The contemporary management of neck pain in adults

The effectiveness of hands-off approaches alone or in combination with hands-on approaches in the treatment of chronic cervical pain within a biopsychosocial framework: A systematic review

PURPOSE

This study aimed to systematically review the current literature comparing hands-off approaches with hands-on approaches from a biopsychosocial perspective of pain processing in people suffering from chronic primary neck pain (CPNP).

METHODS

An electronic search was conducted on PubMed, Web of Science, Scopus, and Cochrane Library. Initial searches were carried out in November 2022, with electronic database searches repeated on November 25, 2024. Eligibility criteria which were randomized controlled trials comparing hands-off approaches alone or in combination with hands-on approaches and hands-on approaches alone in people with CPNP were checked by two independent authors. The risk of bias was assessed using the revised Cochrane Risk of Bias Tool (RoB). The strength of conclusion was determined using the evidence-based guideline development approach.

RESULTS

Fifteen studies with a total of 1029 participants were included in this review. The RoB was rated as low RoB for two studies, some concerns for two studies and high RoB for 11 studies. Pain processing was assessed by pain intensity(100 % of the studies), pain sensitivity(53 % of the studies), pain-related participation in social roles(46 % of the studies), pain-related emotions(26 % of the studies), and pain-related beliefs(6 % of the studies). Limited quality of evidence was found for the hands-off approaches alone being more effective on pain intensity than hands-on approaches alone in the long term. Limited- to moderate-quality of evidence was found for hands-off approaches combined with hands-on approaches, being more effective than hands-on approaches alone in improving pain intensity, pain sensitivity, pain-related participation in social roles, pain-related emotions, and pain-related beliefs in the short-, mid- or long-term.

CONCLUSIONS

The current findings suggest that hands-off approaches alone are superior to hands-on approaches in the long term, at least for pain intensity. Hands-off approaches in combination with hands-on approaches were also more effective than hands-on approaches for pain processing. However, substantial heterogeneity warrants a cautious interpretation of these results. More high-quality, randomized, controlled trials with homogenous data collection and larger sample sizes are needed.

Acute and long-term effect of specific and non-specific exercises in patients with chronic neck pain: A protocol for a randomized controlled trial

Exercise therapy is the most common approach for people with chronic neck pain (CNP). Although well-established, it remains unknown which type of exercise is the best for treating this condition. Moreover, pain processing can play a role in the persistence of pain and in the response to interventions. Thus, the aim of this randomized controlled trial is to compare the acute and long-term effects of two exercise protocols (specific and non-specific) on pain and pain processing in individuals with CNP. One hundred and ten participants aged between 18 and 65 years who have had non-specific neck pain for more than 3 months will be recruited. They will be randomized and allocated into two groups (specific exercises and non-specific exercises) and both groups will perform an exercise programme twice a week for 8 weeks. Both programmes are divided into two progressive and individualized phases. The primary outcomes are change in pain intensity after 8 weeks of exercise and exercise-induced hypoalgesia, and secondary outcomes are pressure pain threshold, temporal summation of pain, conditioned pain modulation, the Neck Disability Index, the Baecke Physical Activity Questionnaire, and the Global Perception of Change Scale. Outcomes will be assessed at baseline, after 8 weeks of intervention, and at 6-month follow-up.

The comparison of Pilates with cognitive functional therapy in adults with chronic neck pain: a protocol for randomized controlled trial

BACKGROUND

Chronic Neck Pain is one of the main musculoskeletal problems in the general population that negatively affects the lives of patients. Its treatment can include various treatment methods, such as Pilates and Cognitive Functional Therapy. The purpose of this research was to investigate the effectiveness of Pilates in relation to Cognitive Functional Therapy in people with Chronic Neck Pain.

METHODS

This single-blind randomized controlled study included 60 patients with Chronic Neck Pain who were randomly divided into two groups (Group 1: Pilates, Group 2: Cognitive Functional Therapy). All patients will undergo 16 sessions over 8 weeks. Outcome measures (pain, disability, fear perception, functionality, quality of life, cervical range of motion, and neck muscle isometric strength) will be evaluated at baseline, at the end of the treatment (week 8) and three months after randomization (week 12). Outcome measures will be analyzed via random effects at the three assessment time points, and the interactions of the treatment groups with the assessment points will be included in the results of the fixed model.

DISCUSSION

This is the first Randomized Controlled Trial to compare the effectiveness of Pilates and Cognitive Functional Therapy in patients with chronic neck pain. The results of this research will provide information on the effectiveness of each intervention separately and whether one of the two can outperform the other.

Photobiomodulation on shoulder and neck pain and disability: A comprehensive review

The purpose of this review was to evaluate the effect of Photobiomodulation (PBM) in managing shoulder and neck pain and disability. A literature search was conducted using the PubMed and ScienceDirect/EMBASE databases. The keywords used were "Low-level laser therapy", "photobiomodulation", "LASER", combined with "shoulder" or "neck". Only clinical studies written in English, Portuguese, Spanish, Italian, French, and German, were included. The review included 36 studies applying PBM therapy to alleviate pain or disability in patients with shoulder and neck conditions. Of these, 12 studies focused on neck conditions, and 24 studies addressed shoulder conditions, with one study concurrently examining both areas. This review on PBM therapy for shoulder and neck conditions shows promising results, particularly in pain relief and functional improvements, with infrared wavelengths being the most commonly used. Subacromial Impingement Syndrome (SAIS) and Myofascial Pain Syndrome (MPS) were the most frequently studied conditions. However, chronic and complex conditions like cervical osteoarthritis and post-stroke shoulder pain were less frequently represented, indicating a research gap. PBM was found to be a safe and non-invasive therapeutic option. Despite positive outcomes, variability in PBM protocols remains a challenge. Further standardized trials are needed to confirm its effectiveness across diverse conditions. This review updates current knowledge, highlights key findings, and provides direction for future research and clinical applications.

Comparison of Short-Term Effects of Different Spinal Manipulations in Patients with Chronic Non-Specific Neck Pain: A Randomized Controlled Trial

Spinal manipulations for chronic non-specific neck pain (CNNP) include cervical, cervicothoracic junction, and thoracic spine (CCT) manipulations as well as upper cervical spine (UCS) manipulations. This study aimed to compare the short-term effects of UCS manipulation versus a combination of CCT spine manipulations on pain intensity, disability, and cervical range of motion (CROM) in CNNP patients. In a private physiotherapy clinic, 186 participants with CNNP were randomly assigned to either the UCS (n = 93) or CCT (n = 93) manipulation groups. Neck pain, disability, and CROM were measured before and one week after the intervention. No significant differences were found between the groups regarding pain intensity and CROM. However, there was a statistically significant difference in neck disability, with the CCT group showing a slightly greater decrease (CCT: 16.9 ± 3.8 vs. UCS: 19.5 ± 6.8; p = 0.01). The findings suggest that a combination of manipulations in the CCT spine results in a slightly more pronounced decrease in self-perceived disability compared to UCS manipulation in patients with CNNP after one week. However, no statistically significant differences were observed between the groups in terms of pain intensity or CROM.

Effectiveness of myofascial release for adults with chronic neck pain: a meta-analysis

BACKGROUND

Every second human will experience a phase of neck pain in their lifetime and a high rate of chronicity exists. Because of the complexity and multiple influencing factors, chronic pain conditions are associated with a long treatment and diagnostic process. This leads to a prolonged healing process and high costs.

OBJECTIVE

To evaluate the effect of myofascial release on the variables of pain and range of motion in patients with chronic neck pain.

METHOD

Selection criteria were set to create a search algorithm for a systematic search in the databases: PubMed, Google Scholar, EBM Reviews, Medline, CINAHL, PEDro, and Science Direct. The risk of bias and the methodological quality was analyzed with the PEDro scale.

RESULT

Ten randomized controlled trials, with 549 participants met the eligibility criteria. The methodological quality was ranked from good to excellent. The myofascial release showed a significant difference in pain (p =  0.03), rotation to the right (p =  0.05), and lateral flexion to the right (p =  0.04), compared to other treatment methods. No significant effect was found for improvements in pressure pain threshold.

CONCLUSION

Modest effects are observed in pain reduction, suggesting potential benefits of myofascial release in managing chronic neck pain. Further research with standardized protocols and direct comparisons to established therapies is crucial for a comprehensive understanding of myofascial release efficacy.

CONTRIBUTION OF THE PAPER

What does the meta-analysis add to the current literature.

Analysis of Clinical Pattern of Musculoskeletal Disorders in the Cervical and Cervico-Thoracic Regions of the Spine

Background: Cervical spine disorders (CSDs) are a common cause of neck pain. Proper diagnosis is of great importance in planning the management of a patient with neck pain. Hence, the aim of this study is to provide an overview of the clinical pattern of early-stage functional disorders affecting the cervical and cervico-thoracic regions of the spine, considering the age and sex of the subjects. Methods: Two hundred adult volunteers were included in the study. Manual examination of segments C0/C1-Th3/Th4 was performed according to the methodology of the Katenborn-Evjenth manual therapy concept and the spine curvatures were assessed (cervical lordosis and thoracic kyphosis). Results: The most common restricted movement was lateral flexion to the left, and the least disturbed movement were observed in the sagittal plane (flexion and extension). The most affected segment was C7/Th1 (71.5% participants had problems in this segment), and the least affected segment was Th3/Th4 (69.5% participants had no mobility disorders in this segment). The number of disturbed segments did not differ between men and women (p > 0.05), but increased with age (r = 0.14, p = 0.04). Conclusions: Cervical mobility in adult population is frequently restricted. The number of affected segments increased with age and was not sex-dependent.

Efficacy of telerehabilitation exercise in patients with chronic neck pain: a protocol for a non-inferiority randomized controlled trial

The aim of this study is to investigate if telerehabilitation is just as effective as the same face-to-face exercise program in patients with chronic neck pain (NP). 140 participants will participate in this non-inferiority randomized controlled trial. Primary outcomes will be pain intensity and disability, and secondary outcomes will be kinesiophobia, catastrophizing, fear avoidance beliefs, anxiety and depression symptoms, self-efficacy for pain and global perceived effect. It will be collected at baseline, 6 weeks and 6 months after intervention. The analysis of non-inferiority will be calculated by mixed linear models considering the non-inferiority margin. The results of this clinical trial will be able to overcome the barriers that physiotherapists face for the success of their therapies. In addition, it may reduce the high demands and public health costs with NP. Brazilian Clinical Trials Registry (RBR-6VBSMB). Clinical Trial Registration: REBEC (Brazilian Registry of Clinical Trials) RBR-6VBSMB (ClinicalTrials.gov).

Effect of high-intensity laser therapy in patients with non-specific chronic neck pain: study protocol for a randomized controlled trial

BACKGROUND

Chronic non-specific neck pain (CNNP) is a prevalent musculoskeletal disorder known for its significant disability and economic burden, ranking second only to low back pain in musculoskeletal conditions. Physical therapy offers effective interventions for CNNP, including low-level laser therapy (LLLT). High-intensity laser therapy (HILT) is a recent treatment for musculoskeletal pain, but studies that support its use in CNNP are limited. The objective of this study is to assess the effect of high-intensity laser therapy on pain intensity in patients with CNNP, given the existing evidence on LLLT for this condition.

METHODS

This is a 2-arm, randomized, placebo-controlled trial with blinded evaluators. The research will be carried out in the laboratory of physical agents at the Andrés Bello University, Campus Casona de las Condes. Eligible participants include the entire internal and external community associated with Andrés Bello University suffering from chronic non-specific NP. Participants will be stratified by sex (4 subgroups) and randomized into 2 study groups: group 1 (HILT and stretching exercises) and group 2 (sham HILT and stretching exercises). Treatments will be performed twice a week for 4 weeks with 3 assessments: before treatment (T0), at the end of treatment (T1), and 12 weeks after treatment (follow-up) (T2). The main outcomes will be pain intensity at rest, pain intensity at movement (active cervical movements: flexion, extension, right and left side bending, and right and left rotation), and pain pressure threshold (average obtained for six evaluation points). Secondary outcome measures will include neck range of motion in the sagittal, coronal, and transverse planes and neck disability.

DISCUSSION

In this study, HILT's effects on patients with non-specific NP will be compared to those of a sham laser intervention. This RCT will offer new evidence regarding the potential benefits of HILT in terms of pain intensity, range of movement, and disability in people suffering with non-specific NP.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05689788. January 19, 2023.

Spanish Cross-Cultural Adaptation and Validation of Neck Bournemouth Questionnaire (NBQ) for Neck Pain Patients

BACKGROUND

Neck pain is highly prevalent and one of the most common musculoskeletal conditions. Instruments that measure the factors involved in neck pain accurately are needed for clinical assessment. Patient-reported outcome measures (PROMs) are reliable, cost-effective, and specific tools for the assessment of musculoskeletal problems at different moments. The Neck Bournemouth Questionnaire (NBQ) assesses pain, function, disability, and psychological and social variables in patients with cervical pathologies. The aim of this study was to perform an adaptation and validation into Spanish of the NBQ (NBQ-Sp).

METHODS

A cross-sectional, observational study was carried out through translation, adaptation, and validation. A total of 129 patients with neck pain, of Spanish nationality, and over 18 years of age were included.

RESULTS

The NBQ-Sp showed excellent internal consistency, with Cronbach's α of 0.897, test-retest reliability with interclass correlation coefficient (ICC) of 0.866, and standard error of measurement (SEM) and minimum detectable change (MDC) values were 1.302 and 3.038, respectively. A Kaiser-Meyer-Olkin value of 0.857 was obtained, and Bartlett's test yielded p < 0.001, finding one factor in the factor analysis.

CONCLUSION

The NBQ-Sp has proven to be a valid and reliable tool for clinicians and researchers to measure neck pain in the Spanish population.

Management of non-specific thoracic spine pain: a cross-sectional study among physiotherapists

BACKGROUND

The thoracic area has mainly been neglected in research compared to the lumbar and cervical regions. No clinical practice guidelines (CPGs) for non-specific thoracic spine pain (TSP) have been compiled. Therefore, it can be argued that the absence of specific CPGs raises questions about the management of non-specific TSP. Hence, this study aimed at determining the management of non-specific TSP among physiotherapists in Italy.

METHODS

A web cross-sectional survey investigating physiotherapists' management of non-specific TSP was conducted. The survey instrument was divided into three sections. The first section obtained participants' characteristics. The second section determined participants' agreement with 29 statements regarding the clinical management of non-specific TSP utilising a five-point Likert scale. Participants who partially or completely agreed (scores 4-5) were considered to agree with the statements. A ≥ 70% of agreement with a statement was considered as consensus according to previous literature. The third section asked the participants to indicate how often they adopted several treatments to manage non-specific TSP with a 5-point scale (always - often - sometimes - rarely - never). The frequencies of answers were calculated, and a visual representation through a bar chart was reported. The online version of the survey instrument was delivered through the newsletter of the Italian Association of Physiotherapists and the postgraduate master's degree in Rheumatic and Musculoskeletal Rehabilitation of the University of Genova (Genova, Italy).

RESULTS

In total, 424 physiotherapists (mean age (SD): 35.1 years (10.5); 50% female) completed the survey. In the second section, physiotherapists achieved consensus for 22/29 statements. Those statements addressed the importance of psychosocial factors, exercise, education, and manual therapy techniques in managing non-specific TSP. In the third section, 79.7% of participants indicated they would always adopt a multimodal treatment (education, therapeutic exercise, manual therapy), followed by education and information (72.9%), therapeutic exercise (62.0%), soft tissue manual therapy (27.1%), and manual therapy (16.5%).

CONCLUSIONS

Study participants considered fundamentally using a multimodal programme based on education, exercise and manual therapy to manage non-specific TSP. This approach aligns with the CPGs for other chronic musculoskeletal pain than non-specific TSP.

Myofascial pain syndrome in the oncologic patient: general considerations

This article aims to make visible a common non-oncologic pain condition in cancer patients. Myofascial pain syndrome can generate an increase in the symptomatic burden of the oncologic patient, increase the demand for opioid medication, and decrease the quality of life. We consider that health professionals involved in the care of cancer patients in its different stages should be aware of it, diagnose it, and treat it early to avoid processes of pain chronification, peripheral tissue modification, and deterioration of the functional condition of patients with oncologic diseases.

Effects of active scapular correction on cervical range of motion, pain, and pressure pain threshold in patients with chronic neck pain and depressed scapula: a randomized controlled trial

BACKGROUND

Correction of scapular alignment is advocated as a component for alleviating symptoms for patients with neck pain.

OBJECTIVE

The study aimed to examine the effect of active scapular correction on cervical range of motion (ROM), pain, and pressure pain threshold (PPT) in patients with chronic neck pain with depressed scapula.

METHODS

A randomized control trial research design was conducted. Twenty-eight participants with chronic neck pain and depressed scapula were randomly assigned to either the intervention (n = 14) or control (n = 14) group. Active cervical rotation ROM, pain at maximum cervical rotation, and PPT over the upper trapezius muscle region were measured at baseline and post active scapular correction.

RESULTS

The participants in the intervention group showed significantly greater active cervical rotation ROM and less pain at maximum cervical rotation than the control group, both on the ipsilateral (p < 0.01) and contralateral (p < 0.05) sides of the depressed scapula. No significant difference in PPT between the groups was demonstrated (p = 0.194).

CONCLUSION

Active scapular correction intervention resulted in an immediate increase in active cervical rotation ROM and a decrease in neck pain at maximum cervical rotation.

Baduanjin improves neck pain and functional movement in middle-aged and elderly people: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Neck pain (NP), one of the most common musculoskeletal diseases, exercises a great influence on the daily life of individuals, especially the elderly. Baduanjin is a traditional Qigong therapy from China, but there is no evidence for its use in the treatment of neck pain in middle-aged and elderly people.

OBJECTIVE

We hope to summarize the efficacy evidence of Baduanjin in the treatment of middle-aged and elderly patients with neck pain (NP) for the first time, conduct a systematic review and meta-analysis, and provide basic evidence-based evidence for clinical practice.

METHODS

Two researchers collectively searched PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine disk (Sino-Med), China National Knowledge Infrastructure (CNKI), Wanfang database, and China Science and Technology Journal Database (VIP). The search time is set from initial to 27 September 2022, to find out RCT articles that may meet the criteria. The risk bias assessment tool Cochrane was applied to assess the methodological quality of involved studies. RevMan 5.3 was used for the meta-analysis with a mean difference (MD) and 95% confidence interval (CI), and the model type was a random effects model. The VAS scores of the intervention and control groups were extracted and the results of the meta-analysis were presented using a forest plot.

RESULTS

In total, 13 randomized controlled trials were meta-analyzed, including 840 patients. The results turned out that the VAS score in the intervention group was below the control group, which was statistically significant [MD = -1.15, 95% CI (-1.39, -0.92) and P < 0. 001]. The result of general efficiency suggests that the Baduanjin group was better than the control group [RR = 1.19, 95% CI (1.10, 1.29), P < 0.001].

CONCLUSION

The existing results seem to show that Baduanjin is safe and has a trend of positive benefits in the treatment of neck pain in middle-aged and elderly people. However, considering the limitations of this study, we need to be cautious in our conclusions, and more studies are needed to verify it in future.

Pestle Needle (Chu Zhen) Treatment for Neck Pain

Background

Neck pain-called Jing Bi or Neck Bi-syndrome in Traditional Chinese Medicine (TCM)-is frequently treated with various TCM modalities. Pestle needle (Chu Zhen) is a unique noninvasive treatment method that originated from the Sichuan province in China. This therapy is a combination of acupuncture and massage. There is little research on the clinical use of pestle needle, and detailed case reports are few in number.

Cases

This report describes 3 patients' neck pain-treatments via pestle needle; the patients were from Denmark, Indonesia, and China.

Results

Each author treated 1 of the patients; 1 patient had a significant reduction of his neck pain and 2 patients had successful resolution of their neck pain.

Conclusions

The clinical experiences of the 3 authors showed that pestle needle therapy could be an effective and simple noninvasive technique to relieve neck pain.