Neck pain: global epidemiology, trends and risk factors

Evaluation of clinical application of Korean medicine standard clinical pathway in a public hospital

BACKGROUND

Clinical pathways (CPs) are structured guidelines introduced to improve healthcare quality and efficiency. In South Korea, CPs for Korean medicine have been developed since 2016 under the 3^rd Comprehensive Plan for Korean Medicine Promotion, with limited studies on their clinical application. Neck and shoulder pain are common conditions frequently treated at Korean medicine clinics, often by patients dissatisfied with conventional treatments. The demand for Korean medicine treatments for neck and shoulder pain is on the rise.

AIM

To evaluate the clinical applicability and effectiveness of Korean medicine CPs for neck pain and shoulder pain in public healthcare institutions in South Korea.

METHODS

We collected and analyzed data from patients aged 19 years and older who visited the outpatient clinic of the Department of Korean Medicine at the National Medical Center in Korea from March 1, 2023 to August 31, 2023. CP completion rates, along with patient satisfaction, clinical outcomes, and economic outcomes between the CP-implemented and non-CP groups were assessed.

RESULTS

The CP completion rates were 93.3% for neck pain and 96.8% for shoulder pain. Patient satisfaction scores showed an improvement of 17.7% for neck pain and 18.0% for shoulder pain in the CP-implemented group compared to the non-CP group. For neck pain, significant improvements were observed in the numerical rating scale (NRS) and the neck disability index, while for shoulder pain, only the University of California-Los Angeles shoulder rating scale showed notable progress, with no substantial change in NRS scores.

CONCLUSION

This study partially confirms the clinical applicability and effectiveness of the Korean medicine CPs for neck pain and shoulder pain. Further research is required to enhance and validate these findings.

A genome-wide association study identifies novel genetic variants associated with neck or shoulder pain in the UK biobank (N = 430,193)

Introduction

Neck and shoulder pain are prevalent musculoskeletal disorders that significantly affect the quality of life for a substantial portion of the global population. Studies have shown that women are more susceptible than men.

Objective

This study aims to discover genetic variants associated with neck or shoulder pain through a genome-wide association study (GWAS), using data from 430,193 participants in the UK Biobank.

Methods

A genome-wide association study was performed adjusting for age, sex, BMI, and 8 population principal components. Significant and independent genetic variants were replicated by FinnGen.

Results

The primary GWAS revealed 5 significant genetic loci (including 2 novel) associated with neck or shoulder pain, with the most significant single nucleotide polymorphism (SNP) being rs9889282 (P = 2.63 × 10-12) near CA10 on chromosome 17. Two novel significant associations were detected on chromosomes 18 and 14, with the top SNPs being rs4608411 (P = 8.20 × 10-9) near TCF4 and rs370565192 (P = 3.80 × 10-8) in DCAF5, respectively. Our secondary GWAS identified a single novel genetic locus in SLC24A3 among males and 2 genetic loci (including one novel near LINC02770) among females. In the replication stage, the SLC39A8 locus was weakly supported by the FinnGen cohort. The tissue expression analysis revealed a significant association between brain tissues and neck or shoulder pain.

Conclusion

In summary, this study has identified novel genetic variants for neck or shoulder pain. Sex-stratified GWAS also suggested that sex played a role in the occurrence of the phenotype.

Efficacy and safety of spinal manipulative therapy in the management of acute neck pain: a systematic review and meta-analysis

BACKGROUND

Spinal manipulative therapy (SMT) is frequently used to manage neck pain; however, its efficacy and safety in treating acute neck pain (ANP) remain uncertain and require further investigation.

OBJECTIVES

This study aims to comprehensively evaluate the efficacy and safety of SMT in the treatment of ANP.

DATABASES AND DATA TREATMENT

A thorough search was conducted in PubMed, Embase, Web of Science, PEDro, and Cochrane Library databases, covering all studies from inception to March 20, 2023. Mean differences (MD) with 95% confidence intervals (CIs) were calculated to assess outcomes such as pain intensity, cervical range of motion (CROM), and disability. The PEDro Scale and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were utilized to evaluate the methodological quality and strength of evidence.

RESULTS

Eight randomized controlled trials (RCTs) with 965 patients were included. Their PEDro scores ranged from 4-9 (mean: 6.38, SD: 1.25). Forest plot analysis showed SMT was better than the control in reducing pain (MD = -1.53, 95% CI [-2.22, -0.83]) and improving CROM in all measured aspects. It also significantly reduced disability scores (MD = -6.20, 95% CI [-9.81, -2.59]). No serious adverse events were reported.

CONCLUSIONS

The evidence supports the use of SMT as an effective and safe intervention for reducing pain, improving CROM, and decreasing disability in patients with ANP. These findings provide valuable insights for clinical practitioners and highlight the potential of SMT as a viable therapeutic option in managing ANP.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021264411.

Effect of osteopathic manipulation on pain, disability, range of motion and reposition sense in subjects with postural neck pain: a systematic review protocol

INTRODUCTION

Postural neck pain is a prevalent musculoskeletal condition associated with discomfort, disability and impaired quality of life. Osteopathic manipulation has emerged as a potential intervention for managing postural neck pain, but a comprehensive synthesis of the existing evidence is lacking. This systematic review protocol introduces the rationale and objective to evaluate the effectiveness of osteopathic manipulation in alleviating postural neck pain and improving associated outcomes, including pain intensity, disability, range of motion and reposition sense.

METHODS

We outline a rigorous methodology for this systematic review. A comprehensive search strategy will be implemented across various databases to identify relevant studies. This systematic review will encompass randomised controlled trials through electronic and manual searches. Electronic searches will be carried out in databases such as PubMed, Medline, Scopus and Web of Science. The search will span articles published from 2004 to December 2024; predefined eligibility criteria involve participants without a history of postural neck pain within the past 6 months. Exposure includes participants diagnosed with postural neck pain, while the comparison group comprises participants without neck pain.

ANALYSIS

Outcome measures focus on pain intensity, range of motion, disability and reposition sense. Two independent reviewers will conduct study selection, data extraction and risk of bias assessment. The primary outcomes encompassing pain intensity, disability, range of motion and reposition sense will be systematically analysed.

ETHICS AND DISSEMINATION

As no primary data will be collected, ethical approval is not required. The findings will be presented at relevant conferences and published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023471857.

Regional concentrations of heavy metals in surface soils and risk of body pain in elderly residential population: a national cohort study in China

BACKGROUND

The accumulation of heavy metals in surface soil raises significant environmental and public health concerns around the world. This study aimed to examine the relationship between exposure to heavy metals in surface soil and the risk of pain among residents.

METHODS

Using national data on eight heavy metals (arsenic, cadmium, chromium, copper, lead, mercury, nickel and zinc) in China's surface soil and a population cohort from 2011 to 2018, we analyzed pain occurrences in various body locations. Logistic regression models were used to assess the association between exposure to heavy metal in soil and pain, as adjusting for gender, age, education level, body mass index, living region, and lifestyle. The study included 13,178 individuals.

RESULTS

Higher exposure to soil arsenic was found to be associated with increased risk of shoulders [adjusted odds ratio (99.99% CI), 1.49 (1.01, 2.19)], wrists [1.68 (1.06, 2.64)] and ankles pain [1.58 (1.01, 2.50)]. No association was found between the remaining seven heavy metals and different types of body pain.

CONCLUSION

Our results indicate that higher soil arsenic exposure is associated with an increased risk of pain in specific body regions. This study is the first examining the associations between multiple heavy metals in surface soil and the risks of pain in different body sites. Our findings provide new insights into the health risks of soil heavy metal exposure.

Causal Relationship Between Psychosocial Factors and Neck Pain: A Two-Sample Mendelian Randomization Study

Purpose

Neck pain (NP) is a multifactorial disorder that leads to severe disability. This study aimed to investigate whether potential risk factors have a causal effect on NP at the genetic level using a two-sample Mendelian randomization (MR) analysis.

Methods

Summary-level data for potential risk factors, including distress, anxiety disorder, depression, mood, sleep disorder, loneliness, education, alcohol consumption, smoking, time spent using the computer, and physical activity, as well as NP, were obtained from multiple large-scale Genome-Wide Association Studies (GWAS). Instrumental variables (IVs) were extracted from these datasets. We employed inverse variance weighting (IVW), weighted median, and MR-Egger regression methods to assess causal effects. Heterogeneity was evaluated using MR-Egger regression and IVW, while horizontal pleiotropy was assessed using MR-PRESSO analysis and MR-Egger regression.

Results

The IVW results showed that major depressive disorder (OR = 1.51, 95% CI: 1.15, 1.98, p = 3.40×10-3) and experiencing mood swings (OR = 2.73, 95% CI: 1.57, 4.75, p = 3.86×10-4) were positively associated with NP and years of schooling (OR = 0.504, 95% CI: 0.410, 0.619, p = 6.55×10-11) was negatively associated with NP. Additionally, loneliness (OR = 16.0, 95% CI: 1.29-198, p = 0.0307) showed a suggestive association with NP. As for the other factors we did not find a clear causal relationship (All p-values > 0.05).

Conclusion

This two-sample MR study provides genetic evidence supporting a causal relationship between major depressive disorder, mood swings, and years of schooling with NP, while loneliness showed a potential association. These findings highlight the critical role of psychosocial factors, such as depression, mood swings, and education level, in the prevention and management of NP. Our results may offer new insights for clinicians to develop targeted intervention strategies aimed at reducing the incidence of NP.

Youth Mental Health in Crisis: Understanding the Relationship Between Mental Health and Physical Pain in Lebanon's Youth - A Scoping Review

Objectives

The mental health crisis among young adults in Lebanon, worsened by events like the Beirut Blast and economic instability, requires urgent attention. Globally, 10%-20% of individuals aged 18-29 face mental health challenges, with many also experiencing physical pain. Despite growing evidence of the bidirectional relationship between mental health and pain, this intersection remains underexplored in Lebanon, especially compared to WEIRD countries. This scoping review examines the relationship between physical pain and mental health issues-anxiety, depression, and stress-among Lebanese youth.

Methods

A systematic review of studies from January 2014 to February 2024 was conducted by screening PubMed, PsychInfo, and ScienceDirect. A total of 33 studies were included.

Results

The findings indicate a bidirectional link between mental health and physical pain. University students (36.1% of studies) were particularly impacted, and 81% of studies reported higher pain prevalence among females. Additionally, mindfulness meditation was identified as a potential protective factor, although it remains underexplored in Lebanon.

Conclusion

Addressing these gaps supports tailored interventions for Lebanese youth and enriches our understanding of mental health in non-WEIRD contexts.

Disease Burden of Neck Pain in China from 1990 to 2021 and Its Prediction for 2042: The Global Burden of Disease Study 2021

Purpose

This study, aimed to report the rates and trends of the prevalence, incidence, and years lived with disability caused by neck pain in the general population of China from 1990 to 2021 and forecast the incidence, prevalence, and disability-adjusted life Years (DALYs) from 2022 to 2042.

Methods

We used data from the Global Burden of Diseases Study (GBD) 2021. The annual percentage change (APC) and average APC between 1990 and 2021 were calculated using joinpoint regression analysis. An autoregressive integrated moving average (ARIMA) model was used to forecast the incidence, prevalence, and DALYs rates between 2022 and 2042.

Results

From 1990 to 2021, the disease burden of neck pain in China showed a clear upward trend, with age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR), and DALYs rates being significantly higher in females than in males. Especially in terms of DALYs, Aging has had the largest impact, contributing 61.88% of the increase, while population growth has accounted for 32.43%. Joinpoint regression analysis showed that the incidence and prevalence of neck pain in China increased gradually from 2000 to 2021. Data from 2021 showed that individuals aged 45-59 years are the most affected by neck pain, regardless of sex. The prediction results of the ARIMA model indicate that China's ASIR and ASPR for neck pain are projected to continue increasing over the next 20 years.

Conclusion

Neck pain is a serious public health problem in the general Chinese population. This may be related to changes in people's lifestyles and work patterns due to improvements in societal well-being and technology. Raising awareness of the risk factors for neck pain in the general population could help reduce the future burden of neck disorders, and neck pain should be a priority for future research on prevention and therapy.

An in vivo 3-dimensional kinematics study of the cervical vertebrae under physiological loads in patients with cervical spondylosis

BACKGROUND CONTEXT

Studies of in vivo kinematic differences between healthy individuals and those with cervical spondylosis (CS) have been reported, but only movements under nonphysiological loads have been investigated. Differences in the in vivo, cervical kinematics between healthy individuals and those with CS are unknown.

PURPOSE

To investigate the in vivo, cervical kinematics of patients with CS under physiological loads.

STUDY DESIGN

This was a retrospective, case-controlled study that used three-dimensional (3D) to 3D registration techniques combined with conical beam computed tomography (CBCT) to investigate the cervical kinematics of patients with CS.

PATIENT SAMPLE

Twenty individuals diagnosed with CS were selected for study participation and matched with 20 participants who did not have CS and were in good health.

OUTCOME MEASURES

Pfirrmann grading, intervertebral range of motion (ROM), kinematics and cross-sectional area of posterior neck muscles (CAPNM).

METHODS

All study participants underwent seven CBCT scans of their cervical vertebrae. The 3D segmental motion features of the vertebra in vivo were calculated using 3D-to-3D volume registration to overlay images of the vertebra at each functional position. The 3D range of motion (ROM) of each cervical segment was expressed with six degrees of freedom using Euler angles and translated onto a coordinate system. A kinematic subgroup analysis was conducted based on the severity of symptoms within the CS group, and differences in muscle volume between the CS and control groups were also evaluated. Project supported by the National Natural Science Foundation of China (Grant No. 81960408,82260445), Key Project of Jiangxi Provincial Natural Science Foundation (Grant No. 20242BAB26125), Clinical Cultivation Project of The First Affiliated Hospital of Nanchang University (Grant No. YFYLCYJPY 20220203).The authors declare no conflict of interest in preparing this article.

RESULTS

The CS group exhibited noticeable reductions in the primary rotational ROMs of left-right rotation at C4-C5, C5-C6, C6-C7, C4-C7, and C1-C7 compared to the controls. During left-right bending, there were no significant differences in the primary ROMs, coupled translations, or rotations between the two groups. However, compared to controls, the CS group had significantly lower primary ROMs for C4-C7, C1-C7 and C5-C6 during flexion-extension. During left-right rotation, the primary rotations and coupled lateral bending at C6-C7 were significantly increased in the mild CS group compared to the moderate CS group. In the mild CS group, the primary ROM of the C4-C5 and C5-C6 during flexion-extension was significantly greater than that of the moderate CS group.

CONCLUSIONS

For the first time, the in vivo 3D kinematics of the cervical spine during head movement under physiological load in CS individuals have been adequately described and compared with healthy cervical vertebrae, which can be used as a reference point for future studies. The application of CBCT helps to obtain accurate and precise movement information of CS patients and effectively enhance the evaluation results obtained from imaging information.

Exploring the Causes of Intervertebral Disc Annulus Fibrosus Impairment

Scope

The annulus fibrosus (AF), as an important component of the intervertebral disc (IVD), contributes to the structural integrity and functional normality of IVD. Degenerative disc diseases (DDD), due to AF impairment, are common problems that could lead to low back pain or neck pain, resulting in considerable disability and financial costs globally. The exact causes and underlying mechanisms of AF impairment, however, remain complex and unclear.

Methods

A literature search was conducted to identify relevant articles published between 1952 and 2024. We summarize the current literature on the potential etiologies of AF damage, while also providing a brief overview of the basic characteristics of the AF and current therapeutic strategies for AF impairment.

Results

The findings suggest that several factors could induce or exacerbate AF impairment. We categorize them into distinct groups as physical and chemical stimuli, nutritional or metabolic disorders, immune and inflammatory responses, and genetic abnormalities.

Conclusion

Various factors could lead to AF impairment, such as particular physical and chemical stimuli, nutritional or metabolic disorders, immune and inflammatory responses, and genetic abnormalities. Meanwhile, enhancing our understanding and management of AF impairment could help discover potential preventive or therapeutic interventions for DDD.

Differences in the clinical presentation of chronic whiplash-associated disorders and nontraumatic neck pain: a systematic review and meta-analysis

ABSTRACT

Health outcomes may be worse for individuals with whiplash-associated disorders (WAD) compared to nontraumatic neck pain (NTNP), and clinical characteristics may differ. This systematic review examined evidence comparing WAD and NTNP in terms of pain, disability, psychological status, quality of life, measures of nociceptive processing, movement, sensorimotor, and muscle function. Studies were identified through electronic database searches and included after screening against predefined eligibility criteria. Standardized mean differences (SMD) or mean differences (MD) and 95% confidence intervals (CI) were calculated. Associations between MDs with demographics and study characteristics were explored using meta-regression. Certainty of evidence was assessed using Grades of Recommendation, Assessment, Development, and Evaluation. Sixty-one studies were eligible with 45 included in meta-analysis. Individuals with WAD reported clinically relevant higher disability (100-point Neck Disability Index MD [95% CI] 11.15 [8.63, 13.68]), greater remote cold sensitivity (SMD 0.89 [0.57, 1.21]), lower quality of life (SMD -0.96 [-1.77, -0.16]), greater depression (SMD 0.60 [0.27, 0.93]), greater local (SMD -0.56 [-1.00, -0.13]) and remote (SMD -0.50 [-0.81, -0.19]) pressure sensitivity, less cervical flexion (MD -5.30° [-7.44, -3.16]) and extension (MD -5.43° [-9.31, -1.55]), higher pain intensity (100-point numerical rating scale: MD 8.15 [5.80, 10.50]), and greater kinesiophobia (SMD 0.35 [0.11, 0.59]). No between-group differences were found for dizziness symptoms, stress, anxiety, balance, and local cold sensitivity. Meta-regression indicated that disability differences were negatively associated with age (R2 = 29.6%, P = 0.006). Certainty of evidence was mostly moderate. Individuals with chronic WAD have a worse clinical presentation compared to those with chronic NTNP, which has implications for patient assessment and management.

Association among clinical severity indicators, psychological health status and elastic properties of neck muscles in patients with chronic mechanical neck pain

BACKGROUND

Since objective stifness measures are not consistent with the patients' perception and its correlation with the clinical severity of neck pain is not clear, novel studies assessing the clinical relevance of muscle stiffness are needed.

OBJECTIVES

To analyze the correlation among psychological factors, clinical severity indicators, and muscle stiffness in neck muscles in patients with chronic mechanical neck pain, and compare these factors with asymptomatic controls.

METHODS

A cross-sectional observational study was conducted. Participants included cases with chronic neck pain and asymptomatic controls, assessed for muscle stiffness using shear wave elastography, psychological health (anxiety and kinesiophobia), and clinical severity. Data analysis involved correlation matrices and comparison between groups.

RESULTS

Although no significant differences in levator scapulae stiffness were observed between groups (p > 0.05), patients exhibited significantly increased stiffness in the anterior scalene and cervical multifidus muscles (p = 0.009 and p = 0.040, respectively). STAI scores were significantly higher in patients for both subscales (STAI-S p = 0.002 and STAI-T p < 0.001), but no kinesiophobic behaviors differences were found (p > 0.05). Significant correlations between pain chronicity, intensity, disability, and psychological factors were confirmed. Notably, the levator scapulae stiffness was positively associated with disability, anxiety, and kinesiophobia (all p < 0.01). However, the anterior scalene and cervical multifidus stiffness, even if significantly associated with demographic factors (p < 0.05), were not associated with clinical or psychological outcomes.

CONCLUSION

The findings underscore the intertwined nature of psychological factors and muscle stiffness in chronic neck pain, suggesting the need for integrated approaches in treatment that consider both physical and psychological dimensions.

Life after benign paroxysmal positional vertigo: one-year analysis of recurrence, headaches, neck pain, falls, and functional vestibular symptoms

PURPOSE

Benign paroxysmal positional vertigo (BPPV) is a vestibular disorder causing recurrent episodes of vertigo. Despite symptom resolution at discharge, events such as relapses, migraines, neck pain, falls, and persistent postural-perceptual dizziness (PPPD) may occur. This study aims to estimate the incidence, timing, and risk factors for these symptoms.

METHODS

This multicenter, prospective, observational study recruited patients with a first episode of BPPV. Patients were treated with canalith repositioning maneuvers and discharged when no nystagmus was observed. Follow-up included in-person and telephone assessments over one year. The incidence and timing of symptoms were calculated, and risk factors were identified through regression models.

RESULTS

201 patients were recruited, and 124 met the inclusion criteria. 70.97% experienced events after discharge, though symptoms were not always severe enough to seek medical care. No useful risk factors were found for predicting BPPV recurrence. Low vitamin D levels increased recurrence risk but did not effectively discriminate patients. Women were more likely to develop headaches. Prior headaches, migraines, or neck pain were the strongest predictors of future occurrences of these conditions. Headaches or neck pain themselves triggered vestibular symptoms, often indistinguishable from BPPV. BPPV was associated with new-onset neck pain. The risk of falls increased with age. Anxiety triggered by BPPV predicted PPPD. Developing symptoms after discharge increased the likelihood of other events.

CONCLUSION

Although BPPV is considered resolved when no nystagmus is observed during provocation tests, it should be understood as a condition accompanied by other symptoms that often persist after discharge in most patients.

Upper limb muscle strength and neuromuscular coordination and other factors as determinants of kinesiophobia in people with cervical and cervicothoracic spine dysfunction

The aim of this study was to analyze the incidence of neuromuscular coordination disorders and upper limb muscle strength in people with functional disorders of the cervical and cervicothoracic spine. A total of 407 participants took part in the study. The level of kinesiophobia was assessed using the Tampa scale. For cervical spine dysfunction, the pain was measured using the visual analogue scale (VAS) and the cervical disability index (NDI). Neuromuscular control was tested using the Deep Cervical Neck Flexor test with the Stabilizer device. Upper limb muscle strength was measured using a dynamometer test. The data obtained revealed a correlation between higher Tampa scale scores and most of the variables assessed. A positive correlation between age (rho = 0.27; p < 0.001), pain (rho = 0.43; p < 0.001), and NDI (rho = 0.43; p < 0.001) was registered. A negative relationship was found between neuromuscular coordination (rho = 0.41; p < 0.001) and muscle strength of most muscles(rho - 0.14 to -0.28, p < 0.01). Higher Tampa scale values correlate with poorer neuromuscular coordination, older age, pain, weaker NDI score, and strength of some upper limb muscles in the cervical and cervicothoracic spine functional impairment group. There is no correlation between kinesiophobia presence and gender.

Trends in chronic neck and low back pain prevalence in Spain (2006-2020): differences by sex, age, and social class

PURPOSE

To analyze the evolution of chronic neck and low back pain prevalence in the general Spanish population (≥ 15 years) from 2006 to 2020, examining differences by sex, age, social class, and the potential influence of the COVID-19 pandemic.

METHODS

A repeated cross-sectional observational study was conducted based on data from six health surveys conducted in Spain between 2006 and 2020, with samples ranging from 21,007 to 29,478 subjects per survey, reported by the European Statistical System and the National Statistical Institute. Overall and specific prevalence rates were calculated, and linear trends were assessed over time. The potential influence of the COVID-19 pandemic was evaluated using the Mann-Kendall test, along with prevalence forecasts up to 2020, derived from S-curve models.

RESULTS

Between 2006 and 2020, the prevalence of chronic neck pain ranged from 23.64 to 12.3%, while chronic low back pain ranged from 24.01 to 14.73%. A decreasing trend was observed in both conditions, slightly more pronounced for neck pain. This trend persisted even when excluding 2020 data, which was potentially influenced by the COVID-19 pandemic, and was independent of health surveys. Forecasts indicated that the actual 2020 prevalence rates were lower (by 3.1-4.4%) than predicted. The prevalence was consistently higher among women, older individuals, and lower social classes, though all subgroups showed similar decreasing trends.

CONCLUSION

The prevalence of chronic neck and low back pain in the Spanish population declined between 2006 and 2020. Subgroup analyses revealed consistent decreases across sex, age, and social class. The COVID-19 pandemic may have impacted the 2020 prevalence rates.

The impact of self-reported temporomandibular pain on neck disability in office workers

BackgroundNeck pain (NP) and temporomandibular disorder (TMD) pain often coexist, particularly among office workers, but their interaction and impact on neck disability remain insufficiently explored.ObjectivesTo investigate the prevalence of self-reported TMD pain in office workers with NP and assess its impact on neck disability.MethodsThis cross-sectional survey collected data through an online questionnaire from 662 office workers (66.3% female; mean age: 35.4 ± 8.9 years) with NP. Participants were categorized into two groups: isolated NP (NP group) and coexisting NP and temporomandibular disorder pain (NP + TMD pain group). TMD diagnosis was based on the Pain Screener. Neck pain and disability were assessed using the Bournemouth Neck Questionnaire (BNQ) and Neck Disability Index (NDI). Parafunctional behaviors were evaluated using the Oral Behaviors Checklist (OBC). Statistical significance was set at p < 0.05.ResultsThe NP + TMD pain group had significantly higher BNQ and NDI scores than the NP group (p < 0.001), indicating more severe pain and disability. Additionally, 69.1% of the NP + TMD pain group reported awake bruxism compared to 37.7% in the NP group (p < 0.001). Joint noises (80.5% vs. 6.9%) and jaw locking (30.1% vs. 1.9%) were also more frequent in the NP + TMD pain group (p < 0.001). Logistic regression showed that high OBC scores, joint noises, and closed jaw locking were strong predictors of NP + TMD pain.ConclusionThe findings reveal significant correlations between NP and TMD pain, but the cross-sectional design limits conclusions about causation. Further longitudinal or interventional studies are needed to explore whether TMD pain contributes to NP, vice versa, or if both share common underlying mechanisms.Clinical Trials Number: NCT04900870.

Longitudinal association between frailty and pain in three prospective cohorts of older population

BACKGROUND AND OBJECTIVES

As the global population ages, frailty and pain have become two significant health issues that impact the quality of life in older adults. Previous studies have not thoroughly explored the relationship between them. This study aims to investigate the longitudinal association between frailty and pain using data from prospective cohorts in China (CHARLS), the United Kingdom (ELSA), and the United States (HRS).

METHODS

This study utilized data from three prospective cohort studies: the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), and the Health and Retirement Study (HRS). Frailty status was assessed using the Rockwood frailty index and categorized into robust, pre-frail, and frail. Pain was evaluated by self-reports. Pain degrees were categorized into mild, moderate and severe. Pain areas were grouped into four main areas: head and neck, trunk, limbs, oral. Generalized linear mixed-effects models were employed to analyze the longitudinal relationship between frailty and pain while adjusting for covariates, including gender, age, marital status, education level, sleep quality, smoking, drinking, hypertension, and diabetes.

RESULTS

According to the inclusion and exclusion criteria, 10,624 participants from CHARLS (47% female, mean age: 60.76 years), 4945 participants from ELSA (52.2% female, mean age: 70.05 years), and 11,439 participants from HRS (55.8% female, mean age: 69.28 years) were included in the subsequent analysis. Compared to robust individuals, those in pre-frail and frail states showed a significantly increased risk of experiencing pain. In all three cohorts, pre-frail individuals had a 3.82-fold increased likelihood of pain compared to robust individuals (OR = 3.82, 95%CI = 3.51-4.15, p-value < 0.001, CHARLS), 4.29-fold (OR = 4.29, 95%CI = 3.74-4.93, p-value < 0.001, ELSA), and 4.17-fold (OR = 4.17, 95%CI = 3.81-4.57 p-value < 0.001, HRS). Frail individuals had a 10.44-fold increased likelihood of pain (OR = 10.44, 95%CI = 9.05-12.04, p-value < 0.001, CHARLS), 10.14-fold (OR = 10.14, 95%CI = 8.05-12.76, p-value < 0.001, ELSA), and 13.27-fold (OR = 13.27, 95%CI = 11.71-15.03, p-value < 0.001, HRS).

CONCLUSION

This study demonstrates that frailty significantly impacts the risk of pain, the degree of pain, and the areas of pain. And this association is consistently observed across older populations in different countries. Future pain management strategies should incorporate frailty assessments to mitigate the adverse effects of pain on the health of older adults.

Dizziness and neck pain: a perspective on cervicogenic dizziness exploring pathophysiology, diagnostic challenges, and therapeutic implications

Dizziness and vertigo affect up to 20% of adults annually. Cervicogenic dizziness (CGD), a debated clinical entity, is characterized by dizziness associated with cervical pain or dysfunction, stemming from altered proprioceptive input from the cervical spine. Despite its recognition in clinical practice, CGD remains controversial due to its reliance on exclusionary diagnosis and the absence of specific diagnostic criteria or gold-standard tests. This perspective explores the pathophysiology of CGD, emphasizing the sensory mismatch theory, where disrupted cervical proprioception interacts maladaptively with vestibular and visual systems, leading to postural instability and dizziness. Central mechanisms, including sensory reweighting and maladaptation, further complicate symptom resolution, particularly in the context of chronic cervical dysfunction. Current diagnostic approaches provide insights but lack specificity. Management strategies, including manual therapy and sensorimotor exercises, show promise in alleviating symptoms by targeting cervical dysfunction and enhancing proprioceptive integration. However, these interventions highlight the need for an integrated approach that addresses both cervical and vestibular contributions to dizziness. This paper underscores the importance of advancing CGD research, particularly understanding central maladaptation mechanisms. By bridging gaps in clinical and research knowledge, a more comprehensive framework for diagnosing and managing CGD can emerge, benefiting patients with persistent dizziness and cervical involvement.

Effects of a Postural Hammock in People with Chronic Neck Pain and Chronic Low Back Pain: A Randomized Controlled Trial

Background and Objectives: Musculoskeletal disorders (MD) affect over 1.7 billion people worldwide, with neck and low back pain being prevalent and debilitating conditions. Current treatments include various interventions, but novel approaches are needed to improve functionality and reduce disability. To evaluate the effects of a postural hammock on pain and functionality in people with chronic neck and low back pain. Materials and Methods: A randomized controlled trial was conducted with participants experiencing chronic neck and/or low back pain. They were assigned to either an experimental group using a postural hammock or a control group lying on a mat. Participants underwent five sessions of 10 min each over five consecutive days. Results: Forty-three subjects completed the study. While both groups showed improvements, the experimental group exhibited significant increases in hamstring flexibility and pain tolerance, measured through the Visual Analog Scale (VAS) and pressure pain thresholds (PPT). Postural hammock use demonstrated potential benefits in pain management and flexibility compared to conventional methods. Conclusions: Using a postural hammock may offer benefits for individuals with chronic back pain. Future research should explore combining hammock therapy with other interventions to enhance outcomes and improve the quality of life for patients with back pain.

Differences in sensorimotor integration, cervical sensorimotor control, and cognitive-motor dual tasking costs in chronic non-specific neck pain patients with high vs. low catastrophizing tendencies compared to healthy controls

Chronic non-specific neck pain (CNSNP) is a common condition and its relationship to the pain catastrophizing construct in terms of sensorimotor functions and dual task performance is not fully understood. We aimed to investigate the differences in sensorimotor integration, cervical sensorimotor control, and cognitive-motor dual tasking abilities between CNSNP patients (> 3 months) with high versus low catastrophizing tendencies and healthy controls. Ninety participants were recruited, 30 asymptomatic controls, and 60 patients with CNSNP; 30 scoring high (> 75th percentile) and 30 scoring low (< 25th percentile) on the pain catastrophizing scale (PCS). The variables of sensorimotor integration (frontal N30 amplitude), cervical sensorimotor control (head repositioning accuracy (HRA) - left and right), and cognitive-motor dual tasking (percentage of gait speed time increase with a cognitive load) were assessed and compared across groups. In general, performance of sensorimotor integration, cervical sensorimotor control, and cognitive-motor dual tasking abilities was incrementally better comparing the high to low catastrophizing groups, and the low catastrophizing group to the controls. Correlation coefficients between PCS and HRA (left and right) was strong (r = .8, p < 0.001), between PCS and dual tasking cost was moderate (r = .7, p < 0.001), and between PCS and frontal N30 amplitude was moderate (r = .57, p < 0.001). In conclusion, we found that higher pain catastrophizing was associated with poorer sensorimotor integration, cervical sensorimotor control, and cognitive-motor dual tasking in CNSNP patients highlighting the importance of both assessing and treating catastrophizing in the treatment of CNSNP. PERSPECTIVE: This study highlights the significant impact of pain catastrophizing on sensorimotor integration, cervical sensorimotor control, and cognitive-motor dual tasking in CNSNP patients. High catastrophizers are particularly vulnerable to these impairments, suggesting the need for comprehensive treatment approaches that address both psychological as well as physical components.

Age-threshold for increased risk of developing back disorders: prospective cohort with 74 000 individuals from the UK Biobank

OBJECTIVE

To investigate the prospective associations between age and the risk of low back disorders (LBD), dorsal disorders (DD), and cervical disorders (CD), and to identify a potential age-threshold for increased risk of back disorders.

METHODS

Prospective cohort from the UK Biobank comprising adults with no history of back disorders. We examined different ages and their association with the risk of back disorders derived from diagnoses of hospital registers. Associations were investigated using restricted cubic splines adjusted for sex, racial and ethnic background, tobacco use, Townsend Deprivation Index, alcohol consumption, educational attainment, employment status, self-reported health, diet quality, body mass index, medication use, physical activity, and handgrip strength.

RESULTS

The analytic sample comprised 74,191 participants (mean [SD] age, 55.2 [7.8] years; 57%women) who were followed-up for 7.9 years (IQR = 7.3-8.4). Overall, 3297 (4.3%) cases of incident LBD, 1224 (1.6%) cases of DD, and 792 (1.0%) of CD were documented. The association between age and LBD showed a curvilinear shape with significant higher risk within the range of 61 (hazard ratio [HR] = 1.39 [95%CI,1.02-1.49]) and 70 (HR = 1.71 [95%CI,1.38-2.12]) years (reference:40 years). Similarly, the association of age with DD exhibited a significant curvilinear association within the range of 60 (HR = 1.31 [95%CI,1.01-1.92]) and 70 (HR = 2.74 [95%CI,1.94-3.86]) years. The association between age and CD was not significant.

CONCLUSIONS

The risk of LBD and DD, but not CD, increases beyond 60 years of age. Targeting people at this critical age-threshold to prevent risk for LBD and DD may be warranted for future interventions and preventive health programmes.

Effectiveness of Manual Joint Mobilization Techniques in the Treatment of Nonspecific Neck Pain: Systematic Review With Meta-Analysis and Meta-Regression of Randomized Controlled Trials

OBJECTIVE: The purpose of this study was to investigate the effects of cervical joint mobilization techniques (JMTs) on pain and disability in adults with nonspecific neck pain. DESIGN: This study is an intervention systematic review with meta-analysis and meta-regression of randomized controlled trials (RCTs). LITERATURE SEARCH: We searched MEDLINE, Cochrane CENTRAL, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Web of Science databases, including references from other reviews or clinical practice guidelines up to October 16, 2024. STUDY SELECTION CRITERIA: Eligible RCTs evaluated JMTs compared to routine physiotherapy, minimally active interventions, or no treatment. The primary outcome was pain; secondary outcomes were disability, Global Perceived Effect (GPE), quality of life, psychosocial status, and adverse events. DATA SYNTHESIS: Meta-analyses and meta-regression were conducted for pain, disability, and GPE. The risk of bias was assessed with Cochrane RoB 2.0 Tool; the certainty of the evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluations approach. We used The Template for the Intervention Description and Replication checklist to evaluate the quality of reporting of interventions delivered. RESULTS: Results from 16 RCTs were pooled (n = 1,157 participants), reporting nonclinically positive results on pain reduction (mean difference [MD] = -0.86 (95% confidence interval [-1.35, -0.36])), disability (MD=-2.11 [-3.31, -0.91]), and GPE (standardized mean difference = 0.11 ([-0.15, 0.37]) and high heterogeneity. The meta-regressions did not identify any covariates associated with the treatment effects. Minor side effects (increased neck pain and headache) were reported. CONCLUSION: There was very low certainty evidence supporting the efficacy of JTMs for reducing pain and improving disability in people with NSNP. J Orthop Sports Phys Ther 2025;55(3):1-20. Epub 12 February 2025. doi:10.2519/jospt.2025.12836.

Temporomandibular Internal Derangements Denote Activity of Axial Spondyloarthritis

Objectives

The group of spondyloarthritis (SpA) disorders shares common clinical manifestations, including internal derangement (ID) of temporomandibular joint (TMJ). This study aimed to investigate SpA activity in patients with ID of TMJ.

Materials and Methods

We assessed 200 patients with neck pain using the Assessment of Spondyloarthritis International Society (ASAS) criteria. TMJ was examined using Diagnostic Criteria for Temporomandibular Disorders (DC/TMD protocol). Patients with SpA were divided into three groups: symptomatic ID of TMJ, asymptomatic ID of TMJ, or healthy TMJ (controls). Activity of SpA was evaluated using the Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Disease Activity Index in Psoriatic Arthritis (DAPSA), patients' self-estimated SpA activity, difficulties in performing daily activities, pain intensity (visual analogue scale) and laboratory parameters.

Results

Patients with symptomatic and asymptomatic ID showed statistically significantly increased ASDAS, anti-streptolysin titer, patients' self-estimated axial pain and activity of SpA, and decreased hematocrit than the control. Patients with symptomatic ID also had statistically significant earlier onset of SpA, along with increased BASDAI and DAPSA, total body pain, difficulties in performing daily activities, platelet count, and serum alpha-amylase but lower hemoglobin concentration than controls. Patients with asymptomatic ID had higher frequencies of exacerbated axial SpA and sacroiliac joint ankylosis compared to the control.

Conclusion

All patients with SpA and ID showed increased axial disease activity.

Not your common neck pain: Longus coli tendonitis

Longus coli tendonitis is a rare etiology of neck pain, occurring so infrequently that a prevalence is difficult to determine. Typical symptoms include neck pain, neck stiffness and an elevation of inflammatory markers, raising a concern for an infectious etiology. Radiographic imaging is essential to establish a diagnosis and differentiate between life-threatening infectious pathologies, including meningitis and abscesses leading to airway compromise. We present a rare case of longus coli tendonitis, initially thought to be infectious. Our case highlights the importance of multimodal imaging for diagnosis and maintaining a broad differential when presented with concerning symptoms.

Prevalence and relative frequency of cervicogenic headache in population- and clinic-based studies: A systematic review and meta-analysis

BackgroundCervicogenic headache is a rare headache disorder which is garnering increasing clinical and research interest, but whose prevalence and clinical phenotype is surrounded by uncertainty. We found it timely to systematically appraise the current literature on prevalence, relative frequency, and clinical features of cervicogenic headache in population- and clinic-based settings.MethodsPubMed and Embase were searched for observational, population- and clinic-based studies published between 1 January 1942 and 3 September 2024 that reported on the prevalence and relative frequency of cervicogenic headache, diagnosed according to the International Classification of Headache Disorders. The titles, abstracts, and full text-articles were screened by two independent investigators. To estimate prevalence and pooled relative frequency of cervicogenic headache across clinic- and population-based studies, random-effects meta-analyses were conducted. The study was pre-registered on PROSPERO (identifier: CRD42024498128) and reported in accordance with the Guidelines for Meta-Analyses of Observational Studies in Epidemiology.ResultsThree studies met the inclusion criteria from the International Classification of Headache Disorders for diagnosing cervicogenic headache. One was population-based reporting on the prevalence and two were clinic-based reporting on the relative frequency of cervicogenic headache among adult patients who were evaluated for headache in a tertiary care unit. The one population study reported a prevalence of 3.9% with females representing 77.8% of those affected. In the two clinic-based studies, the relative frequency was found to be 3.1% (95%, CI, 2.6-3.8) amongst the adult outpatient population of 3165 patients evaluated for headache, with women representing 80.8% (95%, CI, 71.9-87.4).ConclusionsBased on this meta-analysis, data on the prevalence and relative frequency of cervicogenic headache are limited. The scarcity of data stresses the need for further research into cervicogenic headache, the diagnostic criteria, and its current position in the International Classification of Headache Disorders.

The efficacy of thread embedding acupuncture on pain score, neck disability index, and pressure pain threshold for myofascial pain therapy in the upper trapezius muscle

OBJECTIVES

Myofascial pain characterized by myofascial trigger point (MTrP) is a common cause of musculoskeletal pain and the main cause of neck and shoulder pain in the working population. Thread embedding acupuncture (TEA) is a new modality that can provide long-term stimulation to prolong the same therapeutic effect as conventional acupuncture. This study aimed to determine the effect of TEA therapy on pain score, neck disability index (NDI), and pressure pain threshold (PPT) for myofascial pain in the upper trapezius muscle.

METHODS

The research design in this study was a double-blind, randomized clinical trial. This study with 44 research subjects was divided into TEA group (n=22) and sham TEA group (n=22). Both groups will receive TEA therapy once using CARA brand monofilament polydioxanone thread 29Gx50 mm or sham TEA (thread removed) at one trigger point in the upper trapezius muscle which will be followed-up on 3 days, 1 week, 4 weeks, and 8 weeks post-therapy.

RESULTS

Both groups experienced significantly reduced pain intensity and disability, also increased PPT at 3 days, 1 week, 4 weeks, and 8 weeks post-therapy (p<0.001). TEA therapy had better effectiveness in improving pain intensity at 4 weeks (p=0.007) and 8 weeks post-therapy (p=0.004), NDI scores at 8 weeks post-therapy (p=0.004), and PPT at 4 weeks (p=0.04) and 8 weeks post-therapy (p=0.002) compared to sham TEA.

CONCLUSIONS

TEA reduced pain intensity and disability, and increased PPT for patients with myofascial pain in the upper trapezius muscle.

Changes in cerebral cortex activation during upright standing tasks in individuals with chronic neck pain: an fNIRS study

Introduction

Studies show that individuals with chronic neck pain (CNP) exhibit postural control deficits, potentially contributing to persistent and recurrent pain. However, the neural mechanisms underlying these deficits in CNP remain unexplored despite their importance for developing effective rehabilitation strategies. Therefore, this study aimed to investigate the neural activity during postural control using functional near-infrared spectroscopy (fNIRS), providing insights into the central mechanism underlying postural control deficits in individuals with CNP.

Methods

In this cross-sectional study, 10 individuals with CNP (CNP group) and 10 healthy controls (HC group) were assessed under three conditions: Task 1, standing on a force plate with eyes open and both feet; Task 2, standing on a force plate with eyes closed and both feet; Task 3, standing on a force plate with eyes closed and one foot. Cerebral cortex hemodynamic reactions, including bilateral prefrontal cortex (PFC), dorsolateral prefrontal cortex (DLPFC), pre-motor cortex and supplementary motor area (PMC/SMA), primary motor cortex (M1), and primary somatosensory cortex (S1) were measured using fNIRS. Balance parameters, including the sway area, total sway length, mean velocity, and center of pressure (COP) amplitude in the anterior-posterior (AP) and medial-lateral (ML) directions, were measured using a force plate.

Results

In Tasks 1 and 2, no differences were observed between both groups in balance parameters. However, the CNP group exhibited significantly higher activation in the left PMC/SMA (F = 4.788, p = 0.042) and M1 (F = 9.598, p = 0.006) in Task 1 and lower activation in the left (F = 4.952, p = 0.039) and right (F = 6.035, p = 0.024) PFC in Task 2 compared to that of the HC group. In Task 3, the CNP group exhibited a significantly larger COP amplitude in the AP direction (F = 7.057, p = 0.016) compared to that of the HC group. Additionally, activation in the right M1 (F = 7.873, p = 0.012) was significantly higher than in the HC group. Correlation analysis in Task 3 revealed stronger associations between the parameters in the CNP group.

Conclusion

Our findings suggest that individuals with CNP exhibit distinct patterns of cerebral cortex activities and postural control deficits. The PFC, M1, and PMC/SMA were involved in maintaining upright standing balance, and cerebral cortex changes associated with upright standing balance provide a more sensitive indicator of postural control deficits than peripheral balance parameters in individuals with CNP.

Magnitude, temporal trend and inequality in burden of neck pain: an analysis of the Global Burden of Disease Study 2019

BACKGROUND

This study aimed to comprehensively assess the magnitude, temporal trends, and inequalities associated with socioeconomic development in neck pain (NP) based on the Global Burden of Disease Study 2019.

METHODS

An assessment of incidence and years of life with disability (YLD) at the global, regional, and country levels by age, sex and year was conducted for NP. Joinpoint regression (JPR) was used to analyze trends between 1990 and 2019. Decomposition analysis was used to explore the extent to which population growth, aging, and epidemiological changes influenced the changes in incidence and YLD. A Bayesian Age-Period-Cohort (BAPC) model was constructed to predict trends over the next 25 years. Concentration curve and concentration index were used to examine the cross-country relative inequality of the burden of NP at the socio-demographic index (SDI) level.

RESULTS

In 2019, the global ASIR and ASDR of NP were 579.085 and 267.348 per 100,000 individuals, respectively. JPR analysis showed that the global ASIR and ASDR have decreased slightly over the past 30 years, although an increase was observed between 2011 and 2019. The BAPC model predicted that this upward trend would continue over the next 25 years. Decomposition analysis showed that the global increase in incidence and YLD in 2019 compared to 1990 was mainly driven by population growth. The burden of NP was higher in the middle-aged, old-age, and female groups, with differences in regional distribution. The analysis of cross-country inequality showed that the burden of NP was disproportionately concentrated in countries with a high SDI, and this phenomenon continued to increase over the 30-year study period.

CONCLUSIONS

Globally, NP remains an important public health problem, and governments are urgently required to raise public awareness about NP and its risk factors, implement targeted prevention and control policies, and deliver the necessary health services.

Sensory profiles in older adults with orthopedic conditions during quiet stance: a cross-sectional study

BACKGROUND

Pathological aging can impair sensory information, leading to postural control disorders in older adults. Compensatory sensorial mechanisms are emerging to preserve balance function. The objective of the study was to identify sensory profiles in functionally impaired older adults, and determine if they are linked to the frequently observed cervical proprioceptive disorders in this population.

METHODS

Fifty-one older adults (76.9 ± 7.6 years) were divided into 2 Functional Groups (FG-/FG+) according to a composite score that included 3 variables (gait speed, grip strength and fear of falling). All the participants completed the modified clinical test of sensory interaction on balance (m-CTSIB) and the cervical joint sense position error (CJPSE) test. Exploratory factor analysis was used to identify common factors among the variables. Pearson correlation was used to examine relationships between variables.

RESULTS

As expected, conditions 2 and 3 of the m-CTSIB were both challenging to balance, whereas condition 4 was too difficult for several patients. Factor analysis revealed that the stabilometric variables were grouped together in factor one, and proprioceptive performance (CJPSE) and the mean CoP velocity in m-CTSIB condition 3 formed another second factor. Moreover, a significant correlation was highlighted between stability in Condition 3 and CJPSE in the FG-.

CONCLUSION

Our results revealed the predominance of both visual and podal information in functionally impaired adults to control their posture. We speculate that the observed podal preference could be consecutive to a less efficient cervical proprioceptive system.

Physical exercise therapy for chronic non-specific neck pain: protocol for a meta-analysis of individual participant data

BACKGROUND

Every 7 out of 10 people will experience neck pain at some point during their lifetime. A large proportion of these cases will develop into recurrent or chronic conditions. Typically, physical exercise for neck pain seems to be modestly beneficial, but differential effects across participants of randomised trials have not yet been appropriately considered. This individual participant data meta-analysis (IPD MA) will provide a consolidated synthesis of randomised controlled trials (RCTs) that have been conducted to date. We aim to investigate the effectiveness of exercise therapy for chronic non-specific neck pain.

METHODS/DESIGN

This study will address the following research questions: (1) what are the effects of exercise therapy compared to no intervention or control interventions on neck pain intensity, pain-related disability, and quality of life? (2) What are the responder and non-responder rates for exercise therapy? (3) What participant characteristics are associated with a clinically meaningful response to exercise therapy? (4) What are the minimal clinically important difference (MCID) and/or minimal detectable change (MDC) values for neck pain intensity, pain-related disability, and quality of life?. This study will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The raw data will be requested from the primary authors of included RCTs. The received original data will be collated into a main datasheet with all the details on every single study, including study details, methodological details, participant demographics, details about intervention and comparison groups, treatment effect modifiers (e.g. workload, medicine usage), and the main outcome measures: pain intensity, pain-related disability, and quality of life. This IPD MA will be performed following a one-step approach, where data from all studies are analysed together while considering the grouping of participants within each study. Risk of bias of included RCTs will be evaluated using the ROB 2.0 tool, and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach will be used to assess the certainty of evidence.

DISCUSSION

We will analyse IPD of available RCTs exploring the exercise effectiveness for chronic non-specific neck pain. The expected large sample size and consistent presentation of data will allow for further analyses to investigate patient-level heterogeneity in treatment outcomes and the prognosis of chronic non-specific neck pain.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022323359.

Work and lifestyle factors associated with musculoskeletal pain among professional cleaners: a cross-sectional study

Objectives. Among cleaners, lower back pain (LBP) and neck/shoulder pain (NSP) are prevalent musculoskeletal disorders (MSDs). Despite their high occurrence, the underlying causes of LBP and NSP in this population remain largely unknown, suggesting a multifactorial aetiology. This study aims to assess the association between various lifestyle, physical and psychosocial factors with LBP and NSP in professional cleaners. Methods. The study included cleaners from the Danish Work Environment and Health study 2012-2018 with a total of 1042 responses. The cleaners filled in a questionnaire about their work environment, lifestyle and health. Associations between a range of work and lifestyle factors (predictors) with LBP and NSP (outcome) were estimated using general linear models. Results. When controlling for various confounders, cleaners experiencing high physical exertion during work showed higher LBP and NSP compared with those experiencing low and moderate physical exertion (p < 0.0001). Low recognition from management was also associated with higher LBP and NSP (p < 0.05). Several factors did not reach statistical significance: smoking, leisure physical activity, influence at work and support from colleagues. Conclusion. This cross-sectional study showed that obesity, high physical exertion during work and low recognition from management were associated with higher LBP and NSP.

The impact of neck pain and movement performance on the interarticular compressive force of the cervical spine: a cross-sectional study based on OpenSim

BACKGROUND

Excessive interarticular compressive force (CF) caused by poor posture increases the risk of neck pain. However, existing research on cervical CF is based on healthy individuals, and studies on those with neck pain are lacking. This study aims to address this gap by simultaneously collecting data from individuals with neck pain and asymptomatic individuals, simulating the CF during physiological movements such as flexion-extension, lateral bending, and rotation, to explore the impact of neck pain and movement performance on the interarticular CF.

METHODS

A 3D motion capture system and a multicervical unit were utilized to collect kinematic data and maximum voluntary isometric contraction (MVIC), respectively. The kinematic data were processed in OpenSim, using individually scaled cervical spine models. Time and peak angles were obtained via inverse kinematics, and the CF was calculated via joint reaction analysis. Regression analysis was conducted to assess the correlations between neck pain status, movement performance characteristics (time, peak angle, MVIC) and CF normalized by body mass. Variables with p < 0.1 in the univariate regression were included in the multivariate regression model for further adjustment.

RESULTS

Sixty participants were enrolled in the study, comprising 30 individuals in the neck pain group and 30 in the asymptomatic group. The mean peak CF in the neck pain group exceeded that in the asymptomatic group during cervical flexion-extension (13.0 -13.4%), lateral bending (10.4 -15.6%), and rotation (7.0 -8.3%) movements. Multivariate regression analysis revealed that the presence of neck pain was correlated with a significant increase in peak CF during the phases of flexion (p = 0.02), right lateral bending (p = 0.04 except for C6-C7), and left rotation (p = 0.02). The peak CF was positively correlated with peak angles in flexion (p < 0.001), extension (p = 0.001), left lateral bending at C3/4 (p = 0.009), C4/5 (p = 0.008), C5/6 and C6/7 (p = 0.007), right lateral bending at C3/4 and C4/5 (p = 0.002), C5/6 and C6/7 (p = 0.001), left rotation (p < 0.001), and right rotation (p = 0.02) movements. Conversely, peak CF was negatively correlated with MVIC in flexion (p = 0.02), extension at C4/5 (p = 0.008) and C5/6 (p = 0.007), left lateral bending (p = 0.001), right lateral bending at C3/4 (p = 0.02), C4/5 and C5/6 (p = 0.01), and C6/7 (p = 0.009) movements. No significant correlation was found between peak CF and the time taken for movement.

CONCLUSIONS

This study reveals the differences in CF between individuals with neck pain and asymptomatic individuals during identical movements. The peak CF appears to correlate with the presence of neck pain, MVIC, and peak angle. These findings highlight the importance of muscle strength training. Early identification of reduced neck muscle strength could be crucial for preventing and relieving neck pain.

Changes in musculoskeletal pain among computer workers when working from home

OBJECTIVES

This study evaluated the impact of increased working from home on musculoskeletal pain before and after the SARS-CoV-2 pandemic.

METHODS

In an online survey (September 2023 to April 2024), pain was rated on a numeric rating scale. The impact of working from home and covariates on new pain onset and exacerbation was modeled using logistic regression analyses.

RESULTS

Of 1,064 participating computer workers, 968 were working from home. Working from home compared to office-only work, showed a trend of increasing pain. Longer remote working hours and poorer workstation setups also increased the risks for pain (e.g., new neck or upper back pain OR 2.02, 95% CI 1.08-3.76).

CONCLUSIONS

Preventing musculoskeletal pain should involve improving remote workstation ergonomics, promoting healthy lifestyles, participation in regular occupational health screenings, and supporting employees with anxiety or depression symptoms.

The associations between sedentary behavior and neck pain: a systematic review and meta-analysis

BACKGROUND

This study aimed to systematically evaluate the associations between sedentary behavior (SB) in daily life and the risk of neck pain (NP), and to investigate the dose-response relationships between these variables across different populations, including variations in age, sex, occupation, and lifestyle practices.

METHODS

We conducted a systematic literature search of PubMed, Web of Science, Scopus, and Embase for cross-sectional, cohort and case-control studies examining the association between SB and NP risk. The National Institute of Health (NIH) quality assessment tool was utilized to evaluate study quality. Odds ratios (ORs) and relative risks (RRs) with 95% confidence intervals (CIs) were used to assess the association between SB and NP. Due to significant heterogeneity among the studies, a random-effects model was employed for the meta-analysis to obtain pooled estimates.

RESULTS

A total of 25 studies with 43,184 participants met the eligibility criteria. Overall, the meta-analysis revealed a significant relationship between SB and NP (OR = 1.46, 95%CI: 1.33, 1.60). Subgroup analyses revealed that the risk of NP was greater in female (OR = 1.43, 95%CI: 1.22, 1.67) than in male (OR = 1.13, 95%CI: 1.01, 1.27) and was greater in employees (OR = 1.97, 95%CI: 1.70, 2.28) than in students (OR = 1.26, 95%CI: 1.15, 1.39). Among screen-based SB, using mobile phones conferred the greatest risk of NP (OR = 1.82, 95%CI: 1.27, 2.61), followed by using computers (OR = 1.23, 95%CI: 1.08, 1.40), whereas watching TV was not a significant risk (OR = 1.20, 95%CI: 0.99, 1.44). Moreover, SB ≥ 4 h per day (h/d) increased the risk of NP (OR = 1.60, 95%CI: 1.38, 1.87), and the risk further increased with SB ≥ 6 h/d (OR = 1.88, 95%CI: 1.42, 2.48). The risk of NP increased with a screen-based SB dose ≥ 1 h/d (OR = 1.28, 95%CI: 1.17, 1.44), ≥ 2 h/d (OR = 1.35, 95%CI: 1.18, 1.55), and ≥ 4 h/d (OR = 1.45, 95%CI: 1.26, 1.67).

CONCLUSION

SB is a notable risk factor for NP, with the risk escalating with longer durations of sedentary time. Targeted preventative measures, particularly for high-risk groups like female and employees, are necessary. Public health initiatives should encourage the reduction of sedentary behaviors and the promotion of physical activity to enhance neck health and alleviate the global prevalence of NP.

Comparison of trunk muscle endurance between women with and without chronic neck pain

PURPOSE

To compare trunk flexor, extensor, and lateral flexor muscle endurance between women with moderate to severe disability due to chronic neck pain (CNP) and asymptomatic women.

DESIGN

Observational case-control study.

METHODS

Thirty women with CNP and Neck Disability Index scores ranging from 30% to 70% and 28 asymptomatic women were included. The visual analog scale was used to assess neck pain intensity at rest and during activity. To assess trunk muscles endurance, trunk flexor endurance test, Sorensen test, and side bridge endurance test were performed.

RESULTS

Analysis of covariance indicated that neck pain group had lower body mass index-adjusted endurance times of trunk flexor, extensor, and lateral flexor muscles with large effect sizes (p < .001, η2 = 0.378-0.696). Trunk flexor endurance time showed a moderately negative correlation with neck pain intensity at rest and a weakly negative correlation with neck disability score (r = -460 and -365, p < .05).

CONCLUSIONS

Women with moderate to severe disability due to CNP exhibited decreased trunk muscle endurance, which may be a predisposing factor for low back pain. Also, trunk flexor endurance was related to neck pain complaints. A holistic approach, addressing the entire spine rather than focusing solely on the cervical region, might be useful for managing CNP.

CLINICAL IMPLICATIONS

The findings of reduced endurance in trunk muscles should be considered when incorporating interventions in the management of CNP to effectively address pain and disability.

A seventeen-year, population-based study to identify dynamic patterns of interfering neck pain and its burden in South Korea

AIM

The aim of this study were to introduce a profile of a nationwide cohort for patients with neck pain and to identify the patterns of recurrent neck pain over time.

METHODS

Health insurance data for 1,127,323 patients (43.5 ± 11.5 years, 60.8% females) with neck pain in 2010 were extracted from the National Health Information Database of South Korea. Data on the duration and frequency of neck pain and the number of healthcare visits recorded between 2002 and 2018 were screened and used for descriptive analysis.

RESULTS

During the study period, patients experienced 4.1 episodes of neck pain, and 74% of patients experienced multiple episodes. The duration of one episode was 12.1 ± 35.7 days. Following each episode, more than 73% of patients experienced a subsequent episode of neck pain. As patients experienced more episodes, the recurrence rate increased gradually from 73% to 80%, and subsequent episodes occurred in a shorter time and lasted longer with a higher number of healthcare visits, compared to a preceding episode.

CONCLUSION

The study highlighted the dynamic pattern of interfering neck pain, with episodes occurring more frequently and lasting longer over time. Early intensive management with a long-term follow-up is recommended to prevent a dynamic pattern of interfering neck pain.

Cervicothoracic junction mobilization versus autogenic muscle energy technique for chronic mechanical neck pain: A randomized controlled trial

OBJECTIVE

Neck pain is a prevalent global health concern often accompanied by musculoskeletal symptoms. This randomized controlled trial attempted to contrast the impacts of non-thrust Maitland mobilization and Autogenic inhibition muscle energy technique on chronic mechanical neck pain associated with cervico-thoracic junction hypo-mobility.

METHODS

Sixty participants (24 males and 36 females, aged 18-45 years) were allocated randomly into three equally sized groups (A, B, C). Group A: Maitland mobilization plus conventional treatment, Group B: Autogenic Muscle energy technique plus conventional treatment, while; Group C solely received conventional treatment. Treatment was administered for four weeks, three times a week. Outcome measures: neck pain (The primary outcome measure) assessed by Visual Analog Scale (VAS), disability evaluated through Neck Disability Index (NDI), active range of motion (AROM), and joint position error (JPE) as an indicator of cervical proprioception. All measures were assessed both at baseline and after four weeks of intervention.

RESULTS

Results showed significant improvements in VAS, NDI, and increased ROM across all groups post-treatment (p < 0.001). While Groups A and B demonstrated superior outcomes compared to Group C, differences between Groups A and B were not statistically significant (p > 0.05). For VAS and NDI, Cohen-d between Groups A and B was 0.31 and 0.31, and for ROM, Cohen-d was 0.37, 0.16, 0.07, 0.29, 0.36, and 0.53 for flexion, extension, right rotation, left rotation, right bending, and left bending, respectively. Furthermore, all groups experienced a significant decrease in JPE, with Groups A and B showing greater improvement than Group C (p < 0.01). Group B exhibited significantly greater improvement in reducing JPE related to specific motions compared to Group A (p < 0.05).

CONCLUSION

Cervico-thoracic junction mobilization and the Autogenic muscle energy technique offer enhanced management for mechanical neck pain by improving pain, function, ROM, and cervical proprioception.

Differences on lower trapezius pressure pain threshold, muscle strength and muscle thickness in individuals with chronic neck pain and active or latent myofascial triggers points

BACKGROUND

Myofascial trigger points (MTrPs) in the lower trapezius have been recognized as an important source of neck pain. This study aims to compare the lower trapezius muscle strength, pressure pain threshold (PPT) and muscle thickness at rest and contraction between participants and painful vs. no-painful side with active and latent MTrPs; and to examine the associations among these variables with pain intensity, duration and disability in patients with neck pain.

METHODS

A cross-sectional study was carried out in 64 people with neck pain with active or latent MTrPs (34 Active MTrPs group and 30 Latent MTrPs groups). Muscle strength, pressure pain threshold and muscle thickness at rest and contraction of the lower trapezius was recorded.

RESULTS

No significant differences were found in descriptive data, dominant side, or side of neck pain. However, the Active MTrPs Group had lower pain pressure thresholds (PPT) on the neck pain side compared to the Latent MTrPs Group, indicating greater sensitivity. Muscle thickness and strength showed minor differences between groups. Pain intensity correlated moderately with pain duration and strongly with neck pain disability.

CONCLUSIONS

The results of the present study showed differences in PPT on the lower trapezius muscle in active and latent MTrP in neck side pain compared to non-neck side pain. In addition, lower trapezius strength reported differences between the neck side pain compared to non-neck side pain in both active and latent MTrP. Lower trapezius muscle strength showed significant moderate association with muscle thickness at contraction.

7. Cervical facet pain: Degenerative alterations and whiplash-associated disorder

INTRODUCTION

Pain from the cervical facet joints, either due to degenerative conditions or due to whiplash-related trauma, is very common in the general population. Here, we provide an overview of the literature on the diagnosis and treatment of cervical facet-related pain with special emphasis on interventional treatment techniques.

METHODS

A literature search on the diagnosis and treatment of cervical facet joint pain and whiplash-associated disorders (WAD) was performed using PubMed, Cochrane, and Embase databases. All relevant literature was retrieved and summarized.

RESULTS

Facet-related pain is typically diagnosed based on history and physical examination of the patients, combined with a diagnostic block (eg, with local anesthetic) of the medial branches innervating the joints. There is no additive value for imaging techniques to diagnose cervical facet pain, but imaging may be used for procedure planning. First-line therapy for pain treatment includes focused exercise, graded activity, and range-of-motion training. Pharmacological treatment may be considered for acute facet joint pain; however, for chronic facet joint pain, evidence for pharmacological treatment is lacking. Considering the lack of evidence for treatment with botulinum toxin, intra-articular steroid injections, or surgery, these interventions are not recommended. Diagnostic blocks are not considered a viable treatment option, though some patients may experience a prolonged analgesic effect. Long-term analgesia (>6 months) has been observed for radiofrequency treatment of the medial branches.

CONCLUSIONS

Cervical facet pain is diagnosed based on history, physical examination, and a diagnostic block of the medial branches innervating the painful joints. Conservative management, including exercise therapy, is the first line of treatment. When conservative management does not result in adequate improvement of pain, radiofrequency treatment of the medial branches should be considered, which often results in adequate pain relief.

Global burden of neck pain and its gender and regional inequalities from 1990 - 2021: a comprehensive analysis from the Global Burden of Disease Study 2021

BACKGROUND

Neck pain is a growing public health concern, no recent research has comprehensively examined its incidence and years lived with disability (YLDs) across different regions and genders. For the first time, this study aims to provide the most recent estimates on the global burden of neck pain between 1990 and 2021 obtained from the 2021 global burden of disease (GBD) database, focusing on regional and gender inequalities. We also predict future trends, highlighting its increasing impact on public health.

MATERIALS AND METHODS

The study was conducted retrospectively using publicly available data from the GBD 2021 database, acquired on August 20, 2024. The incidence and burden of neck pain were assessed using DisMod-MR 2.1. Data on incidence and years lived with disability (YLDs) rates per 100,000 people were obtained for countries, regions, ages, and sexes globally.

RESULTS

In 2021, the global age-standardized rates for incidence, and YLDs of neck pain per 100,000 population was 519 (95% uncertainty interval, 408-633), and 242 (163-343) per 100,000 population, respectively. Joinpoint regression showed both rates demonstrated an overall increasing trend from 1990 to 2021 worldwide. Projections suggest a slight decline in these rates for the coming years. Women consistently showed a higher burden than men across all age groups. Regional analyses indicated that the Islamic Republic of Iran had the highest rates, whereas New Zealand had the lowest. Negative correlations were observed between the Estimated Annual Percentage Change (EAPC) and both the age-standardized rates and the Sociodemographic Index (SDI). Low-SDI countries generally exhibited higher incidence and YLDs rates, whereas high-SDI countries maintained higher YLDs rates despite relatively lower incidence rates.

CONCLUSION

The global burden of neck pain increased between 1990 and 2021, but future projections indicate a potential mild decrease. Gender and regional inequalities persist, underscoring the need for targeted policy interventions focusing on women and low-SDI regions to alleviate the burden of neck pain.

The impact of biofeedback in enhancing chronic pain rehabilitation: A systematic review of mechanisms and outcomes

Background and objectives

Chronic pain (CP), affecting approximately 20 % of adults globally, imposes a profound burden on individuals and healthcare systems. This condition, characterized by persistent pain, muscle stiffness, and emotional distress, often results in a complex interplay of physical and psychological factors that exacerbate symptoms and hinder recovery. Biofeedback (BFB), a non-invasive intervention, offers a promising rehabilitation strategy by enabling individuals to monitor and self-regulate physiological responses, such as muscle tension, heart rate, and skin temperature. Through this process, BFB disrupts the vicious cycle of pain and stress, fostering relaxation, reducing muscle strain, and alleviating emotional distress. This systematic review aimed to examine the mechanisms underlying BFB's therapeutic effects in CP rehabilitation, specifically its ability to enhance self-regulation and promote relaxation to improve pain control. Furthermore, it aimed to evaluate the impact of BFB on key outcomes, including pain severity, functional capabilities, and quality of life, with the goal of guiding its integration into contemporary rehabilitation practices.

Materials and Methods

Following PRISMA guidelines, a systematic search was conducted in PubMed, Web of Science, and Embase (2014-2024) to identify studies on BFB for CP. Inclusion criteria included original research involving BFB as a primary or secondary intervention for CP, with outcomes related to pain management and rehabilitation. This review is registered on Open OSF (X5HPB).

Results

BFB has shown consistent efficacy as a complementary therapy in CP management, offering significant reductions in pain intensity and enhancements in quality of life across diverse CP conditions. Mechanistically, BFB facilitates improved self-regulation by training patients to modulate physiological responses, such as muscle tension and heart rate variability, leading to better pain control and stress reduction.

Conclusions

BFB shows significant promise as a supplementary treatment for different CP disorders. The evidence that was examined shows that it is effective in improving how pain is perceived, increasing functional results, and boosting overall quality of life among a variety of patient groups.

Physical measures of physical functioning as prognostic factors in predicting outcomes for neck and thoracic pain: Protocol for a systematic review

BACKGROUND

Spinal pain is prevalent and burdensome worldwide. A large proportion of patients with neck and thoracic pain experience chronic symptoms, which can significantly impact their physical functioning. Therefore, it is important to understand factors predicting outcome to inform effective examination and treatment. Knowledge of physical measures of physical functioning as prognostic factors can enhance patient-centered care and aid decision-making. The evidence regarding physical outcome measures as prognostic factors for neck and thoracic pain is unclear. The objective of this study is to summarize the evidence for physical outcome measures of physical functioning as prognostic factors in predicting outcomes in people with neck and thoracic pain.

METHODS AND ANALYSIS

This systematic review follows Cochrane guidelines and aligns with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Included studies will be prospective longitudinal cohort studies in which physical measures of physical functioning are explored as prognostic factors for adults with neck and thoracic pain. A comprehensive search will be performed in key databases (MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science) and the grey literature, with hand searches of key journals, and the reference lists of included studies. Two reviewers will independently perform study selection, data extraction, risk of bias assessment (QUIPS, Quality in Prognostic Studies tool), and quality assessment (Grading of Recommendations Assessment, Development, and Evaluation).

IMPLICATIONS

This systematic review will identify physical measures of physical functioning prognostic factors for neck and thoracic pain populations. Findings will inform researchers about gaps in existing evidence, and clinicians about factors to aid their clinical decisions and to enhance the overall quality of care for individuals with neck and thoracic pain.

The difference in C7 to wall distance in a group of software developers with and without moderate chronic neck pain

BACKGROUND

As the prevalence of non-traumatic neck pain (NTNP) increases, particularly among computer workers, identifying contributing factors is essential for developing preventative strategies.

OBJECTIVE

This study investigates the association between c7-to-wall distance and chronic NTNP in software developers, a population characterized by prolonged sedentary behavior and high computer usage.

METHODS

The study employed the C7-to-wall distance (C7WD) test, recognized for its reliability and ease of use, to measure the kyphotic curve as an indicator of spinal posture. Ninety software developers (age = 35.3 ± 5.4 yrs; male = 56, female = 34;) with an average working experience of 9.2 ± 4.5 yrs as a full-time software developer (40.7 ± 1.8 h/week) were examined for postural pathologies and allocated to two groups based on presence of neck pain.

RESULTS

The key finding was a significant correlation between increased C7WD and the presence of moderate chronic NTNP in software developers, revealing that those with neck pain tended to have a greater C7WD. It was observed that all participants exhibited mild kyphotic posture irrespective of pain presence.

CONCLUSION

The results suggest that although a relationship exists, the clinical significance of the difference in C7WD between those with and without chronic NTNP is debatable. The findings emphasize the need for further comprehensive research that encapsulates biomechanical, functional, and psychosocial factors to holistically understand and manage NTNP in the software developer population.

Infrared thermography in clinical practice: a literature review

BACKGROUND

Infrared thermography technology is a diagnostic imaging modality that converts temperature information on the surface of the human body into visualised thermograms. This technology has the capacity to intuitively detect the presence of certain abnormal conditions or foci in the human body. In recent years, the application of this technology in medicine has become increasingly extensive, especially in the areas of auxiliary diagnosis and early screening of diseases.

OBJECTIVES

The aim of this review is to analyse and summarise the application of infrared thermography in clinical practice.

METHODS

A comprehensive search of the research literature pertaining to the clinical application of medical infrared thermography was conducted, encompassing publications by both domestic and foreign researchers and scholars, in prominent databases including PubMed, ISI Web of Science, and CNKI since the inception of these databases.

RESULTS

A total of 51 articles were ultimately included in the study. The application of infrared thermography has been demonstrated in oncology, painful diseases, inflammation, rheumatism, and vascular-related diseases.

CONCLUSIONS

The extensive utilisation of infrared thermography in clinical settings signifies the technology's considerable potential. Addressing its current limitations can optimise its benefits.

Cost-utility and cost-benefit analysis of a multi-component intervention (NEXpro) for neck-related symptoms in Swiss office workers

BACKGROUND

Neck pain is a significant public health issue, especially among office workers, with a prevalence ranging from 42 to 68%. This study aimed to evaluate the cost-utility and cost-benefit of a multi-component intervention targeting neck pain in the general population of office workers in Switzerland. The 12-week multi-component intervention consisted of neck exercises, health promotion information workshops, and workplace ergonomics sessions.

METHODS

The study was designed as a stepped-wedge cluster randomized controlled trial and assessed using an employer's perspective. The main analysis focused on the immediate post-intervention period. Long-term effects were examined in a subsample at the 4, 8, and 12-month follow-ups. The intervention effects on costs and quality-adjusted life years (QALYs) were estimated using generalized linear mixed-effects models, controlling for confounding factors. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were presented, along with calculations of the break-even point and the return on investment. Various sensitivity analyses were performed.

RESULTS

A total of 120 office workers participated in the trial, with 100 completing the intervention period and 94 completing the entire study. The main analysis included 392 observations. The intervention had a significant positive effect on QALYs and a nonsignificant effect on costs. The ICER was estimated at -25,325 per QALY gain, and the probability of the intervention being cost saving was estimated at 88%. The break-even point was reached one week after the end of the intervention.

CONCLUSION

The multi-component intervention is likely to reduce company costs and simultaneously improve the quality of life of employees. However, the implementation of such interventions critically depends on evidence of their cost-effectiveness. As there is still a large research gap in this area, future studies are needed.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04169646 . Registered 15 November 2019-Retrospectively registered.

TRIAL PROTOCOL

Aegerter AM, Deforth M, Johnston V, Ernst MJ, Volken T, Luomajoki H, et al. On-site multi-component intervention to improve productivity and reduce the economic and personal burden of neck pain in Swiss office-workers (NEXpro): protocol for a cluster-randomized controlled trial. BMC Musculoskelet Disord. 2020;21(1):391.  https://doi.org/10.1186/s12891-020-03388-x .

Investigating the relationship between non-pathological neck pain and hand grip strength: A cross-sectional study

BACKGROUND:

Non-pathological neck pain (NPNP) is neck pain without a known cause. It might weaken the hand grip strength (HGS) by affecting the neck, shoulder, and upper extremity muscles. Head-neck positions (HNPs) can have a significant impact on neck pain. However, no previous study investigated the effect of NPNP and different HNPs on the HGS among healthcare professionals (HCPs).

OBJECTIVE:

To determine how HNPs influence the HGS of medical personnel with NPNP.

METHOD:

A cross-sectional study recruited 46 healthcare professionals: 21 (45.7%) with and 25 (54.3%) without NPNP. A dynamometer, cervical range of motion, and visual analogue scale measured HGS, HNPs, and NPNPs, respectively. Participants were instructed to squeeze the handgrip dynamometer handle in 90-degree elbow flexion as much as possible from a seated position to measure HGS from the neutral head position (NHP), 40° head neck flexion (HFP40°), and 30° head neck extension (HEP30°). Data differences were analysed using ANOVA. The significance level was set at p < 0.05.

RESULTS:

The mean HGS for the dominant hand in NHP, HFP40°, and HEP30° was 29.27 (±9.03), 27.24 (±9.08), and 26.37 (±9.32), respectively, while for the non-dominant hand it was 27.45 (±9.62), 25.23 (±9.36), and 24.61 (±10.17). There was no significant correlation between HNPs and HGS. However, the only significant difference was between dominant HGS in the NHP and non-dominant HGS in the HEP30° (P = 0.018). Furthermore, NPNP had no significant effect on the HGS (P = 0.325).

CONCLUSION:

NPNP had no significant influence on HGS in any of the three HNPs for either hand. Future studies should include other HNPs and other potential variables such as age, gender, weight, and pain intensity.

Evaluation of the Application of Clinical Practice Guideline Recommendations on the Classification of Patients With Neck Pain

Background: Clinical practice guidelines (CPGs) are developed to synthesize evidence into recommendations for clinical practice. Minimal evidence exists on the evaluation practice of physical therapists in the treatment of patients with neck pain. Purpose: We sought to describe (1) the extent to which clinicians perform the Neck Pain CPG-recommended examination measures and (2) the percentage of patients properly classified. Methods: We retrospectively analyzed the electronic health records of 397 patients with neck pain at an ambulatory care setting in an academic medical center. The frequency of physical therapists' evaluation measures, subjective findings, positive examination results, and the percentage of patients properly classified into impairment-based categories (IBCs) were recorded. Descriptive statistics and χ2 tests were used to assess patient demographics and compare classification accuracy across IBCs. Results: Of the 397 patients, 56% were classified into an IBC. The most common IBC was neck pain with mobility deficits (24%), followed by neck pain with radiating pain (17%), neck pain with movement coordination impairments (NPMCIs) (8%), and neck pain with headache (6%). Neck pain with movement coordination impairment had the lowest percentage of proper classifications. Classification accuracy was highest when subjective and objective findings were combined and varied between IBCs. Conclusion: Our findings suggest that physical therapists evaluating patients with neck pain may have increased classification accuracy when subjective and objective findings are considered. Decreased classification accuracy was demonstrated in the NPMCI category, highlighting opportunities for further education and research.

Prevention of neck pain in adults with a Back School-Based intervention: a randomized controlled trial

BACKGROUND

Neck pain is a health problem worldwide. To prevent it, experts recommend exercise and education.

OBJECTIVE

To evaluate the effects of a Back School-based intervention for the prevention of nonspecific neck pain in a healthy adult population.

METHODS

A randomized controlled trial with 58 participants with no history of neck pain within the past six months. The experimental group performed an 8-week Back School-based program. The control group maintained their usual lifestyle. Primary outcomes, which include the number of episodes, days and intensity of neck pain, and the number of medical visits, were recorded in a 1-year follow-up diary and analyzed using the Mann-Whitney test. Secondary outcomes, such as neck flexor, neck extensor, and scapular muscles endurance, were analyzed using the ANOVA test.

RESULTS

In the analysis of the primary outcomes, no significant differences were found in the number of episodes (p = 0.068,d = -0.49), number of days (p = 0.059,d = -0.54), or the average intensity of neck pain (p = 0.061,d = -0.53). There were significant changes in the number of medical visits (p = 0.033,d = -0.57). Moving to secondary outcomes, significant interactions were observed in neck flexor (p = 0.045, ηp2 = 0.036) and neck extensor endurance (p = 0.049, ηp2 = 0.035), but not in scapular muscle endurance (p = 0.536, ηp2 = 0.003).

CONCLUSIONS

The Back School-based program reduced the number of medical visits and increased the endurance of the cervical musculature. Trial registration in ClinicalTrials.gov: NCT05260645.

Drive away neck pain: Transformative motor control therapeutic neck exercises and tailored programs redefine posture for automotive workers

BACKGROUND

Neck discomfort, arising from strained muscles, poor posture, accidents, or underlying medical conditions, significantly impacts daily activities and overall well-being, presenting a substantial healthcare challenge.

OBJECTIVE

This study aims to evaluate the efficacy of motor control therapeutic neck exercise and a Structured Exercise Program on neck pain and posture among automobile industrial workers.

METHODS

Using a lottery technique, 106 participants aged 20 to 45 were selected from the vicinity of Chennai's auto industries based on predetermined eligibility and exclusion criteria. Subsequently, participants were randomly assigned to either the motor control therapeutic neck exercise group or the structured exercise program group, each comprising 53 individuals. Participants received a comprehensive overview of the study and respective interventions, and their informed consent was obtained. Demographic details, Neck Injury and Disability scores, and Assessment of Postural and Ergonomic Characteristics data were then collected.

RESULTS

Statistical analysis revealed a significant difference between the groups, with the Motor Control Therapeutic Neck Exercise group demonstrating superior outcomes in reducing pain and improving posture, with p-values less than 0.001.

CONCLUSIONS

This study highlights the efficacy of Motor Control Therapeutic Neck Exercise over Structured Exercise in improving neck pain and posture among automobile industrial workers. These findings contribute valuable insights for the development of targeted interventions in occupational health settings.

A nationwide multicenter study of the cost effectiveness of five leading drugs for pharmacological management of cervicobrachial symptoms

BACKGROUND

Cervicobrachial pain frequently affects the quality of life (QOL) of the general public and has a significant economic impact on the health care systems of various countries. There are a number of treatment options for this disease, including widely-used drug therapy, but the effectiveness of each option is indeterminate, and there have been no published cost-effectiveness analysis studies so far. This prospective observational study aimed to examine the cost-effectiveness of drug treatment for cervicobrachial symptoms.

METHODS

A 6-month medication regimen for each of five frequently-prescribed drugs for cervicobrachial symptoms was administered to 322 patients at 24 centers in Japan. Outcome measures, including of the EuroQol Group 5D, Short Form-8, and Visual Analog Scale (VAS), were investigated at baseline and every month thereafter. Incremental cost-effectiveness ratios (ICERs) of the drug cost to quality-adjusted life years (QALYs) were calculated. A stratified analysis of patient characteristics was also performed to identify baseline factors potentially affecting cost-effectiveness.

RESULTS

The ICER of entire drug treatment for cervicobrachial symptoms was 7,491,640 yen. Compared with the reference willingness-to-pay, the ICER was assumed to not be cost-effective. A certain number of QALYs were gained during the first 3 months after the treatment intervention, but almost no QALYs were gained during the following 3 months. Stratified analysis showed that cost-effectiveness was extremely low for patients with high baseline VAS and high QOL.

CONCLUSIONS

The available medications for cervicobrachial symptoms did not have excellent cost-effectiveness. Although a certain number of QALYs were gained during the first 3 months after medication, no QALYs were gained in the latter half of the study period, suggesting that it is not advisable to continue the medication needlessly.

LEVEL OF EVIDENCE

II, prospective cohort study.