shoulder symptoms during the use of tablet computer, and to identify the risk factors associated with these symptoms. [Subjects and Methods] A cross-sectional survey was conducted to study tablet computer usage, posture during use, and neck and shoulder symptoms in 412 participants in a school setting. Significant risk factors for musculoskeletal symptoms during tablet computer use were identified. [Results] Overall prevalence of musculoskeletal symptoms during tablet computer use was 67.9% with greater prevalence of neck symptoms (neck: 84.6%; shoulder/upper extremity: 65.4%). Significant risk factors associated with symptoms during use were: current musculoskeletal symptoms, gender, roles, and postural factors including: sitting without back support, sitting with device in lap, and lying on the side and on the back during tablet computer use. A multivariate analysis further showed that the odds for females to have symptoms were 2.059 times higher than males. [Conclusion] The findings revealed that female gender and other postural factors were significantly associated with musculoskeletal symptoms during the use of tablet computer. Among all postural factors, sitting without back support was identified as the most important risk factor for having musculoskeletal symptoms.

Prevalence and Consequences of Injuries in Powerlifting: A Cross-sectional Study

Background:

Powerlifting consists of the squat, bench press, and dead lift, and extreme loads are lifted during training and competitions. Previous studies, which have defined an injury as an event that causes an interruption in training or competitions, have reported a relatively low frequency of powerlifting injuries (1.0-4.4 injuries/1000 hours of training). No previous study has investigated the prevalence of injuries, defined as a condition of pain or impairment of bodily function that affects powerlifters’ training, in a balanced sample of men and women, and no studies have established possible risk factors for an injury.

Purpose:

To investigate the prevalence, localization, and characterization of injuries among Swedish subelite classic powerlifters, with an emphasis on differences between men and women, and to investigate whether training and lifestyle factors are associated with an injury.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 53 female and 51 male Swedish subelite powerlifters answered an online questionnaire including questions about background characteristics, training habits, and lifestyle factors. The main part of the questionnaire included questions about injuries and their consequences. An injury was defined as a condition of pain or impairment of bodily function that affects powerlifters’ training.

Results:

Seventy percent (73/104) of participants were currently injured, and 87% (83/95) had experienced an injury within the past 12 months. The lumbopelvic region, shoulder, and hip were the most commonly injured areas for both sexes. Women experienced a significantly greater frequency of injuries in the neck and thoracic region than men. Injuries seemed to occur during training, although only 16% (11/70) of those currently injured had to completely refrain from training. Training frequency, greater personal best in the dead lift, injury onset during bench-press and dead-lift training, use of straps, alcohol consumption, and dietary issues were associated with current injuries.

Conclusion:

Injuries are very common in subelite powerlifters. Men and women report similar injury frequencies but different anatomic locations. These injuries do not prevent powerlifters from training and competing, but they may change the content of training sessions. Why powerlifters develop injuries is still unclear; however, it is likely that the management of training loads and optimization of the lifting technique during the squat, bench press, and dead lift are of importance.

Reporting of pain by people with chronic obstructive pulmonary disease (COPD): comparative results from the HUNT3 population-based survey

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is often associated with chronic pain, but pain in COPD remains poorly understood, particularly in comparison to pain in other groups. We compared the pain reported by people with COPD with that reported by arthritis, heart disease, diabetes, and those not reporting any disease, while adjusting for the effects of selected sociodemographic and lifestyle factors, comorbidities, anxiety, and depression.

METHODS

Using cross-sectional data from a population-based health survey in Norway (HUNT3; n = 50,807), we included participants with COPD (n = 1199), participants without COPD, but with arthritis (n = 8582), heart disease (n = 4109), or diabetes (n = 1254), and participants without any disease (n = 18,811). Logistic and linear regression analyses were performed to estimate the probability of reporting chronic pain and the level of pain intensity in the different groups adjusting for other relevant factors.

RESULTS

Approximately half (51.8%) of people with COPD reported chronic pain, which was a significantly higher rate than in the diabetes and non-disease groups, and similar to the heart disease group. People with arthritis had a chronic pain rate of 75.4%, which was higher than all other groups, including COPD. Analyses of pain intensity yielded similar findings, with the COPD group having higher pain intensity than the diabetes and non-disease groups, similar pain intensity as the heart disease group, and less pain intensity than the arthritis group. The likelihood of chronic pain and the intensity of pain were generally higher among women, people employed in occupations with low educational requirements, smokers, and those with comorbidity. Chronic pain rates and pain intensity increased with age and higher anxiety and depression scores, and were inversely related to physical activity.

CONCLUSIONS

People with COPD are at increased risk for chronic pain and higher pain intensity, second only to those with arthritis among the disease groups included in this study. The findings indicate a close relationship between pain and anxiety and depression. The relationships between pain and socioeconomic and lifestyle factors (e.g., smoking and exercise) suggest the need for efforts at the societal level to reduce inequality in health.

Effects of Myofascial Release on Pressure Pain Thresholds in Patients With Neck Pain: A Single-Blind Randomized Controlled Trial

OBJECTIVE

This study aimed to investigate the efficacy of myofascial release therapy (MRT) for improving pressure pain thresholds (PPTs) and pain in patients with mechanical neck pain.

DESIGN

Forty-one participants with neck pain were randomly allocated to either a MRT group (five sessions) or a physical therapy (PT) group (ten sessions) for 2 wks. The multimodal PT program included ultrasound therapy (US), transcutaneous electric nerve stimulation, and massage. Visual analog scale (VAS) and PPTs in suboccipital and upper trapezius muscles were measured at baseline, at the end of treatment, and at 1 month follow-up.

RESULTS

At the end of treatment, significant mean differences in VAS (-0.99, 95% confidence interval [CI] = -1.82 to -0.16), in both left (0.28, 95% CI = 0.06 to 0.50) and right (0.40, 95% CI = 0.16 to 0.63) suboccipital PPTs and in the right trapezius PPT (0.38, 95% CI = 0.07 to 0.69) were observed. At 1-month follow-up, significant mean differences were found for VAS (-1.85, 95% CI = -2.76 to -0.94) and both left (0.46, 95% CI = 0.12 to 0.80) and right (0.38, 95% CI = 0.06 to 0.69) suboccipital PPTs.

CONCLUSIONS

This study provides evidence that MRT could be better than a multimodal PT program for short-term improvement of pain and PPTs in patients with neck pain.

A Lower Level of Physically Demanding Work Is Associated with Excellent Work Ability in Men and Women with Neck Pain in Different Age Groups

BACKGROUND

The aim of this study was to investigate which physical and psychosocial work demands were associated with excellent work ability in individuals with neck pain, and to investigate age and sex differences in these associations.

METHODS

The study sample was obtained from the Statistics Sweden cross-sectional Work Environment survey and consisted of workers who reported neck pain after work (N = 3,212).

RESULTS

The findings showed an association between excellent work ability and self-reported low exposure to lifting, twisted work posture, working with hands in shoulder level or higher, and leaning forward without support and combination of exposures containing these work demands. Low exposure to seated work and high demands showed a reversed association. The associations were present mainly among older workers and were generally stronger for men than for women.

CONCLUSION

This study indicates that a lower level of physically demanding work is an important element to maintain excellent work ability, especially for the older worker with neck pain.

Progression of untreated mild thoracic Scheuermann's kyphosis - Radiographic and functional assessment after mean follow-up of 46 years

BACKGROUND

There is no data available on the radiographic development of the Scheuermann's deformity. Our purpose was to investigate radiographic deformity progression and the relation between kyphosis progression and clinical outcome in patients with untreated Scheuermann's kyphosis.

METHODS

Thoracic kyphosis (Th4-Th12) was measured from standing lateral radiographs in 19 patients at baseline and after mean 46-year follow-up. Mean age at baseline was 19.2 and at follow-up 64.7 years. At follow-up, height, weight, hand grip strength, and hamstring tightness were measured, and sit-to-stand and walking tests were performed. Additionally general health and quality of life questionnaires were administered.

RESULTS

The mean thoracic kyphosis increased from 46° (range 25°-78°) at baseline to 60° (34°-82°) (p < 0.001) at follow-up. Mean of the vertebrae wedge increased from 8.8° to 9.9° (p = 0.046). There was no correlation between extent of kyphosis progression and function at follow-up.

CONCLUSIONS

Among patients with Scheuermann's disease the degree of radiographic deformity progressed slightly during long-term follow-up. Progression did not predict symptoms.

Musculoskeletal diagnostic ultrasound imaging for thickness measurement of four principal muscles of the cervical spine -a reliability and agreement study

BACKGROUND

The reliability of musculoskeletal diagnostic ultrasound imaging (MSK-DUSI) for the evaluation of neck musculature has been sparsely documented in the research literature. Until now, research has featured a limited number of subjects and only few studies have tested for both inter- and intra-reliability using appropriate methodology.

METHODS

Four examiners conducted an inter- and intra-rater reliability and agreement study. Fifty females with and without neck pain (NP) between the ages of 20-70 were recruited from October 2014 to April 2015. The muscles that were evaluated were the longus colli (Lcol), the rectus capitis posterior major (Rcpm), the deep cervical extensors (Dce) and the semispinalis capitis (Sscap). Each of the examiners captured ultrasound images of their allocated muscle and measured the thickness of that muscle twice, on separate occasions, for the first part of the intra-rater reliability study. For the second part, a second image of the same muscle was taken on the same subject and measured by the same examiner. The four examiners then met to measure on each other's images, to test inter-rater reliability. Their results were compared pair-wise using Interclass Correlation Coefficients (ICC) and Bland-Altman plots. Linear regression analysis was performed to evaluate for possible bias.

RESULTS

Inter-rater reliability was found to be good for Lcol and Sscap muscles and moderate towards poor for the deeper Rcpm and Dce muscles. Intra-rater reliability was good for all the muscles, with the exception of the Dce, which was found to be moderate in the second part of the study. The B&A plots showed good agreement, few outliers, and no bias. However, the agreement intervals indicated a measurement error within the variance of the method that may not have been acceptable for these small muscles if the aim is to evaluate change in thickness.

CONCLUSIONS

This study found that MSK-DUSI had variable reliability in assessing the thickness of the Lcol, Rcpm, Dce, and Sscap muscles. No bias was demonstrated, but agreement intervals were wide.

Diabetes mellitus and hyperlipidaemia as risk factors for frequent pain in the back, neck and/or shoulders/arms among adults in Stockholm 2006 to 2010 - Results from the Stockholm Public Health Cohort

BACKGROUND AND AIMS

Frequent back, neck and/or shoulder pain (BNSP) are common conditions which pose high burden for the society. Results from previous studies suggest that diabetes and hyperlipidaemia may be associated with a higher risk of getting such conditions, but there is in general, few studies based on longitudinal designs. The aim of this study was therefore to compare the risk of developing frequent BNSP in men and women with and without diabetes and/or hyperlipidaemia.

METHODS

A longitudinal study based on the Stockholm Public Health Cohort was conducted based on subjects aged 45-84, who were free from pain at the mentioned sites in 2006 and followed up until 2010. The data in the current study is based on questionnaires, except socioeconomic status which was derived from Statistics Sweden. The exposure diabetes and hyperlipidaemia was self-reported and, a categorical variable was created; without any of the conditions, with hyperlipidaemia only, with diabetes only and with both conditions. The outcome frequent BNSP was defined using the following questions in the questionnaire in 2010: "During the past 6months, have you had pain in the neck or upper part of the back?", "During the past 6months, have you had pain in the lower back?", and "During the past 6months, have you had pain in the shoulders/arms?". All questions had three possible response options: no; yes, a couple of days per month or less often and; yes, a couple of days per week or more often. Those who reported weekly pain to at least one of these questions were considered to having frequent BNSP. Binomial regressions were run to calculate the crude and adjusted risk ratio (RR) in men and women separately. Additional analysis was performed in order to control for potential bias derived from individuals lost to follow-up.

RESULTS

A total of 10,044 subjects fulfilled the criteria to be included in the study. The mean age of the sample was 60years and evenly distributed by sex. After adjusting for age, body mass index, physical activity, high blood pressure and socioeconomic status, the RR for frequent BNSP among men with diabetes was 1.64 (95% CI: 1.23-2.18) and 1.19 (95% CI: 0.98-1.44) for hyperlipidaemia compared to men with neither diabetes nor hyperlipidaemia. Among women the corresponding RRs were 0.92 (95% CI: 0.60-1.14) and 1.23 (95% CI: 1.03-1.46). Having both diabetes and hyperlipidaemia at baseline was not associated with increased risk of frequent BNSP. Diabetes and hyperlipidaemia seems to be associated with an increased risk for frequent BNSP and the risk may differ between men and women. Behaviours and/or biological underlying mechanisms may explain the results.

CONCLUSIONS

This study suggests that metabolic diseases such as diabetes and hyperlipidaemia may have an impact on the pathophysiology of frequent BNSP and thus, contributes to the knowledge in musculoskeletal health. Furthermore, it confirms that men and women may differ in terms of risk factors for BNSP.

IMPLICATIONS

Health professionals should contemplate the results from this study when planning primary prevention strategies.

Feasibility of a Smartphone-Based Exercise Program for Office Workers With Neck Pain: An Individualized Approach Using a Self-Classification Algorithm

OBJECTIVE

To explore the feasibility of a newly developed smartphone-based exercise program with an embedded self-classification algorithm for office workers with neck pain, by examining its effect on the pain intensity, functional disability, quality of life, fear avoidance, and cervical range of motion (ROM).

DESIGN

Single-group, repeated-measures design.

SETTING

The laboratory and participants' home and work environments.

PARTICIPANTS

Offices workers with neck pain (N=23; mean age ± SD, 28.13±2.97y; 13 men).

INTERVENTION

Participants were classified as having 1 of 4 types of neck pain through a self-classification algorithm implemented as a smartphone application, and conducted corresponding exercise programs for 10 to 12min/d, 3d/wk, for 8 weeks.

MAIN OUTCOME MEASURES

The visual analog scale (VAS), Neck Disability Index (NDI), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Fear-Avoidance Beliefs Questionnaire (FABQ), and cervical ROM were measured at baseline and postintervention.

RESULTS

The VAS (P<.001) and NDI score (P<.001) indicated significant improvements in pain intensity and functional disability. Quality of life showed significant improvements in the physical functioning (P=.007), bodily pain (P=.018), general health (P=.022), vitality (P=.046), and physical component scores (P=.002) of the SF-36. The FABQ, cervical ROM, and mental component score of the SF-36 showed no significant improvements.

CONCLUSIONS

The smartphone-based exercise program with an embedded self-classification algorithm improves the pain intensity and perceived physical health of office workers with neck pain, although not enough to affect their mental and emotional states.

Prevalence of chronic spinal pain and identification of associated factors in a sample of the population of São Paulo, Brazil: cross-sectional study

CONTEXT AND OBJECTIVE:

Chronic spinal pain, especially low-back pain and neck pain, is a leading cause of years of life with disability. The aim of the present study was to estimate the prevalence of chronic spinal pain among individuals aged 15 years or older and to identify the factors associated with it.

DESIGN AND SETTING:

Cross-sectional epidemiological study on a sample of the population of the city of São Paulo.

METHOD:

Participants were selected using random probabilistic sampling and data were collected via face-to-face interviews. The Hospital Anxiety and Depression Scale (HADS), EuroQol-5D, Alcohol Use Disorders Identification Test (AUDIT), Fagerström test for nicotine dependence and Brazilian economic classification criteria were used.

RESULTS:

A total of 826 participants were interviewed. The estimated prevalence of chronic spinal pain was 22% (95% confidence interval, CI: 19.3-25.0%). The factors independently associated with chronic spinal pain were: female sex, age 30 years or older, schooling level of four years or less, symptoms compatible with anxiety and high physical exertion during the main occupation. Quality of life and self-rated health scores were significantly worse among individuals with chronic spinal pain.

CONCLUSION:

The prevalence of chronic spinal pain in this segment of the population of São Paulo was 22.0%. The factors independently associated with chronic pain were: female sex, age 30 years or older, low education, symptoms compatible with anxiety and physical exertion during the main occupation.

The impact of work related physical activity and leisure physical activity on the risk and prognosis of neck pain - a population based cohort study on workers

BACKGROUND

The effect of physical activity on risk and prognosis for neck pain has been studied earlier with inconclusive results. There is a need for large prospective studies on the subject. The aim of this study was to investigate if work related physical activity and physical activity during leisure time are of importance for the risk and prognosis of neck pain in men and women.

METHODS

We used the Stockholm Public Health Cohort and formed two sub-cohorts of the working population based on data from 2002. Cohort I (risk cohort) included persons without neck pain (n = 4681), and cohort II (prognostic cohort) included persons with occasional neck pain (n = 6820) during the previous six months. Both cohorts were assessed for the outcome long duration troublesome neck pain (LDNP) in 2007. The exposures and potential confounders were assessed through a questionnaire in 2002. The question regarding work related physical activity over the past 12 months had five answering categories ranging from "sedentary" to"heavy". The question regarding leisure physical activity for the past 12 months had five answering categories ranging from "sedentary" to "regular physical activity". LDNP in 2007 was defined as having had troublesome neck pain lasting ≥ 3 consecutive months during the previous five years. Associations between work related physical activity and LDNP, as well as leisure physical activity and LDNP, were investigated by multivariable logistic regression, considering potential confounding factors.

RESULTS

In cohort I (risk cohort) we found an association between leisure physical activity and LDNP. In cohort II (prognostic cohort) we found no association between the exposures and the outcome.

CONCLUSION

The results suggest that leisure physical activity has a protective effect on the risk of developing LDNP in a population free from neck pain. It did not, however, affect the prognosis of occasional neck pain. Neither the risk nor the prognosis of neck pain was affected by work related physical activity in this study.

Prognostic factors for recurrences in neck pain patients up to 1 year after chiropractic care

OBJECTIVE

Information about recurrence and prognostic factors is important for patients and practitioners to set realistic expectations about the chances of full recovery and to reduce patient anxiety and uncertainty. Therefore, the purpose of this study was to assess recurrence and prognostic factors for neck pain in a chiropractic patient population at 1 year from the start of the current episode.

METHODS

Within a prospective cohort study, 642 neck pain patients were recruited by chiropractors in Switzerland. After a course of chiropractic therapy, patients were followed up for 1 year regarding recurrence of neck pain. A logistic regression analysis was used to assess prognostic factors for recurrent neck pain. The independent variables age, pain medication usage, sex, work status, duration of complaint, previous episodes of neck pain and trauma onset, numerical rating scale, and Bournemouth questionnaire for neck pain were analyzed. Prognostic factors that have been identified in previous studies to influence recovery of neck pain are psychologic distress, poor general health at baseline, and a previous history of pain elsewhere.

RESULTS

Five hundred forty five patients (341 females), with a mean age of 42.1 years (SD, 13.1) completed the 1-year follow-up period. Fifty-four participants (11%) were identified as "recurrent." Prognostic factors associated with recurrent neck pain were previous episodes of neck pain and increasing age.

CONCLUSION

The results of this study suggest that recurrence of neck pain within 1 year after chiropractic intervention in Swiss chiropractic patients presenting from varied onsets is low. This study found preliminary findings that older age and a previous episode of neck may be useful predictors of neck pain recurrence within 1 year.

The effect of massage therapy and/or exercise therapy on subacute or long-lasting neck pain--the Stockholm neck trial (STONE): study protocol for a randomized controlled trial

BACKGROUND

Neck pain is a major health problem in populations worldwide and an economic burden in modern societies due to its high prevalence and costs in terms of health care expenditures and lost productivity. Massage and exercise therapy are widely used management options for neck pain. However, there is a lack of scientific evidence regarding their effectiveness for subacute and long-lasting neck pain. This study protocol describes a randomized controlled trial aiming to determine the effect of massage and/or exercise therapy on subacute and long-lasting neck pain over the course of 1 year.

METHODS/DESIGN

A randomized controlled trial in which at least 600 study participants with subacute or long-lasting nonspecific neck pain will be recruited and randomly allocated to one of four treatment arms: massage therapy (A), exercise therapy (B), exercise therapy plus massage therapy (C) and advice to stay active (D). The study has an E-health approach, and study participants are being recruited through advertising with a mix of traditional and online marketing channels. Web-based self-report questionnaires measure the main outcomes at 7, 12, 26 and 52 weeks after inclusion. The primary outcomes are a clinically important improvement in pain intensity and pain-related disability at follow-up, measured with a modified version of the Chronic Pain Questionnaire (CPQ). The secondary outcomes are global improvement, health-related quality of life (EQ-5D), sick leave, drug consumption and healthcare utilization. Adverse events are measured by questionnaires at return visits to the clinic, and automated text messages (SMSes) survey neck pain intensity and pain-related disability every week over one year.

DISCUSSION

The results of this study will provide clinicians and stakeholders much needed knowledge to plan medical care for subacute and long-lasting neck pain disorders.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN01453590. Date of registration: 3 July 2014.

Development of an attention-touch control for manual cervical distraction: a pilot randomized clinical trial for patients with neck pain

Background

Manual cervical distraction (MCD) is a traction-based therapy performed with a manual contact over the cervical region producing repeating cycles while patients lie prone. This study evaluated a traction force-based minimal intervention for use as an attention-touch control in clinical trials of MCD for patients with chronic neck pain.

Methods

We conducted a mixed-methods, pilot randomized clinical trial in adults with chronic neck pain. Participants were allocated to three traction force ranges of MCD: low force/minimal intervention (0-20 N), medium force (21-50 N), or high force (51-100 N). Clinicians delivered five treatments over two weeks consisting of three sets of five cycles of MCD at the C5 vertebra and occiput. Traction forces were measured at each treatment. Patient-reported outcomes included a pain visual analogue scale (VAS), Neck Disability Index (NDI), Credibility and Expectancy Questionnaire (CEQ), and adverse effects. A qualitative interview evaluated treatment group allocation perceptions.

Results

We randomized 48 participants, allocating an average of five each month. Forty-five participants completed the trial with three participants lost to follow-up. Most participants were women (65 %) and white (92 %) with a mean (SD) age of 46.8 (12.5) years. Mean traction force values were within the prescribed force ranges for each group at the C5 and occiput levels. Neck pain VAS demonstrated a benefit for high traction force MCD compared to the low force group [adjusted mean difference 15.6; 95 % confidence interval (CI) 1.6 to 29.7]. Participants in the medium traction force group demonstrated improvements in NDI compared to the low force group (adjusted mean difference 3.0; 95 % CI 0.1 to 5.9), as did participants in the high traction force group (adjusted mean difference 2.7; 95 % CI -0.1 to 5.6). CEQ favored the high force group. Most low force participants correctly identified their treatment allocation in the qualitative interview. No serious adverse events were documented.

Conclusions

This pilot study demonstrated the feasibility of a clinical trial protocol and the utility of a traction-based, minimal intervention as an attention-touch control for future efficacy trials of MCD for patients with neck pain.

Trial registration

ClinicalTrials.gov NCT01765751 (Registration Date 30 May 2012)

Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial

BACKGROUND

Acupuncture stimulates points on the body, influencing the perception of myofascial pain or altering physiologic functions.

OBJECTIVE

The aim was to evaluate the effect of electroacupuncture (EAC) and acupuncture (AC) for myofascial pain of the upper trapezius and cervical range of motion, using SHAM acupuncture as control.

METHOD

Sixty women presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were randomized into EAC, AC, and SHAM groups. Eight sessions were scheduled and a follow-up was conducted after 28 days. The Visual Analog Scale assessed the intensity of local and general pain. A fleximeter assessed cervical movements. Data were analyzed using paired t or Wilcoxon's tests, ANOVA or Friedman or Kruskal-Wallis tests and Pearson's correlation (α=0.05).

RESULTS

There was reduction in general pain in the EAC and AC groups after eight sessions (P<0.001). A significant decrease in pain intensity occurred for the right trapezius in all groups and for the left trapezius in the EAC and AC groups. Intergroup comparisons showed improvement in general pain in the EAC and AC groups and in local pain intensity in the EAC group (P<0.05), which showed an increase in left rotation (P=0.049). The AC group showed increases in inclination (P=0.005) sustained until follow-up and rotation to the right (P=0.032).

CONCLUSION

EAC and AC were effective in reducing the pain intensity compared with SHAM. EAC was better than AC for local pain relief. These treatments can assist in increasing cervical range of motion, albeit subtly.

The sex-specific interrelationship between spinal pain and psychological distress across time in the general population. Results from the Stockholm Public Health Study

BACKGROUND CONTEXT

Detailed knowledge about the interrelationship between neck pain, back pain, and psychological distress is important from a public health prospective, but missing because of lack of large population-based cohort studies.

PURPOSE

To assess and compare the sex-specific recovery rate of spinal pain and psychological distress as single and comorbid conditions, to describe the interrelationship between these conditions at the baseline (2002) and follow-up 5 years later, and to explore the questions of spinal pain as a risk factor for the onset of psychological distress and vice versa.

STUDY DESIGN

A prospective cohort study.

PATIENT SAMPLE

General population in Stockholm county aged 18 to 84 years, n=19,774.

OUTCOME MEASURES

Spinal pain (modified Nordic Pain Questionnaire) and psychological distress (General Health Questionnaire-12).

METHODS

A random sample of the population in Stockholm was approached with postal questionnaires at the baseline and at follow-up.

RESULTS

Comorbidity of spinal pain and distress was twice as common among women (11%) than among men (4%) (relative risk=2.4, 95% confidence interval [CI]: 2.1-2.7). Women also more commonly had spinal pain without psychological distress (women, 20%; men, 14%) and vice versa (women, 15%; men, 12%). Comorbidity makes recovery less probable (women, 26%; men, 27%) than having single conditions of spinal pain (women, 41%; men, 44%) or psychological distress (women, 49%; men, 52%). No statistical significant sex differences were seen. Twenty-four percent of the women and 17% of the men with spinal pain without psychological distress at the baseline had psychological distress at follow-up. Corresponding figures for spinal pain among participants with psychological distress without spinal pain at the baseline were 24% and 20%. Spinal pain was a determinant of psychological distress (odds ratio [OR]=2.6, 95% CI: 2.3-2.9) and vice versa (OR=2.0, 95% CI: 1.8-2.2).

CONCLUSIONS

Spinal pain and psychological distress as comorbid and single conditions are common in the general population, especially among women. Comorbidity affects recovery negatively both in men and women. This study confirms the bidirectional association between spinal pain and psychological distress in the general population.

Are job strain and sleep disturbances prognostic factors for neck/shoulder/arm pain? A cohort study of a general population of working age in Sweden

OBJECTIVE

To study whether job strain, that is, psychological job demands and decision latitude, and sleep disturbances among persons with occasional neck/shoulder/arm pain (NSAP) are prognostic factors for having experienced at least one episode of troublesome NSAP, and to determine whether sleep disturbances modify the association between job strain and troublesome NSAP.

DESIGN

Prospective cohort study.

SETTING

Stockholm, Sweden.

PARTICIPANTS

A population-based cohort of individuals with occasional NSAP (n=6979) who answered surveys in 2006 and 2010.

OUTCOME MEASURES

Report of at least one episode of troublesome NSAP in 2010.

RESULTS

The ORs for troublesome NSAP at follow-up were in individuals exposed to passive jobs 1.2 (95% CI 0.9 to 1.4); to active jobs 1.3 (95% CI 1.1 to 1.5); to high strain 1.5 (95% CI 1.0 to 2.4); to mild sleep disturbances 1.4 (95% CI 1.3 to 1.6) and to severe sleep disturbances 2.2 (95% CI 1.6 to 3.0). High strain and active jobs were associated with having experienced at least one episode of troublesome NSAP during the previous 6 months in persons with sleep disturbances, but not in individuals without sleep disturbances.

CONCLUSIONS

Our results indicate that high strain, active jobs and sleep disturbances are prognostic factors that should be taken into account when implementing preventive measures to minimise the risk of troublesome NSAP among people of working age. We suggest that sleep disturbances may modify the association between high strain and troublesome NSAP.