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

Background: Kinesiophobia or fear of movement is a cause of decreased level of activity in patients with chronic neck pain. Traditional forms of treatment, such as physiotherapy alone, can tackle problems of neck pain, but not kinesiophobia. This study aims to study the effect of visual distractiontechnique in the treatment of kinesiophobia. Study design: Quasi experimental study. Methods: A total of 43 participants with chronic neck pain and kinesiophobia were selected for the study. These participants underwent assessments on the NRS, Tampa scale and evaluation of cervical ROM. Assessment was done pre and post intervention of two weeks. Results: A significant reduction in Tampa score and NRS scores was observed and improvement in cervical ROM were seen post intervention in all subjects. Conclusion: The new visual distraction tool is effective in reducing kinesiophobia levels and NRS scores and improving cervical ROM in patients with chronic neck pain with kinesiophobia. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effectiveness of McKenzie neck exercise and cranio-cervical flexion (CCF) exercise on strength and endurance of deep neck flexor (DNF) muscles, pain, disability, and craniovertebral angle (CVA) in individuals with chronic neck pain. Methods: Forty individuals with chronic neck pain were randomly allocated to the McKenzie neck or CCF exercise group. Each group performed exercises at home daily. The strength and endurance of DNF muscles were measured at baseline, immediately after the first exercise session, and each week follow-up for six weeks. Average pain over the past week was measured at baseline and each week follow-up for six weeks. Disability and CVA were measured at baseline and the end of six weeks. Results: At six weeks, both groups exhibited significant improvements across all outcome variables (p < 0.001) but there were no differences between groups (p > 0.05). The significant difference from baseline in the strength of DNF muscles was observed as early as the second week of each intervention (p ≤ 0.001). The significant difference from baseline in the endurance of DNF muscles was observed as early as the first week in the CCF exercise group (p < 0.05) and the second week in the McKenzie neck exercise group (p < 0.05). A significant decrease in pain intensity from baseline was observed after the first week in the McKenzie neck exercise group (p < 0.001) while it was after the second week in the CCF exercise group (p < 0.05). Conclusion: Both the McKenzie neck exercise and CCF exercise produced similar effects in enhancing the strength and endurance of the DNF muscles, decreasing pain, alleviating neck disability, and improving the CVA. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the research was to observe the variations in brain activity between young cervical spondylosis patients with chronic neck pain (CNP) and healthy volunteers in the resting state and to investigate the central remodeling mechanisms in the patients. Patients and methods: Our study recruited 31 patients with chronic neck pain from cervical spondylosis and 30 healthy volunteers. Eventually, 29 patients (CNP group) and 29 healthy volunteers (HC group) completed the acquisition of clinical data and resting-state functional magnetic resonance (rs BOLD-fMRI) amplitude of low-frequency fluctuations (ALFF) data; in addition, we assessed the relationship between differentially active brain regions and clinical indicators. Results: The CNP group found greater ALFF values in the insula, cingulate gyrus, prefrontal lobe, and other brain regions. The occipital, parietal, and other brain regions had lower ALFF values. In addition, there was a negative connection between the duration of the sickness in the CNP group and the ALFF value of the right superior parietal gyrus (SPG.R). The level of tenderness threshold exhibited a negative correlation with the ALFF value of the left insula (INS.L). In addition, the NPQ score showed a negative association with the ALFF value of the ORBinf.R and a positive correlation with the ALFF value of the CC1.L. Finally, the HADS-A score exhibited a positive correlation with the ALFF value of the right anterior cingulate and paracingulate gyrus (ACG.R). Conclusion: Young patients with chronic neck pain show extensive central remodeling, with altered functional activity in pain-emotion brain areas (such as the cingulate gyrus and insula), pain-cognition brain areas (such as the prefrontal lobe), and other special sensory brain areas (such as the parietal and occipital lobes). These changes are linked to clinical tenderness, functional disability, and negative emotion indicators. [ABSTRACT FROM AUTHOR]

Objectives. The objective of this study was to translate and culturally adapt the Pain Self-Efficacy Questionnaire (PSEQ) into Hindi (PSEQ-H), the local language of India, and assess its psychometric properties. Background. The PSEQ is a commonly used outcome measure in patients with pain and related psychosocial aspects too. The PSEQ invites participants to consider their pain while assessing their self-efficacy views. Because about half of India's population understands Hindi, there is a need to translate the PSEQ into Hindi for patient convenience and better comprehension, as well as for research purposes. Materials and Methods. The PSEQ has been translated and culturally adapted into Hindi. A total of 120 patients with chronic neck pain were recruited. The PSEQ-H's content validity, construct validity, internal consistency, test-retest reliability, and responsiveness were all assessed. To determine test-retest reliability, the intraclass correlation coefficient was calculated. Cronbach alpha was used to determine internal consistency. Criterion validity was assessed using the neck disability index, NRS, and anxiety and depression measures. The area under the curve and the change cut-point were determined using the receiver operating characteristic curve analysis. Results. The PSEQ-H exhibited strong test-retest reliability (intraclass correlation coefficient = 0.90) and good internal consistency (Cronbach alpha = 0.88). Factor analysis confirmed a one-factor structure for the PSEQ-H. Furthermore, the PSEQ-H demonstrated amoderate correlation with the neck disability index, numerical pain rating scale, anxiety, and depression scales. A change detection threshold of 8.3 was established. Conclusions. The PSEQ-H is a reliable and valid measure for use in research and clinical purposes in the Indian population with chronic neck pain. [ABSTRACT FROM AUTHOR]

BACKGROUND: Red light therapy has the non-invasive and cost-effective characteristics, and is widely used in various acute and chronic pains in clinic. However, currently, the phototherapy equipment used in clinic is expensive and has certain site limitations, so it is necessary to explore more convenient and economical phototherapy applications. OBJECTIVE: To observe the clinical efficacy of a self-developed photon cervical vertebra massage instrument for chronic neck pain. METHODS: From November 2022 to February 2023, 24 patients with chronic neck pain were recruited from the Department of Rehabilitation Medicine, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 18 females and 6 males, with a mean age of (29.67±6.40) years. The body mass index was (21.39±3.52) kg/m2 . Photon cervical vertebra massage instrument was used twice a day for 20 minutes each time for four weeks. The changes in visual analog scale score, pressure pain threshold, neck active activity, neck disability index, and Pittsburgh sleep quality index were observed before, after 2 and 4 weeks of treatment. RESULTS AND CONCLUSION: (1) Compared with before treatment, after four weeks of treatment, visual analog scale score, pressure pain threshold, neck disability index, and Pittsburgh sleep quality index were all improved (P < 0.05), while some cervical motion (extension, left and right rotation) improved (P < 0.05) after 4 weeks of treatment. (2) Bilateral visual analog scale scores, left trapezius muscle pressure pain threshold, C5C6 pressure pain threshold, and neck disability index improved after 2 weeks of treatment (P < 0.05). (3) It is indicated that the application of photon cervical vertebra massage instrument can improve the pain score, muscle tenderness, sleep quality, functional level, and partial active activity of patients with chronic neck pain in a short period, and is a convenient, effective, and safe treatment method. [ABSTRACT FROM AUTHOR]

Background: It can be challenging to perform activities of daily living in patients with chronic neck pain. As the severity of the pain increases, the quality of the movements decreases. Not only the neck, but also the shoulder, elbow, grip strength and psychomotor skills are affected by these pains. Objective: In this study, it was aimed to investigate the effect of neck pain on grip strength and psychomotor skills in adults diagnosed with chronic neck pain. Methods: A cross‐sectional study was conducted to examine the effect of pain on grip strength and psychomotor skills in patients with chronic neck pain. This study was planned to be carried out between October 2019 and May 2020 at the Private Yaşam Medical Center in Adana, with the official permission of the institution manager, but this period was carried out between October 2019 and November 2020 due to the fact that sufficient number of patients could not be reached due to the COVID‐19 global epidemic. A total of 80 individuals, including 40 control and 40 patients, were included in the study. Forty adult patients who applied to the clinic with a diagnosis of chronic neck pain and 40 healthy adults without a diagnosis of chronic neck pain were included in the study. Conducted with 80 adults between the age of 19 and 74 years old. Individuals were divided into Group 1—control group (n = 40) and Group 2—patient group (n = 40). Information such as age, height, body weight and occupation of the groups were noted. Visual analogue scale and Neck Disability Index were applied to both the groups; hand grip strength with a Jamar hydraulic hand dynamometer, finger lateral grip strength with a pinchmeter and psychomotor skills with the Purdue Pegboard test were evaluated. Results: In the study, hand grip strength (p <.05), finger lateral grip strength (p <.05), psychomotor skills (p <.01) showed a statistically significant decrease in the patient group compared to the control group. Conclusion: It is thought that in addition to the routine treatments for neck pain in the treatment plan of patients with chronic neck pain, exercises to improve the functionality and psychomotor skills in daily living activities can be included in the direction of increasing the grip strength and will guide future studies. [ABSTRACT FROM AUTHOR]

This paper presents the anatomical and biomechanical aspects of chronic instability of the craniocervical junction (CCJ) with a discussion on clinical diagnostics based on mobility tests and provocative tests related to ligamentous system injuries, as well as radiological criteria for CCJ instability. In addition to the structural instability of the CCJ, the hypothesis of its functional form resulting from cervical proprioceptive system (CPS) damage is discussed. Clinical and neurophysiological studies have shown that functional disorders or organic changes in the CPS cause symptoms similar to those of vestibular system diseases: dizziness, nystagmus, and balance disorders. The underlying cause of the functional form of CCJ instability may be the increased activity of mechanoreceptors, leading to "informational noise" which causes vestibular system disorientation. Due to the disharmony of mutual stimulation and the inhibition of impulses between the centers controlling eye movements, the cerebellum, spinal motoneurons, and the vestibular system, inadequate vestibulospinal and vestibulo-ocular reactions occur, manifesting as postural instability, dizziness, and nystagmus. The hyperactivity of craniocervical mechanoreceptors also leads to disturbances in the reflex regulation of postural muscle tone, manifesting as "general instability". Understanding this form of CCJ instability as a distinct clinical entity is important both diagnostically and therapeutically as it requires different management strategies compared to true instability. Chronic CCJ instability significantly impacts the quality of life (QOL) of affected patients, contributing to chronic pain, psychological distress, and functional impairments. Addressing both structural and functional instability is essential for improving patient outcomes and enhancing their overall QOL. [ABSTRACT FROM AUTHOR]

Background: Neck self-awareness, related to sensorimotor dysfunction, can be monitored with the Fremantle Neck Awareness Questionnaire (FreNAQ). The cross-cultural adaptation of the FreNAQ in Greek (FreNAQ-GR) and an assessment of its psychometric properties were conducted. Methods: This study included 104 participants (65 female) with non-specific chronic neck pain (NSCNP). Once the cross-cultural adaptation process of the FreNAQ-GR was complete, the testing of its construct validity was conducted via an exploratory factor analysis (EFA). The construct validity examination also included a correlational analysis with a Pain Intensity Visual Analogue Scale (PI-VAS), the Neck Disability Index (NDI), the Tampa Scale of Kinesiophobia (TSK), the Pain Catastrophizing Scale (PCS), and demographics. The internal consistency of the FreNAQ-GR was also examined. A sub-sample of participants (n = 30) completed the FreNAQ-GR again after 5–7 days. Results: The dataset was appropriate for EFA (measure of sampling adequacy KMO = 0.763 and Bartlett's test of sphericity p < 0.001). The FreNAQ-GR demonstrated a single-factor 6-item structure (items 7–9 removed), explaining 53.69% of the common variance. Statistically significant correlations (Spearman's) were registered between the FreNAQ-GR (both versions) and the NDI (r = 0.33/0.29, p < 0.001), the TSK (r = 0.46/0.41, p < 0.001), and the PCS (r = 0.37/0.33, p < 0.001). For the 9-item and the 6-item FreNAQ-GR, the internal consistency (Chronbach's a/McDonald's ω) was 0.80/0.79 and 0.826/0.816, respectively. The test–retest reliability was excellent for both versions ICC2,1 (95% CI) = 0.98/0.98 (0.97–0.99/0.95–0.99), with low error values SEM = 0.90/0.74 and MDC95% = 2.49/2.05 points. Conclusions: The FreNAQ-GR is suitable for assessing neck self-awareness in Greek-speaking patients with NSCNP. [ABSTRACT FROM AUTHOR]

Background/Objectives: Cervical facet joint syndrome (CFJS) is a frequent cause of neck pain and motor disability. Among the available therapies for CFJS, ultrasound (US)-guided injections are becoming more and more widespread, but the evidence about their accuracy and effectiveness is still debated in the scientific literature. The aim of this systematic review is to assess efficacy, accuracy and feasibility of US-guided cervical facet injections for the related chronic neck pain treatment. Methods: This review was conducted following the preferred reporting items for systematic reviews and meta-analysis 2020 (PRISMA) statement guidelines. The scientific articles were identified through the PubMed, Google Scholar and Cochrane Library databases. Qualitative assessment of the selected studies was carried out using the modified Oxford quality scoring system. Nine studies with a total of 958 patients were included in this review. The risk of bias was assessed using the Cochrane Collaboration tool. The protocol was registered at PROSPERO 2024 (n°CRD42024512214). Results: The results of this review suggest that the US-guided cervical facet injection for CFJS treatment is an effective technique in terms of accuracy (using the lateral technique it ranges from 92% to 98%), and efficiency (it grants pain relief with a decrease in the procedure time and fewer needle passes in comparison with the X-ray-guided technique, which also involves radiation exposure). Conclusions: US-guided injections are a safe and effective method to treat this musculoskeletal disease, granting a high functional recovery and long-lasting pain relief, net of the used drugs. However, these procedures are strictly operator-dependent and require important training to acquire good expertise. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cervicogenic headache is characterized by chronic posterior neck pain radiating to one side of the head, resulting from cervical spine bone or soft tissue diseases. Cervical ganglioneuroma (GN), a rare benign neuroblastic tumor, especially in the cervical spine, may cause cervicogenic headache-like symptoms. OBJECTIVE: We report a case of GN which was surgically removed successfully to relieve the symptom. CASE REPORT: A 68-year-old male presented with right posterior neck pain with referred pain to the ipsilateral occipital area in May 2020. Despite administration of medications, physical therapy, and spine interventions, the symptoms intermittently recurred over one year. In July 2021, the patient complained of painful limitation of neck motion, especially on right-sided bending; no motor or sensory deficits, except for subjective numbness of the finger tips, were detected. Plain radiography of the cervical spine showed moderate degenerative changes in the mid-cervical spine. Cervical MRI revealed a cystic mass (1.5 cm × 0.5 cm × 1 cm-in size) around the right C2 dorsal root ganglion adjacent to the C1–C2 facet joint. His symptoms significantly improved after complete tumor excision. CONCLUSION: GN of the upper cervical spine should be considered when persistent cervicogenic headache is refractory to conservative management. In such a case, advanced imaging studies such as MRI should be performed for early diagnosis and appropriate treatment. [ABSTRACT FROM AUTHOR]

Objective: Chronic neck pain, a prevalent health concern characterized by frequent recurrence, requires exploration of treatment modalities that provide sustained relief. This systematic review and meta-analysis aimed to evaluate the durable effects of acupuncture on chronic neck pain. Methods: We conducted a literature search up to March 2024 in six databases, including PubMed, Embase, and the Cochrane Library, encompassing both English and Chinese language publications. The main focus of evaluation included pain severity, functional disability, and quality of life, assessed at least 3 months post-acupuncture treatment. The risk of bias assessment was conducted using the Cochrane Risk of Bias 2.0 tool, and meta-analyses were performed where applicable. Results: Eighteen randomized controlled trials were included in the analysis. Acupuncture as an adjunct therapy could provide sustained pain relief at three (SMD: − 0.79; 95% CI − 1.13 to − 0.46; p < 0.01) and six (MD: − 18.13; 95% CI − 30.18 to − 6.07; p < 0.01) months post-treatment. Compared to sham acupuncture, acupuncture did not show a statistically significant difference in pain alleviation (MD: − 0.12; 95% CI − 0.06 to 0.36; p = 0.63). However, it significantly improved functional outcomes as evidenced by Northwick Park Neck Pain Questionnaire scores 3 months post-treatment (MD: − 6.06; 95% CI − 8.20 to − 3.92; p < 0.01). Although nine studies reported an 8.5%–13.8% probability of adverse events, these were mild and transitory adverse events. Conclusion: Acupuncture as an adjunct therapy may provide post-treatment pain relief lasting at least 3 months for patients with chronic neck pain, although it is not superior to sham acupuncture, shows sustained efficacy in improving functional impairment for over 3 months, with a good safety profile. [ABSTRACT FROM AUTHOR]

Purpose: To compile all the scientific evidence available to date to evaluate the effect of virtual reality based therapy (VRBT) on reducing pain intensity, kinesiophobia, and associated disability, and on increasing the hr-QoL in patients with chronic neck pain (CNP) or chronic low back pain (CLBP). Methods: Studies published in PubMed Medline, SCOPUS, Web of Science, CINAHL Complete, and Physiotherapy Evidence Database (PEDro) up to June 2023 were searched. All searches followed the PICOS Framework. Two authors independently screened the studies found in the searches. Any differences of opinion regarding the selection of studies were settled by a third author. Results: Twenty-five RCTs, published between 2013 and 2022, providing data from 1261 patients (20 RCTs) with CLBP and 261 patients (five RCTs) with CNP, were included. In reducing pain intensity for patients with CLBP, meta-analyses showed that VRBT is effective in reducing pain just to the end of the intervention, and this effect could be maintained 1 and 6 months after the therapy. Conclusion: VRBT was found to be better than therapeutic exercise (TE), sham, and no intervention (NI), showing a major effect when VRBT was used as a complementary therapy to conventional physiotherapy (CPT). Further, VRBT showed an immediate effect and immersive VRBT was the most adequate VRBT modality in reducing pain in CNP patients. No differences were found between non-immersive VRBT and immersive VRBT in reducing pain, kinesiophobia, disability, and hr-QoL in patients with CLBP.

The purpose of this paper is to evaluate the effect of different exercise therapy on patients with chronic neck pain. By searching PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and other databases, we screened the literatures that met the inclusion criteria until June 2022. RCT bias risk assessment tool recommended in Cochrane manual was used to evaluate the literature quality, and Stata16.0 software was used for mesh meta-analysis. A total of 76 studies, 12 exercise therapies and 5219 participants were included. In terms of pain, Pilates [MD ​= ​−2.71,95%CI (−3.87, −1.55), P ​= ​0.000] had the most significant effect. Second training for the stability of [MD ​= ​-2.39, 95 ​% CI (−3.14, −1.64), P ​= ​0.000) and VR [MD ​= ​−2.35, 95 ​% CI (−3.6, −1.11), P ​= ​0.000). In terms of functional indexes, respiratory training [MD ​= ​−16.31,95%CI (−28.52, −4.1), P ​= ​0.009] had the most significant effect. Secondly for muscle energy technology [MD ​= ​−7.47, 95 ​% CI (−12.37, −2.58), P ​= ​0.003) and aerobic training [MD ​= ​−7.36, 95 ​% CI (−12.56, −2.16), P ​= ​0.006]. Current evidence shows that Pilates, stability training and virtual reality training are the most effective in pain intervention, muscle energy technology and comprehensive exercise training are outstanding in helping functional recovery, suggesting that appropriate exercise therapy should be implemented according to the symptoms of patients to achieve the best treatment effect.

Introduction: Chronic neck pain (CNP) is a global public health problem, with high prevalence and absenteeism rates. Central sensitization (CS) as a basis for chronic pain may play an essential role in its development and progression. It is often comorbid with low conditioned pain modulation (CPM) effects, cognitions, and psychological problems. Objectives: The purposes of this study were to (1) explore the relationship between pain-related cognitions and psychological factors, CPM effects, and the central sensitization inventory (CSI) scores; and (2) determine whether cognitions and psychological factors can predict CSI scores and CPM effects in individuals with CNP. Methods: Fifty-four individuals with CNP were recruited for this cross-sectional study. The following outcome measures were evaluated: The CSI (screening tool) was compared with the cold pressor test (CPT), which was the psychophysical test used to assess the CPM; neck pain intensity using the visual analogue scale (VAS), as well as pain-related cognitions (including kinesiophobia and pain catastrophization) and psychological states (including anxiety and depression) using self-report questionnaires. Results: CSI score was not associated with the CPM effect (r = 0.257, p > 0.05), and no cognitions or psychological factors were associated with CPM (p > 0.05), but CSI score was moderately positively correlated with kinesiophobia (r = 0.554, p < 0.01), lowly positively correlated with pain catastrophization (r = 0.332, p = 0.017) and anxiety (r = 0.492, p < 0.01), but not depression (r = 0.207, p = 0.132). Multiple linear regression analysis showed that kinesiophobia (B = 1.308, p < 0.01) and anxiety (B = 1.806, p = 0.02) were significant positive predictors of CSI score. Conclusions: The findings confirm some of our hypotheses. Accordingly, the findings inferred that the CSI does not seem to respond to CPM effect in patients with CNP effectively. In addition, CSI score was associated with cognitions and psychological factors, of which kinesiophobia and anxiety were effective predictors. In clinical practice, pain-related cognitions and psychological factors should be fully considered to manage neck pain efficiently. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsPain neuroscience education (PNE) is a therapeutic strategy that has proven its effectiveness among several chronic pain conditions, but its effectiveness in chronic neck pain (CNP) is still uncertain. This systematic review assesses the evidence of PNE effectiveness among adults with CNP.A systematic review with no date limit was conducted until January 2024 through eight databases. Clinical trials assessing PNE effectiveness (in isolation or in combination with other therapies) among adults with CNP were selected. PNE was compared to other interventions or no intervention. Two independent authors extracted information and assessed the methodological quality of the included studies with Cochrane Collaboration Risk of Bias Tool 2. Results were reported through a narrative synthesis.Eleven interventions in seven randomised clinical trials (422 participants) were selected. PNE was evaluated with great variability of outcome instruments. PNE groups showed effectiveness (vs. control group) for the following: kinesiophobia (in 3 out of 4 studies with this outcome), fear and avoidance beliefs (2/2), catastrophizing (2/4), anxiety (1/1), pain neurophysiology knowledge (1/1), pain intensity (2/4), disability (2/3), self-efficacy (1/1) and perceived overall improvement (1/1).PNE may have an effect on CNP compared with other therapies, especially regarding beliefs and attitudes. [ABSTRACT FROM AUTHOR]

Chronic traumatic neck pain has a high prevalence of post-traumatic stress symptoms (PTSS). However, whether PTSS moderates treatment effects is unknown. This study investigated: 1) whether PTSS was associated with patient-reported outcomes and clinical test results at baseline; 2) whether PTSS moderated the effect of a multimodal physiotherapy intervention of exercise therapy and patient education; and 3) whether adherence to the intervention differed across PTSS groups. Secondary data analysis from a randomized controlled trial on chronic neck pain with 12-month follow-up was conducted. Patients were divided into three groups (NT = non-traumatic, LT = traumatic low PTSS, HT = traumatic high PTSS) based on self-reported onset of pain and the Impact of Event Scale. The baseline data were used to analyze the association of PTSS with patient demographics and scores of physical and mental health-related quality of life, depression, neck-related disability, kinesiophobia, and clinical tests. Baseline, 4-month and 12-month follow-up data were analyzed to investigate possible moderating effects on outcomes. Data on adherence were collected at four months. 115 participants were included (NT n = 45; LT n = 46; HT n = 24). The HT group reported lower mental health scores and more depressive symptoms at baseline. PTSS did not significantly moderate the treatment effect on any outcomes. The HT group tended to have lower adherence to the multimodal physiotherapy intervention than the LT group. For patients with traumatic neck pain, high levels of PTSS are associated with poorer psychological outcomes but do not affect the outcomes of multimodal physiotherapy intervention. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this research was to investigate the effects of telerehabilitation-based remote supervised or unsupervised structured exercise therapy on pain, disability, and quality of life related to chronic nonspecific neck pain. Method: The study was designed as a single-blinded randomized controlled trial. Sixty-six eligible chronic nonspecific neck pain patients were randomized across three groups: remote supervised group (RSG, n = 22), unsupervised group (UG, n = 22), and waitlist control group (CG, n = 22). Progressive structured exercise therapy program was delivered weekly to patients in remote supervised group and unsupervised group to perform four days a week for four weeks. Remote supervised group was supervised by videoconference and text message. Pain, disability, and quality of life of participants were assessed at baseline, week 2, and post-therapy. Results: Post-therapy pain and disability total change scores were −3.64 (95% CI −4.85 to −2.42) and −7.27 (95% CI −11.05 to −3.50) for remote supervised group compared with a change of −2.44 (95% CI −3.46 to −1.43) and −5.77 (95% CI −8.54 to −3.01) for unsupervised group, respectively. Post-therapy, quality of life improvements were greater for remote supervised group than unsupervised group overall (general health; remote supervised group: 19.01 (95% CI 6.86 to 31.16), unsupervised group: 12.50 (95% CI 4.79 to 20.21), and physical health; remote supervised group: 18.35 (95% CI 10.35 to 26.35), unsupervised group: 7.31 (95% CI 0.01 to 14.60)). Significant improvements in psychological health and environment-telerehabilitation for remote supervised group were not seen for unsupervised group and outcomes differences did not reach significance for control group (p > 0.05) post-therapy, except environment-telerehabilitation. Discussion: Structured exercise therapy can improve chronic nonspecific neck pain outcomes when remotely supervised or unsupervised. Structured exercise therapy content and frequent communication are important for remote chronic nonspecific neck pain management. [ABSTRACT FROM AUTHOR]

The purpose of the present cross-sectional study was to examine the relationship between heart rate variability (HRV) and the range of cervical motion, disability, pain intensity, pain catastrophizing, and quality of life in patients with chronic, non-specific neck pain. Thirty-five patients, aged 20–48 years, with chronic non-specific neck pain, completed validated questionnaires regarding neck pain intensity, pain-associated disability, catastrophic thoughts, and quality of life. The range of cervical motion was assessed using a digital goniometer. HRV indices were recorded in three positions (supine, sitting, and standing) through a smartphone application. Several significant correlations were observed between HRV indices and neck pain disability, the helplessness factor of catastrophizing, neck rotation, and quality of life. These correlations were only observed in the standing position. Pain catastrophizing was positively correlated with disability and pain intensity during active neck movement (Pearson r = 0.544, p < 0.01; Pearson r = 0.605, p < 0.01, respectively). Quality of life was negatively correlated with pain intensity during active movement (Pearson r = −0.347, p < 0.05). HRV indices were correlated with the psychological and physical domains of neck pain. These cardiac indices have been related to neck pain variables in some previous studies. Further research is needed to confirm this relationship in different daily conditions. [ABSTRACT FROM AUTHOR]

Chronic neck pain is one of the most frequent musculoskeletal disorders, with high prevalence worldwide. Rehabilitation is an essential component of therapeutic strategy. Virtual reality based rehabilitation (VRBR) is a powerful distraction technique that could be beneficial for chronic neck pain patients. The objective of this systematic review was to analyse the effectiveness of VRBR in chronic neck pain treatment. We followed the PRISMA guidelines and used four databases (CINAHL, Medline (Via PubMed), Scopus and Web of Science) from their inception to August 2023. Eligibility criteria were established using PICOS. Methodological quality was evaluated with the Downs and Black scale and the risk of bias with the Revised Cochrane risk-of-bias tool. The meta-analysis was performed using the RevMan software. Six studies were included in the systematic review and the meta-analysis. We observed significant differences in favour of VRBR for pain intensity (SMD = − 0.46; 95% CI = − 0.74, − 0.19; p = 0.001), disability (MD = − 2.84; 95% CI = − 4.23, − 1.45; p < 0.0001), global perceived effect (MD = 0.49; 95% CI = 0.25, 0.72; p < 0.0001) and patient satisfaction (MD = 0.62; 95% CI = 0.38, 0.86; p < 0.00001). However, at short-term follow-up significant differences were only obtained for disability (MD = − 3.52; 95% CI = − 5.85, − 1.20; p = 0.003). VRBR can significantly improve pain intensity, disability, global perceived effect and patient satisfaction. The small number of articles included in the analysis is a limitation, even considering the good methodological quality of these studies. Investigating the effects of VRBR on mid and long-term follow-up and exploring different types of VR are needed. PROSPERO database, registration number ID: CRD42020222129. [ABSTRACT FROM AUTHOR]

Abstract Background Chronic neck pain (CNP) is a common public health problem that affects daily living activities and quality of life. There is biomechanical interdependence between the neck and scapula. Studies have shown that shoulder blade function might be related to chronic neck pain. We therefore evaluated the effects of scapular targeted therapy on neck pain and function in patients with CNP. Methods Databases, including MEDLINE (via PubMed), EMBASE (via Ovid), Ovid, Web of Science, and Scopus, were systematically searched for randomized controlled trials published in English investigating treatment of the scapula for CNP before July 16, 2023. Results A total of 313 participants were included from 8 RCTs. Compared with those in the control group, the intervention in the scapular treatment group exhibited greater improvement in pain intensity (standardized mean difference (SMD) = 2.55; 95% CI = 0.97 to 4.13; P = 0.002), with moderate evidence. Subgroup analysis for pain intensity revealed a significant difference between the sexes, with only the female population (SMD = 6.23, 95% CI = 4.80 to 7.65) showing better outcomes than those with both sexes (SMD = 1.07, 95% CI = 0.57 to 1.56) (p

Abstract Background Daoyin therapy (DT), an ancient therapeutic approach with a history spanning thousands of years, has traditionally been employed to address musculoskeletal pain and psychosomatic disorders. However, the application of DT for chronic neck pain (CNP) has received limited attention in the existing literature, and systematic randomized clinical trials (RCTs) in this context remain scarce. This manuscript outlines an RCT protocol designed to investigate whether DT is more effective at alleviating CNP in adult individuals compared to other interventions. Methods A 12-week RCT was conducted, with participants undergoing randomization into one of three groups: DT, Meditation + Fitness Exercise (M+FE), or a control group. Participants in the DT and M + FE groups attended their respective training classes three times per week for 12 weeks. Participants in the control group were required to attend health education workshops every 2 weeks. Following the 12-week intervention period, all participants underwent follow-up assessments at the 16th week. Outcome measures encompassed the Simplified Chinese Neck Pain and Disability Scale (SC-NPAD) and Visual Analog Scale (VAS) for pain assessment, Static Neck Posture Assessment (SNPA) to evaluate neck and shoulder posture and function, Short Form-36 (SF-36) to assess quality of life, and blood tests measuring 5-Hydroxytryptamine (5-HT), Norepinephrine/Noradrenaline (NE/NA), γ-aminobutyric acid (GABA), Adreno-Cortico-Tropic-Hormone (ACTH), β-Endorphin (β-EP), and Calcitonin-Gene-Related Peptide (CGRP) levels via high-performance liquid chromatography (HPLC), chemiluminescence immunoassay (CLIA), enzyme-linked immunosorbent assay (ELISA), and radioimmunoassay (RIA). Brain activity changes were monitored through MRI scans. Repeated measures analyses of variance (ANOVAs) will be used to evaluate the outcomes at baseline, at the 12th week, and at the 16th week. Generalized Estimating Equation (GEE) models will be applied to analyze changes in outcomes over time and differences between groups. Discussion This trial aims to evaluate the efficacy of DT in comparison to other interventions and explore the neuroendocrine mechanisms underlying its effects in adults with CNP. If the intervention and procedures demonstrate feasibility and acceptability, there are plans to conduct a more extensive controlled trial. This could potentially pave the way for the broader application of DT, not only in the context of CNP but also for other chronic diseases. Trial registration This trial has been registered with the Chinese Clinical Trial Registry (Registration ID: [ChiCTR2400079571]).

This study aimed to evaluate the inter-examiner reliability of shear wave elastography (SWE) for measuring cervical multifidus (CM) muscle stiffness in asymptomatic controls and patients with chronic neck pain. A longitudinal observational study was conducted to assess the diagnostic accuracy of a procedure. SWE images, following a detailed procedure previously tested, were acquired by two examiners (one novice and one experienced) to calculate the shear wave speed (SWS) and Young's modulus. The painful side was examined for the experimental cases while the side examined in the control group was selected randomly. Data analyses calculated the intra-class correlation coefficients (ICCs), absolute errors between examiners, standard errors of measurement, and minimal detectable changes. A total of 125 participants were analyzed (n = 54 controls and n = 71 cases). The Young's modulus and SWS measurements obtained by both examiners were comparable within the asymptomatic group (both, p > 0.05) and the chronic neck pain group (both, p > 0.05). Nonetheless, a notable distinction was observed in the absolute error between examiners for shear wave speed measurements among patients with neck pain, where a significant difference was registered (p = 0.045), pointing to a sensitivity in measurement consistency affected by the presence of chronic neck pain. ICCs demonstrated moderate-to-good reliability across both groups, with ICC values for asymptomatic individuals reported as >0.8. Among the chronic neck pain patients, ICC values were slightly lower (>0.780). The study revealed moderate-to-good consistency, highlighting the practicality and generalizability of SWE. [ABSTRACT FROM AUTHOR]

BACKGROUND: The purpose of this meta-analysis was to evaluate the effectiveness and safety of thoracic manipulation (TM) in patients with neck pain (NP). OBJECTIVE: The purpose of this meta-analysis was to evaluate the effectiveness and safety of thoracic manipulation (TM) in patients with neck pain (NP). METHODS: Seven electronic databases were searched from their inception through October 2023 by two authors. The methodological quality assessments were performed with the Physiotherapy Evidence Database (PEDro) scale. Pain, cervical range of motion (ROM), disability, and quality of life (QOL) were estimated for TM treatment in patients with NP. RESULTS: Eighteen randomized controlled trials (RCTs) with 914 patients were included with a PEDro score of 6.923 ± 3.120. Pooled effect sizes of pain (SMD = - 0.481, 95% CI - 0.653 to - 0.309, P = 0.000), disability (SMD = - 1.435, 95% CI - 2.480 to - 0.390, P = 0.007), QOL-physical component score (PCS) (SMD = 0.658, 95% CI 0.290 to 1.025, P = 0.000), ROM of flexion (SMD = 0.921, 95% CI 0.287 to 1.555, P = 0.000), ROM of extension (SMD = 0.572, 95% CI 0.321 to 0.822, P = 0.000), ROM of left lateral flexion (SMD = 0.593, 95% CI 0.075 to 1.112, P = 0.025) and ROM of left rotation (SMD = 0.230, 95% CI 0.010 to 0.450, P = 0.04) were favored by the TM group. CONCLUSIONS: TM provides short-term effect on relieving neck pain, increasing cervical ROM, and disability in patients with NP without serious side effects. Continuous therapy and distraction therapy are recommended as optimal choice on reducing pain and improving cervical ROM, especially in patients with chronic NP (> 3 months). The TM-induced improvements in the QOL of patients with NP should be verified by more further high-quality RCTs. [ABSTRACT FROM AUTHOR]

Background and Objective: Myofascial pain syndrome (MPS) is a chronic musculoskeletal disorder characterized by the presence of trigger points. Among the treatment options, botulinum toxin injections have been investigated. The aim of this paper was to provide a synthesis of the evidence on intramuscular botulinum toxin injections for upper back MPS. Databases and Data Treatment: A systematic review of the literature was performed on the PubMed, Scopus and Cochrane Library, using the following formula: ("botulinum") AND ("musculoskeletal") AND ("upper back pain") OR ("myofascial pain"). Results: Ten studies involving 651 patients were included. Patients in the control groups received placebo (saline solution) injections, anaesthetic injections + dry needling or anaesthetic injections. The analysis of the trials revealed modest methodological quality: one "Good quality" study, one "Fair" and the other "Poor". No major complications or serious adverse events were reported. Results provided conflicting evidence and did not demonstrate the superiority of botulinum toxin over comparators. Most of the included trials were characterized by a small sample size, weak power analysis, different clinical scores used and non-comparable follow-up periods. Even if there is no conclusive evidence, the favourable safety profile and the positive results of some secondary endpoints suggest a potentially beneficial action in pain control and quality of life. Conclusion: The currently available studies show conflicting results. Their overall low methodological quality does not allow for solid evidence of superiority over other comparison treatments. Further insights are needed to properly profile patients who could benefit more from this peculiar injective approach. Significance: The randomized controlled trials included in this review compared using botulinum toxin to treat upper back MPS with placebo or active treatments (e.g., dry needling or anaesthetics) showing mixed results overall. Despite the lack of clear evidence of superiority, our study suggests that the use of botulinum toxin should not be discouraged. Its safety profile and encouraging results in pain control, motor recovery and disability reduction make it an interesting treatment, particularly in the subset of patients with moderate to severe chronic pain and active trigger points. To support the safety and efficacy of botulinum toxin, further high-quality studies are needed. [ABSTRACT FROM AUTHOR]

The use of instrument-assisted soft tissue mobilization (IASTM) has been documented to be effective for improving pain and function, but it is unclear whether it helps improve muscle performance in musculoskeletal diseases. This study investigated the effects of IASTM combined with exercise therapy on muscle endurance and pain intensity in patients with chronic neck pain. Forty-eight individuals with chronic neck pain were randomly divided into exercise therapy (ET, n = 24) and combined therapy (CT, n = 24) groups. For 4 weeks, each group underwent exercise therapy 3 days a week for a total of 12 sessions. The ET group received exercise therapy only. The CT group received IASTM combined with exercise therapy twice per week for a total of 8 sessions. The muscle endurance of the participants was assessed with the Deep Neck Flexor Muscle Endurance (DNFE) test and pain intensity with Visual Analogue Scale (VAS) at baseline and post-treatment. While both groups showed significant improvement in pain intensity (p < 0.05), the CT group showed a greater effect size for pain (CT group: Cohen's d = 3.28; ET group: Cohen's d = 2.12). The CT group showed significant improvement for muscle endurance (p < 0.05), whereas the ET group did not (p > 0.05). In the current study, the IASTM intervention combined with ET improved pain and muscular endurance in participants with chronic neck pain compared to exercise therapy alone. As an alternative method, IASTM intervention before exercise seems to increase the short-term recovery effect in chronic neck pain conditions. [ABSTRACT FROM AUTHOR]

Background Owing to progress in information and communication technology, use of computers has been increased in developed nations. Neck discomfort is known to have psychological effect that makes daily life challenging and contributes toward persistence. To create an effective, reliable rehabilitation plan and improve the existing protocols available for the patients, the proposed study attempted to address the subject of the association between kinesiophobia, anxiety, and chronic neck pain. Objective The aim of this study was to find the association between kinesiophobia, anxiety, and severe neck pain among computer programmers. Method After getting the consent, 388 subjects based on selection criteria were recruited from various information technology industries in Bangalore. Then, the subjects underwent a check for neck pain using Nordic Musculoskeletal questionnaires that were divided into case and control groups, respectively. Subjects were thereafter assessed for kinesiophobia and anxiety using Tampa Scale of Kinesiophobia and Penn State Worry Questionnaire, respectively. Descriptive and inferential statistics were used for the collected data using SPSS software. Results Out of 388 participants, the neck pain prevalence was found to be 68.80%. The result shows that the mean and standard deviation for kinesiophobia and anxiety score was 43.47 ± 16.132 and 47.15 ± 22.799 for case group, respectively, whereas for control group, it was 22.40 ± 6.470 and 21.92 ± 9.656, respectively. Significant association between kinesiophobia anxiety and long-term neck pain in computer programmers that shows p-value less than 0.05 was detected with chi-squared test. Conclusion There was positive association seen in kinesiophobia and anxiety among computer programmers with persistent neck pain. [ABSTRACT FROM AUTHOR]

Background: Chronic neck pain (CNP) is a common public health problem that affects daily living activities and quality of life. There is biomechanical interdependence between the neck and scapula. Studies have shown that shoulder blade function might be related to chronic neck pain. We therefore evaluated the effects of scapular targeted therapy on neck pain and function in patients with CNP. Methods: Databases, including MEDLINE (via PubMed), EMBASE (via Ovid), Ovid, Web of Science, and Scopus, were systematically searched for randomized controlled trials published in English investigating treatment of the scapula for CNP before July 16, 2023. Results: A total of 313 participants were included from 8 RCTs. Compared with those in the control group, the intervention in the scapular treatment group exhibited greater improvement in pain intensity (standardized mean difference (SMD) = 2.55; 95% CI = 0.97 to 4.13; P = 0.002), with moderate evidence. Subgroup analysis for pain intensity revealed a significant difference between the sexes, with only the female population (SMD = 6.23, 95% CI = 4.80 to 7.65) showing better outcomes than those with both sexes (SMD = 1.07, 95% CI = 0.57 to 1.56) (p < 0.00001). However, moderate evidence demonstrated no improvement in neck disability after scapular treatment (SMD of 0.24[-0.14, 0.62] of Neck Disability Index or Northwick Park Neck Pain Questionnaire). No effect of scapular treatment was shown on the pressure pain threshold (PPT). The cervical range of motion (CROM) and electromyographic activity of neck muscles could not be conclusively evaluated due to limited support in the articles, and further study was needed. However, the patient's head forward posture appeared to be corrected after scapular treatment. Conclusion: Scapular therapy was beneficial for relieving pain intensity in patients with CNP, especially in women. Head forward posture might also be corrected with scapular therapy. However, scapular therapy may have no effect on the PPT or neck disability. However, whether scapular therapy could improve CROM and cervical muscle activation in patients with CNPs had not been determined and needed further study. [ABSTRACT FROM AUTHOR]

(1) Background: This systematic review and meta-analysis explores the effectiveness of telerehabilitation in patients suffering from chronic neck pain, specifically on pain and disability. The research delves into an area of growing significance within the realm of healthcare, aiming to understand the impact of digital interventions on the rehabilitation process for individuals with prolonged neck pain. (2) Methods: The comprehensive review encompasses a wide array of studies evaluating the collective outcomes of numerous trials focused on telerehabilitation strategies. In this systematic review, PubMed/MEDLINE, Scopus, and Web of Science databases were systematically searched to identify studies on telerehabilitation's impact on pain. (3) Results: Eight studies met the inclusion criteria. Using the Downs and Black quality assessment, three studies were classified as good and five as fair. The authors identify specific modalities within telerehabilitation, such as remote exercise programs and virtual consultations, that contribute significantly to positive patient outcomes. Meta-analysis indicated a significant overall effect of telerehabilitation on pain reduction (MD = −1.27; 95% CI = −2.06; −0.47; p = 0.002). These findings support telerehabilitation's efficacy in pain management. (4) Conclusions: The synthesis of evidence presented in this systematic review and meta-analysis underscores the potential of telerehabilitation as an effective and accessible means of managing chronic neck pain, offering valuable insights for both healthcare practitioners and policymakers in advancing patient-centered care. [ABSTRACT FROM AUTHOR]

Background: Daoyin therapy (DT), an ancient therapeutic approach with a history spanning thousands of years, has traditionally been employed to address musculoskeletal pain and psychosomatic disorders. However, the application of DT for chronic neck pain (CNP) has received limited attention in the existing literature, and systematic randomized clinical trials (RCTs) in this context remain scarce. This manuscript outlines an RCT protocol designed to investigate whether DT is more effective at alleviating CNP in adult individuals compared to other interventions. Methods: A 12-week RCT was conducted, with participants undergoing randomization into one of three groups: DT, Meditation + Fitness Exercise (M+FE), or a control group. Participants in the DT and M + FE groups attended their respective training classes three times per week for 12 weeks. Participants in the control group were required to attend health education workshops every 2 weeks. Following the 12-week intervention period, all participants underwent follow-up assessments at the 16th week. Outcome measures encompassed the Simplified Chinese Neck Pain and Disability Scale (SC-NPAD) and Visual Analog Scale (VAS) for pain assessment, Static Neck Posture Assessment (SNPA) to evaluate neck and shoulder posture and function, Short Form-36 (SF-36) to assess quality of life, and blood tests measuring 5-Hydroxytryptamine (5-HT), Norepinephrine/Noradrenaline (NE/NA), γ-aminobutyric acid (GABA), Adreno-Cortico-Tropic-Hormone (ACTH), β-Endorphin (β-EP), and Calcitonin-Gene-Related Peptide (CGRP) levels via high-performance liquid chromatography (HPLC), chemiluminescence immunoassay (CLIA), enzyme-linked immunosorbent assay (ELISA), and radioimmunoassay (RIA). Brain activity changes were monitored through MRI scans. Repeated measures analyses of variance (ANOVAs) will be used to evaluate the outcomes at baseline, at the 12th week, and at the 16th week. Generalized Estimating Equation (GEE) models will be applied to analyze changes in outcomes over time and differences between groups. Discussion: This trial aims to evaluate the efficacy of DT in comparison to other interventions and explore the neuroendocrine mechanisms underlying its effects in adults with CNP. If the intervention and procedures demonstrate feasibility and acceptability, there are plans to conduct a more extensive controlled trial. This could potentially pave the way for the broader application of DT, not only in the context of CNP but also for other chronic diseases. Trial registration: This trial has been registered with the Chinese Clinical Trial Registry (Registration ID: [ChiCTR2400079571]). [ABSTRACT FROM AUTHOR]

The purpose of this randomized controlled trial was to evaluate the effectiveness of the Myofascial Release Technique (MRT) along with Cognitive Behavioral Therapy (CBT) on pain, craniovertebral angle (CVA), and neck disability in university students with chronic neck pain and forward head posture. A total of sixty-six eligible participants with chronic neck pain and forward head posture were randomized into the Myofascial Release Therapy (MRT) group (n = 33) and MRT and Cognitive Behavior Therapy (CBT) group (n = 33). Clinical outcomes included neck pain measured using the numerical pain rating scale, neck disability measured through the neck disability index, and forward head posture measured through the cranial vertebral angle. The outcomes were assessed at baseline and the four and eight weeks after the intervention. Both groups showed significant improvement in pain intensity, CVA, and neck disability after the intervention. However, the CBT group demonstrated greater improvements than the MRT group. The difference in outcomes between the groups was statistically significant. Myofascial Release Therapy combined with CBT is an effective treatment method for patients with chronic neck pain and forward head posture. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbances frequently occur in patients with chronic neck pain. In these patients, upper trapezius muscle dysfunction is observed during sleep. This study aimed to evaluate the trapezius muscle activity during sleep among patients with chronic neck pain and sleep disturbances for comparison with healthy subjects. Study design: Cross-sectional study. Methods: Patients with chronic neck pain and healthy subjects participated in the study. Two overnight polysomnography recordings were conducted for each subject. Surface electromyography was utilized to record the nocturnal activity of the right and left upper trapezius muscles throughout the night. The nocturnal upper trapezius activity recording was divided into the following parts: wakefulness, rapid eye movement sleep (REM), and non-rapid eye movement sleep (NREM). The nocturnal activity during NREM sleep was further divided into three parts (stage I NREM sleep, stage II NREM, and stage III NREM. Normalization of EMG signals was performed. The normalized value of nocturnal activity was derived for analysis. Results: Among 15 patients with chronic neck pain and 15 healthy subjects, statistically significant differences were observed in the nocturnal activity of the upper trapezius. Compared to healthy subjects, the nocturnal activity of the upper trapezius was significantly higher during wakefulness, REM sleep, and NREM II and III sleep in patients with chronic neck pain and sleep disturbances. Conclusion: There was higher nocturnal upper trapezius activity in patients with chronic neck pain compared to healthy controls. The findings suggest a possible pathophysiological mechanism that may relate to chronic neck pain. Trial registration: CTRI/2019/09/021028. [ABSTRACT FROM AUTHOR]

Background: Depression affects a significant portion of the global adult population, with chronic pain patients being particularly susceptible to severe depression. Pain and mental illness contribute to an imbalance in the autonomic nervous system, affecting heart function. Myofascial release promises to improve mental and physical health by addressing fascial dysfunctions. Objective: This study aims to investigate the influence of myofascial release on emotional states and autonomic nervous system functioning in individuals with chronic neck pain and depression. Additionally, it seeks to evaluate the myofascial release effect on fascial properties, pain intensity and sensitivity, and cervical spine range of motion. Method: Experimental Study. Result: The study revealed significant enhancements in the myofascial release group, such as a substantial reduction in pain perception and stiffness, increased range of motion of the cervical spine, heart rate variability, positive affect, and pressure pain threshold. The effect sizes of these improvements ranged from small to large. No significant differences were observed in elasticity and tone. Conclusion: The findings suggest that myofascial release has a positive impact on individuals with chronic neck pain and depression, particularly in reducing pain intensity. Integrating myofascial release into treatment approaches may be beneficial. However, further research is needed to confirm and expand upon these findings, explore long-term effects, and better understand the clinical significance of certain outcomes. Trial registration: http://www.osf.io, doi.org/10.17605/OSF.IO/6F5RS

Abstract Introduction Sinuvertebral nerve overactivation is one of the mechanisms of neck pain caused by cervical disc herniation. Radiofrequency ablation (RFA) of sinuvertebral nerves has shown efficacy for the treatment of discogenic low back pain. However, relatively few studies evaluated the efficacy of RFA of sinuvertebral nerves for the treatment of chronic neck pain caused by cervical disc herniation. Methods Clinical data were retrospectively collected from 168 patients diagnosed with cervical disc herniated neck pain from January 1, 2019, to September 1, 2022, who were treated with computed tomography (CT)-guided cervical disc RFA of at the Pain Medicine Center of Zhejiang Provincial People’s Hospital. A 22-G RFA needle (Inomed, Emmendingen, Germany) was inserted between the carotid artery and trachea to the intervertebral disc under the direction of CT the scanner. Depending on the position of the protruding nucleus pulposus or the rupture of the annulus fibrosus, the needle was inserted into the posterior side of the intervertebral disc until the tip of the needle reached the target position. The numeric rating scale (NRS) score, pain relief and appearance of complications after RFA were evaluated. Results A total of 168 patients underwent CT-guided RFA for cervical disc herniation. The average duration of pain was 67.07 ± 70.42 months. At 6 months of follow-up, the median preoperative NRS score decreased significantly from preoperative 5.41 ± 1.08 to postoperative 1.341 ± 1.25 at 1 month, 1.4 ± 1.38 at 3 months and 1.72 ± 1.41 at 6 months after RFA (p

Abstract Background Neck pain is among the common musculoskeletal problem that hinders a person’s daily activities. Fascial tightness is a familiar cause of chronic neck pain that is often neglected and can further cause neck disability and a limited range of motion. Objective The purpose was to compare the effects of fascia therapy and fascial manipulation on pain, range of motion and function in patients with chronic neck pain. Methods A randomized clinical trial was conducted from February to August 2022 in the Riphah Rehabilitation Centre, Lahore, Pakistan. Fifty-two participants of both genders, aged 18–40 years with chronic neck pain of at least 3–6 months were included. Group A (n = 26) received fascia therapy along with a conventional physical therapy protocol of hot pack, strengthening and stretching, while group B (n = 26) received the fascial manipulation treatment with conventional physical therapy. All the participants were assessed at baseline and after 3 weeks (3 sessions per week). Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI) and Goniometer (range of motions) were the outcome measures. SPSS 25 was used for the data analysis and normality of the data through the Shaphiro-Wilk test (p > 0.05), and parametric tests were applied. Results The mean age of group A was 24.82 ± 2.64 years, and group B was 24.17 ± 2.20 years. The independent t-test result showed no significant difference (p ≥ 0.05) in all parameters except in cervical extension and right-side bending (p

Background: Depressive disorder and chronic pain are prevalent conditions that often co-occur. The myofascial fascial continuum has been hypothesized to contribute to both conditions. However, limited research exists on the specific association between fascial properties and chronic pain and depression. Objective: This study aims to investigate the properties of the deep fascia of the M. trapezius and their relationship with depression, chronic neck pain, and cervical spine mobility. Method: This study compared fascial properties between two groups: individuals with depression and chronic neck pain, and healthy individuals. Fascial thickness, elasticity, and stiffness were measured as primary outcomes using standardized techniques such as ultrasound imaging and compliance meter. Statistical analyses were conducted to identify potential differences and correlations in fascial properties between the two groups. Result: Significant differences emerge in stiffness, tone, and fascia thickness in the deep fascia, alongside identified correlations between depression, chronic pain, and these variables. Conclusion: The study highlights the impact of depression and chronic pain on fascial properties, emphasizing the need for further research in this domain to unravel the intricate connections and potential implications for treatment strategies.

Background: Chronic Neck Pain (CNP) among rotary-wing aircrew is thought to stem from night vision goggles (NVG) and counterweight (CW) systems which displace the centre of mass of the head. This investigation aimed to quantify the loads acting on the neck as a function of movement magnitude (MM), helmet conditions, and movement axes in rapid movements. Methods: Cervical spine kinematics during rapid head repositioning tasks for flexion-extension (FE) and axial rotation (AR) movements were measured from 15 males and 15 females. Participants moved in either a 35° (Near MM) or 70° arc (Far MM), while donning a helmet, helmet with NVG, helmet with NVG and a typical CW, and a CW Liner (CWL). Measured EMG from three muscles bilaterally and used to drive a biomechanical model to quantify the compression and shear acting at the C5-C6 joint. Results: In AR, the NVGs were associated with the largest compression magnitudes, 252 (24) N. CW conditions decreased the maximum compression to 249 (53) N. For FE, the compression was 340 N for the Far MM trials and 246 N for Near MMs. Changing the helmet configuration only modestly influenced these magnitudes in FE. Conclusion: Every 30° of MM increased compression by 57 to 105 N. The reduction of the moment of inertia by 16% in the CWL did not reduce reaction forces. Joint loads scaled proportionately with head-supported weight by a factor of 2.05. The magnitudes of loads suggest a cumulative loading pathway for CNP development. [ABSTRACT FROM AUTHOR]

Background: Mechanical neck pain (MNP) affects all age groups, it has a substantial physical, psychological, and economic impact, especially in elderly. This study aimed to evaluate effect of addition of magnetic therapy (MT) to exercise versus exercise therapy alone on neck pain (NP), proprioception, and balance in elderly patients with chronic MNP. Materials & Methods: 50 elderly patients with chronic MNP were assigned to magnetic group (25 patients who practiced exercise program for 35-40 minutes/session three sessions per week for four weeks in addition exposure to MT for 20 minutes each session three sessions per week for four weeks) and control group (25 patients who practiced only the exercise program). The severity of pain, cervical joint position sense (JPS) and balance performance were measured by using the visual analogue scale (VAS) goniometer and the both single-leg stance time (SLST), and timed up and go (TUG) tests, respectively. ANOVA and Independent t-tests were used to determine significant differences within and between two groups for normal variables, whereas the Mann-Whitney and Kruskal-Wallis tests were used for not normal variables. Results: The results show significant improvements in VAS, SLST (with open and closed eyes), TUG, and JPS after interventions in both groups, p-value <0.05, while addition of MT to exercise program induced only significant differences in VAS, SLST (with open & closed eyes), TUG, except JPS, p-value = 0.002, 0.047 & 0.037, 0.001, and 0.928 respectively, in favor to the magnetic group. Conclusions: Multi-dimensional exercise program is effective in relieving NP and improving balance in elderly with MNP, addition of MT to exercise program could induce superior effects only on pain and balance for elderly patients with MNP. [ABSTRACT FROM AUTHOR]

Introduction: Sinuvertebral nerve overactivation is one of the mechanisms of neck pain caused by cervical disc herniation. Radiofrequency ablation (RFA) of sinuvertebral nerves has shown efficacy for the treatment of discogenic low back pain. However, relatively few studies evaluated the efficacy of RFA of sinuvertebral nerves for the treatment of chronic neck pain caused by cervical disc herniation. Methods: Clinical data were retrospectively collected from 168 patients diagnosed with cervical disc herniated neck pain from January 1, 2019, to September 1, 2022, who were treated with computed tomography (CT)-guided cervical disc RFA of at the Pain Medicine Center of Zhejiang Provincial People's Hospital. A 22-G RFA needle (Inomed, Emmendingen, Germany) was inserted between the carotid artery and trachea to the intervertebral disc under the direction of CT the scanner. Depending on the position of the protruding nucleus pulposus or the rupture of the annulus fibrosus, the needle was inserted into the posterior side of the intervertebral disc until the tip of the needle reached the target position. The numeric rating scale (NRS) score, pain relief and appearance of complications after RFA were evaluated. Results: A total of 168 patients underwent CT-guided RFA for cervical disc herniation. The average duration of pain was 67.07 ± 70.42 months. At 6 months of follow-up, the median preoperative NRS score decreased significantly from preoperative 5.41 ± 1.08 to postoperative 1.341 ± 1.25 at 1 month, 1.4 ± 1.38 at 3 months and 1.72 ± 1.41 at 6 months after RFA (p < 0.01). The numbers of patients with ≥ 50% of their neck pain relieved were 84% (141/168), 87% (147/168), 87% (147/168) and 79% (133/168) at 1 day, 1 month, 3 months and 6 months after RFA, respectively. No serious complications related to treatment or long-term complications were observed. Conclusions: This study highlights that CT-guided RFA targeting the edge of cervical disc herniation to destroy the sinuvertebral nerves can effectively relieve neck pain, and the computed tomography (CT)-guided RFA treatment strategy has the advantages of having few complications. [ABSTRACT FROM AUTHOR]

Purpose: To translate and cross-culturally adapt the English version of the Central Sensitisation Inventory (CSI) into Thai (CSI-Thai) and to evaluate its psychometric properties in individuals with chronic non-specific neck pain. Materials and methods: Cross-cultural translation and adaptation of the CSI were performed according to standard guidelines. A total of 340 participants were invited to complete the CSI-Thai, Visual Analogue Scale (pain intensity), Neck Disability Index, Fear-Avoidance Beliefs Questionnaire, Pain Catastrophising Scale (PCS), and Short Form-36. Psychometric evaluation included confirmatory factor analysis, internal consistency, test-retest reliability, agreement, and construct validity. Results: Dimensionality analyses indicated that a bifactor model, comprising one general factor plus four orthogonal factors, fit the CSI structure better than unidimensional and the four-factor models. The general factor showed substantial reliability (Cronbach α=0.91, Omega ω=0.94, and omega hierarchical x-h=0.91). The intraclass correlation coefficient was 0.90, representing excellent stability over a 48 h interval. Moderate-to-strong correlations and acceptable-to-excellent discriminations were found between the CSI-Thai and all questionnaires. The exception was the PCS (no correlation and discrimination). The standard error of measurement and minimal detectable change of the CSI-Thai were 2.33 and 6.47, respectively. Conclusions: The translation and cross-cultural adaptation of the CSI-Thai were successful, with satisfactory reliability and construct validity. [ABSTRACT FROM AUTHOR]

Self-care programs for chronic neck pain are relevant to everyday life and can lead to long- term improvement. More studies on their effectiveness, key components and appropriate duration are needed. The aim of this study was to determine the effectiveness of self-care programs for patients with chronic neck pain. A systematic review and meta-analysis of randomized controlled trials was conducted according to the PRISMA guidelines. After searching in PubMed, Web of Science, Scopus and ScienceDirect, eleven studies met the inclusion criteria. Self-care education interventions typically consisted of education (i.e., pain neuro-science education or general educational concepts) accompanied by exercise or manual therapy. The most frequent components were addressing physical and psychological symptoms and engaging in self-care strategies. The least frequent ones were monitoring and recording symptoms and discussing with providers of medical care. The duration of the interventions ranged from three sessions to six months. Finally, individual and supervised modalities were the most frequent. After pooling the data, a meta-analysis was carried out according to four variables (i.e., pain, disability, kinesiophobia and catastrophization) and showed significant results (p < 0.05) in favor of self-care interventions. This systematic review and meta-analysis suggests that self-education interventions improve pain, psychological pain-related variables and disability in patients with chronic neck pain. The most frequently used components were addressing physical and psychological symptoms and engaging in self-care strategies. Future trials should focus on including other components, such as discussing symptoms with providers of medical care or self-monitoring symptoms. Additional areas of focus include more homogeneous doses and comparator treatments, as well as studies with better evidence to reach more solid conclusions. [ABSTRACT FROM AUTHOR]

Study Design. Translation and psychometric testing. Objectives. To cross-culturally adapt the Neck Disability Index (NDI) into the Hindi language, the local language of India, and to investigate the psychometric properties of the Neck Disability Index-Hindi (NDI-H) version in patients with neck pain. Summary of Background Data. The NDI is the most used selfreported outcome measure for neck pain. The previous NDI-H version did not obtain advance permission from Mapi trust to translate this scale. As a result, this scale's availability is limited. Materials and Methods. Following established guidelines, the NDI was translated and culturally adapted into Hindi. A total of 120 chronic neck pain patients (20 for cognitive interviews and 100 for psychometric testing) participated in this study. The content validity, construct validity, internal consistency, test-retest reliability, and responsiveness of the NDI-H were all evaluated. The intraclass correlation coefficient was computed to determine test-retest reliability. Internal consistency was assessed using Cronbach α. The NDI's factor structure was investigated using principal component factor analysis. The Neck Pain and Disability Scale, Numeric Pain Rating Scale, and Anxiety and Depression scales were used to test criterion validity. The receiver operating characteristic curve analysis was used to determine the cut-off point and the area under the curve. Results. The NDI-H demonstrated good test-retest reliability (intraclass correlation coefficient = 0.92) and excellent internal consistency (Cronbach α = 0.90). The one-factor structure was revealed by the factor analysis. The NDI has a strong relationship with the Neck Pain and Disability Scale and Numeric Pain Rating Scale, as well as the Anxiety and Depression scales. The cut-point for detecting a change was 9.3. Conclusions. The NDI was successfully translated into Hindi in this study. The NDI-H is a reliable and valid and responsive instrument that can be used to treat patients with chronic neck pain in clinical and research settings. [ABSTRACT FROM AUTHOR]

Background and Objectives: Although acupuncture is listed as a beneficial treatment for neck/shoulder stiffness, which has increased with the spread of information technology, to date, evidence of its efficacy under double-blind conditions has not been shown. This study aimed to assess whether acupuncture treatment with superficial skin piercing is superior to placebo treatment. Materials and Methods: A randomized, double-blind (practitioner–patient) placebo-controlled trial was performed at a single center with four arms (ISRCTN76896018). Four hundred patients with essential neck/shoulder stiffness were randomly assigned to penetrating needle treatment (acupuncture ritual and skin penetration), skin-touch needle treatment (acupuncture ritual and skin touch), no-touch needle treatment (acupuncture ritual alone), and no-treatment control. Each of the six acupuncturists applied a needle to each of the four acupoints in the neck/shoulder of 50 patients. Results: Each of the three treatments significantly (p = 0.01) improved neck/shoulder stiffness compared with the no-treatment control immediately and 24 h after treatment. There was a significant improvement in penetrating needle treatment over no-touch needle treatment 24 h later. However, there was no significant difference between the penetrating and skin-touch and skin-touch vs. no-touch. Conclusions: All treatments that received the ritual of acupuncture were better than the no-treatment control. Only genuine acupuncture involves the specific effects of needle insertion into the body. The acupuncture ritual had a significant impact on the subjective improvement of neck/shoulder stiffness; however, improvement with ritual alone versions of placebo acupuncture was not maintained as with superficial skin piercing. Our study provides important evidence of acupuncture efficacy and information regarding inert no-touch placebo control in acupuncture research. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Loss of cervical lordosis, cervicogenic somatic tinnitus, and cervicogenic vertigo have some similarities. Also, no a specific laboratory or radiological finding for cervicogenic somatic tinnitus and cervicogenic vertigo. Herein, to assess the prevalences of tinnitus and vertigo in patients with loss of cervical lordosis was aimed. METHODS: Between January 2022 and December 2022, a total of 70 chronic neck pain patients were divided into two groups considering loss of cervical lordosis. These patients were questioned about individual characteristics and tinnitus and vertigo within the last month. Cervical lordosis angle was measured by using a method called posterior tangent. RESULTS: The two groups had similarity for individual characteristics (p>0.05). The prevalence of tinnitus was higher in patients having loss of cervical lordosis than without (25% vs 17.4%), but it not at the level of statistical significance (p=0.534). The prevalence of vertigo was increased in patients having loss of cervical lordosis (29.2%) compared to those with normal cervical lordosis (8.7%) (p=0.038). In addition, the prevalence of tinnitus+vertigo was higher in patients having loss of cervical lordosis than without (25.0% vs 4.3%) (p=0.017). DISCUSSION AND CONCLUSION: The prevalences of tinnitus and vertigo is increased in chronik neck pain patients with loss of cervical lordosis compared to without. Loss of cervical lordosis may be a facilitating finding for diagnosis and treatment processes of these conditions.

(1) Background: Worldwide, asthma, back pain, and migraine are major public health problems due to their high prevalence, effect on the quality of life, and huge economic costs. The association of asthma with an increased risk of these types of pain has been suggested; however, no conclusive results have been obtained to date. The aims of our study were (1) to describe and compare the prevalence of three types of pain localization, namely migraine or frequent headaches (MFH), chronic neck pain (CNP), and chronic low back pain (CLBP), in adults with and without asthma in Spain during the years 2014 and 2020 and (2) to identify which variables were associated with the presence of these types of pain in adults with asthma. (2) Methods: A cross-sectional study and a case–control study were conducted. The 2014 and 2020 European Health Interview Surveys for Spain were used as the data source. (3) Results: A total of 2463 individuals were interviewed and had self-reported asthma. In this group, the prevalence of pain was high, with CLBP (30.9%) being the most common, followed by CNP (26.7%) and MFH (13.3%). All types of pain remained stable from 2014 to 2020. In both surveys, the women with asthma reported a remarkably higher prevalence of all the types of pain analyzed than the men with asthma. After matching by age and sex, the prevalence of all pain types was significantly higher in the patients with asthma than in the matched individuals without asthma. Multivariable adjustment showed that asthma increased the likelihood of CNP by 1.45 times (OR 1.45; 95% CI 1.19–1.76), that of CLBP by 1.37 times (OR 1.37; 95% CI 1.11–1.64), and that of MFH by 1.19 times (OR 1.19; 95% CI 1.02–1.51). The three types of pain analyzed were associated with the female sex and worse self-rated health. (4) Conclusions: Among the men and women with asthma, the prevalence of all the pain types was high and remained stable over time. The prevalence was higher and the severity was greater among the women with asthma than among the men with asthma. The prevalence of any pain was significantly higher in people with asthma than in the sex–age-matched individuals without asthma. Multivariable analysis showed that the variables associated with the reporting of the three types of pain in people with asthma were female sex, worse self-reported health, and self-reported mental illness. [ABSTRACT FROM AUTHOR]

BACKGROUND: As a new and objective method for the measurement and treatment of muscle training, pressure biofeedback can provide real-time feedback to improve the accuracy and effectiveness of deep neck flexor exercises. However, there are few reports on clinical studies related to pressure biofeedback and neck deep muscle exercise in China. OBJECTIVE: To investigate the clinical efficacy of pressure biofeedback training combined with deep neck flexor exercises in patients with chronic neck pain. METHODS: A total of 60 patients with chronic neck pain treated in the Out-Patient Department and Orthopedic Ward of the First Affiliated Hospital of Guangxi University of Chinese Medicine from April to October 2021 were enrolled in this study. These patients were selected and divided into experimental group and control group. The former group used pressure biofeedback to perform deep neck flexor exercises, while the latter group performed regular deep neck flexor exercises. The primary outcome was the peak pressure measured by pressure biofeedback at each follow-up point (1, 2, and 3 months after treatment) and the secondary outcomes were peak pressure maintenance time as well as the Northwick Park Neck Pain Questionnaire score. RESULTS AND CONCLUSION: (1) There were significant differences in peak pressure value and peak pressure maintenance time before and after exercises in the two groups (P < 0.05). Compared with the control group, the peak pressure value and maintenance time were significantly higher in the experimental group at each time point (P < 0.05). (2) The Northwick Park Neck Pain Questionnaire score in each group was significantly lowered at each time point after exercises (P < 0.05), and the score in the experimental group was significantly lower than that in the control group at 2 and 3 months after exercises (P < 0.05). (3) To conclude, pressure biofeedback combined with deep neck flexor exercises can effectively alleviate the symptoms of chronic neck pain, feedback real-time exercise results for patients, and increase the sustainability of functional exercises, which is a simple, convenient, and low-cost treatment for neck pain and can be a part of the community re-education program for prophylaxis and treatment. [ABSTRACT FROM AUTHOR]