Identifying and treating the causes of neck pain

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

Objective

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

Materials and Methods

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

Results

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

Conclusion

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

The influence of cultural and religious factors on cross-national variations in the prevalence of chronic back and neck pain: an analysis of data from the global burden of disease 2019 study

Introduction

Low back pain and neck pain are among the most commonly reported forms of chronic pain worldwide, and are associated with significant distress, disability and impairment in quality of life. Though these categories of pain can be analyzed and treated from a biomedical perspective, there is evidence that they are both related to psychological variables such as depression and anxiety. The experience of pain can be significantly influenced by cultural values. For example, cultural beliefs and attitudes can influence the meaning attached to the experience of pain, the responses of others to a sufferer's pain, and the likelihood of seeking medical care for particular symptoms. Likewise, religious beliefs and practices can influence the both experience of pain and the responses to it. These factors have also been associated with variations in the severity of depression and anxiety.

Methods

In the current study, data on the estimated national prevalence of both low back pain and neck pain, obtained from the 2019 Global Burden of Disease Study (GBD 2019), is analyzed in relation to cross-national variations in cultural values, as measured using Hofstede's model (n =115 countries) and in religious belief and practice, based on the most recent Pew Research Center survey (n = 105 countries). To address possible confounding factors, these analyses were adjusted for variables known to be associated with chronic low back or neck pain, namely smoking, alcohol use, obesity, anxiety, depression and insufficient physical activity.

Results

It was found that the cultural dimensions of Power Distance and Collectivism were inversely correlated with the prevalence of chronic low back pain, and Uncertainty Avoidance was inversely correlated with the prevalence of chronic neck pain, even after adjustment for potential confounders. Measures of religious affiliation and practice were negatively correlated with the prevalence of both conditions, but these associations were not significant after adjusting for cultural values and confounders.

Discussion

These results highlight the existence of meaningful cross-cultural variations in the occurrence of common forms of chronic musculoskeletal pain. Psychological and social factors that could account for these variations are reviewed, along with their implications for the holistic management of patients with these disorders.

Effects of autogenic and reciprocal inhibition techniques with conventional therapy in mechanical neck pain - a randomized control trial

Background

Neck pain is a common musculoskeletal issue that has been seen as high in terms of disability. Muscle Energy Techniques (MET) are advanced soft tissue techniques to treat Mechanical Neck Pain (MNP). This study compares the Autogenic inhibition (AI) technique with the Reciprocal Inhibition (RI) technique providing conventional treatment to improve functional outcomes.

Methods

A randomized control trial was conducted at Sindh Institute of Physical Medicine & Rehabilitation, Karachi, Pakistan from August 28, 2021, to December 31, 2021 among 20–50 years old patients with Moderate intensity MNP for more than 4 weeks and with limited Neck ROMs. The sample were divided randomly and allocated into two groups (groups 1 and 2). Group 1 and 2 received 12 sessions of AI and RI with Conventional therapy respectively. The randomization sheet was generated online from randomization.com for a sample size of 80 and two groups of study ‘AI’ and ‘RI’ with a ratio of 1:1 by an independent statistician. Pain (primary outcome), range of motion, and functional disability (secondary outcomes) were assessed through visual analog scale (VAS), Goniometer, and Neck disability index (NDI) at baseline, 1st, and last session respectively. Mean and standard deviation, frequency, and percentages were calculated. Chi-square test and independent t-test compare baseline characteristics. The Repeated Measure Two-Way ANOVA compared mean VAS, NDI, and ROM. The significant P-value was less than 0.05.

Results

The mean duration of neck pain was 8 weeks. There was a more significant (p < 0.001) improvement in pain (ES = 0.975), disability (ES = 0.887), neck ROMs; flexion (ES = 0.975), extension (ES = 0.965), right and left lateral flexion (ES = 0.949 and 0.951), and right and left rotation (ES = 0.966 and 0.975) in the AI group than the RI group at 12th session.

Conclusion

The Autogenic Inhibition-MET is more beneficial than Reciprocal Inhibition-MET in improving Pain, Range of Motion, and Functional Disability in patients with Sub-Acute and Chronic Mechanical Neck Pain. Therefore, it is a beneficial technique to add with conventional neck pain therapy to get better treatment outcomes in MNP patients.

Trial Registration

Prospectively registered on ClincalTrials.Gov with ID: NCT05044078.

The effect of spinal manipulative therapy and home stretching exercises on heart rate variability in patients with persistent or recurrent neck pain: a randomized controlled trial

BACKGROUND

Persistent or recurrent neck pain is, together with other chronic conditions, suggested to be associated with disturbances of the Autonomic Nervous System. Acute effects on the Autonomic Nervous System, commonly measured using Heart Rate Variability, have been observed with manual therapy. This study aimed to investigate the effect on Heart Rate Variability in (1) a combination of home stretching exercises and spinal manipulative therapy versus (2) home stretching exercises alone over 2 weeks in participants with persistent or recurrent neck pain.

METHODS

A randomized controlled clinical trial was carried out in five multidisciplinary primary care clinics in Stockholm from January 2019 to April 2020. The study sample consisted of 131 participants with a history of persistent or recurrent neck. All participants performed home stretching exercises daily for 2 weeks and were scheduled for four treatments during this period, with the intervention group receiving spinal manipulative therapy in addition to the home exercises. Heart Rate Variability at rest was measured at baseline, after 1 week, and after 2 weeks, with RMSSD (Root mean square of successive RR interval differences) as the primary outcome. Both groups were blinded to the other group intervention. Thus, they were aware of the purpose of the trial but not the details of the "other" intervention. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. The clinicians provided treatment for participants in both groups and could not be blinded. A linear mixed-effects model with continuous variables and person-specific random intercept was used to investigate the group-time interaction using an intention to treat analysis.

RESULTS

Sixty-six participants were randomized to the intervention group and sixty-five to the control group. For RMSSD, a B coefficient of 0.4 (p value: 0.9) was found, indicating a non-significant difference in the regression slope for each time point with the control group as reference. No statistically significant differences were found between groups for any of the Heart Rate Variability indices.

CONCLUSION

Adding four treatments of spinal manipulation therapy to a 2-week program of daily stretching exercises gave no significant change in Heart Rate Variability.

TRIAL REGISTRATION

The trial was registered 03/07/2018 at ClinicalTrials.gov, registration number: NCT03576846. ( https://pubmed.ncbi.nlm.nih.gov/31606042/ ).

The effect of two weeks of spinal manipulative therapy and home stretching exercises on pain and disability in patients with persistent or recurrent neck pain; a randomized controlled trial

Background

Recurrent or persistent neck pain affects a vast number of people globally, leading to reduced quality of life and high societal costs. Clinically, it is a difficult condition to manage, and treatment effect sizes are often moderate at best. Activity and manual therapy are first-line treatment options in current guidelines. We aimed to investigate the combination of home stretching exercises and spinal manipulative therapy in a multicentre randomized controlled clinical trial, carried out in multidiscipline ary primary care clinics.

Methods

The treatment modalities utilized were spinal manipulative therapy and home stretching exercises compared to home stretching exercises alone. Both groups received 4 treatments for 2 weeks. The primary outcome was pain, where the subjective pain experience was investigated by assessing pain intensity (NRS − 11) and the quality of pain (McGill Pain Questionnaire). Neck disability and health status were secondary outcomes, measured using the Neck Disability Indexthe EQ-5D, respectively. One hundred thirty-one adult subjects were randomized to one of the two treatment groups. All subjects had experienced persistent or recurrent neck pain the previous 6 months and were blinded to the other group intervention. The clinicians provided treatment for subjects in both group and could not be blinded. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. An intention-to-treat analysis was used.

Results

Sixty-six subjects were randomized to the intervention group, and sixty-five to the control group. For NRS − 11, a B-coefficient of − 0,01 was seen, indication a 0,01 improvement for the intervention group in relation to the control group at each time point with a p-value of 0,305. There were no statistically significant differences between groups for any of the outcome measures.

Conclusion

Based on the current findings, there is no additional treatment effect from adding spinal manipulative therapy to neck stretching exercises over 2 weeks for patients with persistent or recurrent neck pain.

Trial registration

The trial was registered 03/07/2018 at ClinicalTrials.gov, registration number: NCT03576846.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04772-x.

EFFECTIVENESS OF CERVICAL MANUAL MOBILIZATION TECHNIQUES VERSUS STRETCHING EXERCISES FOR PAIN RELIEF IN THE MANAGEMENT OF NECK PAIN

Introduction. A huge literature is available regarding the efficacy of various physiotherapy techniques for neck pain (NP), however, comparative study is still in scarcity. Therefore, this study aimed to compare effectiveness of stretching exercises versus manual mobilization techniques in the management of NP. Material and method. A randomized controlled trial parallel-group design study was conducted on the patients suffering from NP. Participants with the history of NP, aged between 19 to 60 years, NP without radiculopathy, and no history of trauma were included in the study. Two outcome measures were used i.e., Numeric pain rating scale (NPRS) and neck pain disability index (NDI) questionnaire. Two groups were equally divided had twenty-five patients each. Group A received cervical stretching with strengthening exercises as home-treatment program and group B received manual mobilization with strengthening exercises as home-treatment program. Six sessions were given on alternate basis and assessed pre- and post-treatment information of all patients. Results and discussions. Independent sample t-test was run to compare the post difference between stretching exercises and manual mobilization at 95% confidence interval (p<0.05). The Post NPRS difference between the groups shows no significant improvement (p=0.32). Similarly no significant difference was found in post NDI Disability (p=0.57). Therefore, both the treatment strategies are equally effective in improving NP and disability. Conclusions. This clinical trial concluded that stretching or manual mobilization is equally effective to reduce pain and disability. Hence, improve the quality of life in neck pain survivors. Keywords: Manual Mobilization Technique, Neck Pain, , Neck Pain Disability Index Questionnaire, Numeric Pain Rating Scale, Range of Motion, Stretching Exercises,

Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review

Neck pain is very common, but most of the causes are unknown, making diagnosis and treatment extremely challenging. Current studies have found that one of the main problems in patients with neck pain is the impairment of cervical proprioception, which subsequently leads to cervical sensorimotor control disturbances. Cervical spine has a very delicate proprioceptive system that plays a crucial role in controlling posture and balance. Cervical proprioceptive impairment in neck pain occurs through a variety of mechanisms. Experimental neck muscle pain induced by injection of hypertonic saline results in inhibition of the activation of painful muscle; chronic neck pain causes structural and functional impairment of cervical muscles; excessive activation of mechanoreceptors in degenerative cervical discs and facet joints produces a large number of erroneous sensory signals. Clinical examinations to assess the link between structural pathology and neck pain have been unsuccessful, opening the way for the development of function-based tests. To date, eight neck sensorimotor control tests have been reported to evaluate patients with chronic neck pain. Although some tests may involve different subsystems (such as oculomotor system and vestibular system), all tests measure sensorimotor control in the neck, and the most commonly used is cervical joint position error (JPE) test. Current studies support the effectiveness of exercises targeting different aspects of sensorimotor function, in particular retraining aimed at improving cervical proprioception and muscle coordination. Based on the available evidence, it is recommended that patients with neck pain should be assessed and managed for cervical proprioceptive impairment and sensorimotor control disturbances.

Efficacy of Kinesio Taping and Postural Correction Exercises on Levator Scapula Electromyographic Activities in Mechanical Cervical Dysfunction: A Randomized Blinded Clinical Trial

OBJECTIVE

Mechanical neck dysfunction (MND) is a major health burden. Although postural correction exercises (PCEs) are commonly used for its treatment, efficacy of Kinesio Taping (KT) has received considerable attention. This study was conducted to determine the effect of KT and PCEs on levator scapula (LS) electromyography.

METHODS

Ninety-one patients with MND were randomly assigned into 1 of 3 groups that received 4 weeks' treatment: group A, KT; group B, PCE; and group C, both interventions. Neck pain, LS root mean square (RMS), and median frequency (MDF) were measured pretreatment and post-treatment with the Numerical Pain Rating Scale and surface electromyography, respectively, by an assessor blinded to the patients' allocation.

RESULTS

Multivariate analysis of variance indicates a statistically significant group-by-time interaction (P = .000). Pain intensity was significantly reduced in group C more than in group B (P = .001). Mean values of RMS were significantly reduced in group C compared to both group A (P = .001) and group B (P = .022), whereas MDF was significantly increased in group C compared to either group A (P = .00) or group B (P = .026), and in group B compared to group A (P = 0.26). A paired t test revealed that there was a significant decrease in pain and RMS, and a significant increase in MDF in all groups (P < .01).

CONCLUSION

Application of both KT and PCE combined can significantly reduce neck pain and normalize LS activities in patients with MND more than the application of either intervention.

Ingrowth of Nociceptive Receptors into Diseased Cervical Intervertebral Disc Is Associated with Discogenic Neck Pain

OBJECTIVE

To investigate the distribution of nociceptive nerve fibers in the cervical intervertebral discs of patients with chronic neck pain and determine whether these nociceptive nerve fibers are related to discogenic neck pain.

METHODS

We collected 43 samples of cervical intervertebral discs from 34 patients with severe chronic neck pain (visual analog scale [VAS] ≥ 70 mm), 42 samples from 36 patients who suffered cervical spondylotic radiculopathy or myelopathy without neck pain or with mild neck pain (VAS ≤ 30 mm) and 32 samples from eight donators to investigate their innervation immunohistochemically using an antibody against neuropeptide substance P.

RESULTS

The immunohistochemical investigation revealed that substance P-positive nerve fibers were obviously increased in number and deeply ingrown into the inner anulus fibrosus and even into the nucleus pulposus in the degenerative cervical discs of patients with severe neck pain in comparison with the discs of patients with cervical spondylotic radiculopathy or myelopathy and normal control discs (P<0.01).

CONCLUSIONS

The current study may indicate a key role of nociceptive nerve fibers in the pathogenesis of neck pain of cervical disc origin.

Association between cervical degeneration and self-perceived nonrecovery after whiplash injury

BACKGROUND CONTEXT

Pre-existing radiological degenerative changes have not previously been considered a risk factor for nonrecovery from neck pain due to motor vehicle accidents (MVA). Results from previous studies are however often based on assessment of plain radiography or MRI and little consideration has been given to facet joints. Furthermore, previous studies have often lacked a validated scoring system for degenerative changes.

PURPOSE

To investigate the association between cervical degeneration on computed tomography (CT) and nonrecovery after whiplash trauma.

STUDY DESIGN

Longitudinal cohort study.

PATIENT SAMPLE

One hundred twenty-one patients attending the Emergency Department because of neck pain after MVA, 2015-2017, with a valid CT-scan of the cervical spine and completion of follow up after 6 months.

OUTCOME MEASURES

The primary outcome measure was self-perceived nonrecovery (yes/no) after 6 months. A secondary outcome measure was self-reported pain level (Numeric Rating Scale).

METHODS

Baseline data regarding demographics and health factors were gathered through a web-based questionnaire. Degeneration of facet joints and intervertebral discs was assessed on CT-scans according to a validated scoring system. Binary logistic regression was used to study the association between cervical degeneration and nonrecovery.

RESULTS

Moderate facet joint degeneration was associated with nonrecovery. In the group with moderate degree of facet joint degeneration, 69.6% reported nonrecovery compared with 23.6% among patients without any signs of degeneration (adjusted odds ratio 6.7 [95% confidence interval: 1.9-24.3]). There was no association between disc degeneration and nonrecovery. Combined facet joint degeneration and disc degeneration were associated with nonrecovery (adjusted odds ratio 6.2 [2.0-19.0]).

CONCLUSIONS

These results suggest that cervical degeneration, especially facet joint degeneration, is a risk factor for nonrecovery after whiplash trauma. We hypothesize that whiplash trauma can be a trigger for painful manifestation of previously asymptomatic facet joint degeneration.

The Emergent Evaluation and Treatment of Neck and Back Pain

Neck and back pain are among the most common symptom-related complaints for visits to the emergency department (ED). They contribute to high levels of lost work days, disability, and health care use. The goal of ED assessment of patients with neck and back pain is to evaluate for potentially dangerous causes that could result in significant morbidity and mortality. This article discusses the efficient and effective evaluation, management, and treatment of patients with neck and back pain in the ED. Emphasis is placed on vertebral osteomyelitis, epidural abscess, acute transverse myelitis, epidural compression syndrome, spinal malignancy, and spinal stenosis.

Adding Temporomandibular joint treatments to routine physiotherapy for patients with non-specific chronic neck pain: A randomized clinical study

INTRODUCTION

Neck Pain can be related to the disorders of other adjacent areas such as the Temporomandibular Joint (TMJ). This study aimed to investigate whether there is value in adding TMJ treatments to routine physiotherapy in patients with non-specific chronic neck pain compared with a control group.

METHODS

A randomized, single-blind, clinical study desined including two groups of patients. Group A (20 people) received routine physiotherapy for neck pain and group B (20 people) received TMJ manual therapy plus exercise therapy in addition to routine physiotherapy for neck pain. The Treatment program included six sessions for two days a week over a period of 21 days. Assessments were performed during the first session, in the last session and one month after treatment as a follow-up. Outcome measures included neck range of motion (ROM), neck disability index (NDI) and visual analogue scale (VAS). Before starting the study, the reliability of methods for measuring neck ROM was evaluated.

RESULTS

Participants were 21 women and 19 men. Initially, a pilot study was carried out on the 40 volunteers to assess the reliability of the measurement methods, and the results were acceptable. With both the control group and the intervention group, the indexes showed significant improvement (p < 0.001), although the intervention group showed more improvement (p < 0.001).

CONCLUSION

This result means adding treatments of TMJ to routine neck physiotherapy can magnify the effect of the intervention, a significant change still in evidence at follow up. Moreover, given the clinically important differences, our results for VAS and NDI were acceptable.

Changes in chronic neck pain following the introduction of a visco-elastic polyurethane foam pillow and/or chiropractic treatment

BACKGROUND

Sleep ergonomics are increasingly prescribed as an adjunct treatment to chronic neck pain. Postulated benefits to maintaining the ideal sleeping posture are improved tissue repair in and around the facet joints, decrease in tension of associated musculature and better quality sleep.

AIM

The purpose of this study was to determine if the inclusion of a visco-elastic polyurethane (VEP) pillow could benefit the chiropractic treatment of chronic neck pain.

SETTING

The study took place at a chiropractic training clinic in Johannesburg.

METHOD

Participants were randomly assigned to either a chiropractic treatment only group (CHI) (n = 15) or a chiropractic treatment with a VEP pillow group (CHI+P) (n = 15). Both groups underwent six chiropractic treatments spaced at 3-4-day intervals and the CHI+P were provided with a VEP pillow. Baseline and post-test measurements consisted of the initial Numerical Pain Rating Scale (NRS) and the Vernon-Mior Neck Pain and Disability Index (NDI).

RESULTS

Both the CHI and CHI+P groups significantly (p ≤ 0.05) improved their NRS (p = 0.001 for both groups) and NDI (p = 0.001 and p = 0.000, respectively) scores. Furthermore, post hoc analysis indicated a significant difference at post-test between the two groups for NRS (p = 0.015), but not for NDI (p = 0.195). The CHI+P demonstrated an improved minimum clinically important difference (MCID) (43% vs. 73% for NRS and 59% vs. 71% for the NDI).

CONCLUSION

Findings of this study suggest that a VEP pillow could be included as an adjunct management tool to chiropractic treatment of chronic neck pain.

A randomized, placebo- and active-controlled, multi-country, multi-center parallel group trial to evaluate the efficacy and safety of a fixed-dose combination of 400 mg ibuprofen and 100 mg caffeine compared with ibuprofen 400 mg and placebo in patients with acute lower back or neck pain

Background

Ibuprofen is a well-established analgesic for acute pain symptoms. In several acute pain models, caffeine has demonstrated an analgesic adjuvant effect. This randomized trial (NCT03003000) was designed to compare the efficacy of a fixed-dose combination of ibuprofen and caffeine with ibuprofen or placebo for the treatment of acute lower back/neck pain.

Methods

Patients with acute lower back/neck pain resulting in pain on movement (POM) ≥5 on a 10-point numerical rating scale were randomized 2:2:1 to receive orally, three times daily for 6 days, 400 mg ibuprofen+100 mg caffeine, 400 mg ibuprofen or placebo, respectively. The primary endpoint was change in POM_WP (POM triggering highest pain score at baseline [worst procedure]) between baseline and the morning of day 2. Key secondary endpoints included POM_WP area under curve (AUC) between baseline and the morning of day 4 (POM_WPAUC_72h) and day 6 (POM_WPAUC_120h).

Results

In total, 635 patients were randomized (256 ibuprofen + caffeine: 253 ibuprofen: 126 placebo). Active treatments exhibited similar reductions in POM_WP, with an adjusted mean reduction of 1.998 (standard error [SE]: 0.1042) between baseline and day 2 for ibuprofen, 1.869 (SE: 0.1030) for ibuprofen + caffeine and 1.712 (SE: 0.1422) for placebo. Similar results were observed for POM_WPAUC_72h and POM_WPAUC_120h. Safety and tolerability was as expected.

Conclusion

A decrease in lower back/neck pain, indicated by reduced POM_WP, was shown in all active treatment arms; however, treatment effects were small versus placebo. Ibuprofen plus caffeine was not superior to ibuprofen alone or placebo for the treatment of acute lower back/neck pain in this setting.

Possible Role of Myopia as a Risk Factor for Mechanical Neck Pain in Medical Students : A Pilot Study

Background

Mechanical neck pain (MNP) is a common health concern. Some studies suggested a relationship between neck pain and visual activity. We assessed the role of myopia as a contributing factor in the development of chronic MNP.

Materials and Methods

All medical students at Shiraz University School of Medicine, who were 18 to 22 years old, were invited to participate in this retrospective case-control study from March 2016 to March 2017. Numeric Pain Rating Scale (NPRS) was used to assess the average neck pain severity over the past 6 months in order to enroll participants as the case (≥3) or control (<3) groups. Demographic data and medical profile were obtained. After identifying eligible cases, we assigned age- and sex-matched controls, who also met the study criteria. Subsequently, participants completed the Neck Disability Index (NDI) and Neck Pain and Disability Scale (NPDS) questionnaires and were evaluated for myopia severity. Variables were compared between the case and control groups as well as within the case group. P-value<0.05 was considered statistically significant.

Results

From over 700 medical students, around 150 cooperated. Eventually, 31 eligible cases (and 31 controls) were studied. NDI and NPDS were significantly higher in the case group (P<0.001). However, no significant differences were noticed between the groups regarding the severity (P=0.123) and the duration (P=0.417) of myopia. Also, the correlation of myopia severity with NDPS (ρ=0.159, P=0.216) and NDI (ρ=0.201, P=0.116) was non-significant within the case group.

Conclusion

Our findings have not supported the influential role of myopia in the development of chronic MNP.

Cervical disc degeneration and neck pain

Cervical intervertebral disc has long been considered a common source of neck pain. However, the pain caused by the disc itself has not been clearly defined so far, and its diagnosis and treatment has always been controversial. Degenerative cervical disc has a rich supply of nerve fibers, is prone to inflammatory reactions, and is susceptible to pain that can be provoked by disc stimulation or distention, and can be eliminated by block. Overwhelming clinical evidence demonstrates that neck pain in patients with degenerative cervical radiculopathy or myelopathy can be subsided rapidly by anterior cervical surgery, further indicating that this neck pain stems from the pathology of cervical disc itself. Cervical discography is advocated as the only test that connects disease to symptoms, but the procedure remains controversial. If strict criteria and technique are maintained, discography can discriminate painful, symptomatic discs from nonpainful, asymptomatic discs. Discogenic neck pain alone without cervical disc herniation or cervical spondylosis accounts for a large proportion of chronic neck pain. For these patients who continue to have refractory neck pain and fail to respond to conservative treatment, anterior cervical fusion surgery or artificial cervical disc replacement may be a better choice, and preoperative cervical discography can guarantee the excellent surgical results. Existing basic and clinical studies have scientifically shown that cervical intervertebral disc degeneration can lead to neck pain.

Clinical Evidence of Chinese Massage Therapy (Tui Na) for Cervical Radiculopathy: A Systematic Review and Meta-Analysis

Objective. The review is to assess the current evidence of Chinese massage therapy (Tui Na) for cervical radiculopathy. Methods. Seven databases were searched. Randomised controlled trials incorporating Tui Na alone or Tui Na combined with conventional treatment were enrolled. The authors in pairs independently assessed the risk of bias and extracted the data. Results. Five studies involving 448 patients were included. The pooled analysis from the 3 trials indicated that Tui Na alone showed a significant lowering immediate effects on pain score (SMD = -0.58; 95% CI: -0.96 to -0.21; Z = 3.08, P = 0.002) with moderate heterogeneity compared to cervical traction. The meta-analysis from 2 trials revealed significant immediate effects of Tui Na plus cervical traction in improving pain score (MD = -1.73; 95% CI: -2.01 to -1.44; Z = 11.98, P < 0.00001) with no heterogeneity compared to cervical traction alone. No adverse effect was reported. There was very low quality or low quality evidence to support the results. Conclusions. Tui Na alone or Tui Na plus cervical traction may be helpful to cervical radiculopathy patients, but supportive evidence seems generally weak. Future clinical studies with low risk of bias and adequate follow-up design are recommended.

Subjective and clinical assessment criteria suggestive for five clinical patterns discernible in nonspecific neck pain patients. A Delphi-survey of clinical experts

BACKGROUND

Nonspecific neck pain patients form a heterogeneous group with different musculoskeletal impairments. Classifying nonspecific neck pain patients into subgroups based on clinical characteristics might lead to more comprehensive diagnoses and can guide effective management.

OBJECTIVE

To establish consensus among a group of experts regarding the clinical criteria suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central' and 'sensorimotor control' dysfunction patterns distinguishable in patients with nonspecific neck pain.

STUDY DESIGN

Delphi study.

METHODS

A focus group with 10 academic experts was organized to elaborate on the different dysfunction patterns discernible in neck pain patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 distinct dysfunction patterns resulting from the focus group.

RESULTS

A total of 21 musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating neck pain patients completed the 3-round Delphi-survey. Respectively, 33 (response rate, 100.0%), 27 (81.8%) and 21 (63.6%) respondents replied to rounds 1, 2 and 3. Eighteen 'articular', 16 'myofascial', 20 'neural', 18 'central' and 10 'sensorimotor control' clinical indicators reached a predefined ≥80% consensus level.

CONCLUSION

These indicators suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns may help clinicians to assess and diagnose patients with nonspecific neck pain. Future validity testing is needed to determine how these criteria may help to improve the outcome of physical therapy interventions in nonspecific neck pain patients.