Risk factors for non-specific neck pain in young adults. A systematic review

Evaluating the Use of a 3D Exoscope to Improve Ergonomics in Cleft Surgery

The aim of this study was to investigate and compare the technical feasibility, ergonomics, and educational value of the 3D exoscope in comparison with traditional and prism loupes in cleft surgery.

A variety of cleft and pharyngeal operations were performed with the VITOM® 3D exoscope (Karl Storz GmbH, Tuttlingen, Germany), traditional/prism loupes, and microscope. The cervical neck angulation of the operating surgeon was recorded in real-time with an inertia measurement unit system (Mbient, San Francisco, USA) and experiences of the surgeon and assistant were prospectively evaluated with 5-point Likert scales.

National Health Service, England.

Eleven patients were recruited in whom 12 procedures were performed. Two main surgeons, 3 assistant surgeons, and 3 scrub nurses were recruited into the study.

Four procedures were performed with the VITOM® 3D exoscope, and as the comparison groups, 5 procedures were performed with normal loupes, 3 with prism loupes, and 2 were done in combination with a microscope and analyzed separately.

Neck angle measurements and feedback from surgeons, assistants, and scrub nurses.

The VITOM® system improved surgeon ergonomics with reduced procedure time in cervical flexion when compared to the other visualization methods (versus loupes, P < .01, and prism, P < .01). The VITOM® system also scored favorably in terms of image-related fields, ergonomics, and ease of use.

Use of the 3D exoscope in cleft surgery yielded improved experiences for both surgeons, assistants, and nurses in comparison with loupes and microscopes without increasing operating time.

Nonspecific cervical spine pain/neck pain/in medical personnel of north-eastern Poland-A cross-sectional study

Both mechanical and psychological overload are inherent to the work of nurses and paramedics, resulting spondylogenic pain.

Aim of the study

To identify potential risk factors influencing the prevalence of non-specific cervical spine pain in professionally active nurses and paramedics.

Material and methods

324 nurses (53.2% of the total) and 285 paramedics (46.8%) were included in the study-609 people in total. The study was carried out using an auditorium survey technique supervised by the researchers. The methods used were: Nordic Musculoskeletal Questionnaire, a spinal pain questionnaire validated according to IEA guidelines, a short version of the IPAQ and the author's survey questionnaire, concerning sociodemographic data, chronic diseases including metabolic syndrome (MetS). A univariate logistic regression model was used in the statistical analysis. The level of statistical significance was taken as p < 0.05.

Results

Recurrent NP was significantly more common in paramedics compared to nurses (29.5 % vs. 9.3 %; p < 0.0001). In a univariate logistic regression model, the risk of NP was significantly increased by: length of service > 15 years (p < 0.024), presence of: low back pain (p < 0.0001), type 2 diabetes (p = 0.013), hypertension (p < 0.001), depression (p < 0.01). Of the modifiable factors, the risk of NP was significantly increased by high physical activity and short sleep <7 h (p < 0.001).

Anatomical landmarks and procedure technique of Levator Scapulae Plane Block (LeSP block): Case report: Ultrasound-guided block of the superficial, deep and distal planes of the levator scapulae muscle for treatment of shoulder girdle myofascial pain

Neck pain is a prevalent issue associated with musculoskeletal disorders. This study describes the interfascial Levator Scapulae Plane Block (LeSP Block) technique, using ultrasound guidance for local anesthetic administration to treat chronic neck pain. Two patients, 1 77-year-old female and 1 50-year-old female, underwent the LeSP Block. Immediate postprocedure pain relief was achieved in both, with 1 patient experiencing complete pain remission (VAS = 0) and the other showing significant improvement (VAS = 2) after 30 days. The LeSP Block demonstrated effectiveness and ease of use, suggesting its inclusion in pain management strategies for shoulder girdle and scapular pain. Further anatomical studies aimed at improving the anatomical description of the accessory spinal nerve are recommended to refine the technique.

Temporal trends and projections in the global burden of neck pain: findings from the Global Burden of Disease Study 2019

ABSTRACT

Data were obtained from the Global Burden of Disease study 2019. Joinpoint regression model was used to analyze the temporal trends from 1990 to 2019 of neck pain burden, focusing on age-standardized incidence rates, age-standardized prevalence rates, and age-standardized years lived with disability (YLDs) rates at the global, regional, and national levels. The age-period-cohort analysis was used to estimate the effects of age (5-99 years), period (1990-2019), and cohort (1893-2012) at the global, regional, and national levels. Future projections for the global burden of neck pain from 2020 to 2044 were estimated using the nordpred age-period-cohort model. From 1990 to 2019, the global incidence, prevalence cases, and YLDs counts of neck pain have increased by 71.89%, 98.21%, and 78.17%, respectively. The joinpoint analysis indicated significant shifts in the global trends of age-standardized neck pain burden, which varied across regions and nations. The age-period-cohort model indicated that the neck pain burden was predominantly concentrated in middle-aged and older age, with period and cohort effects showing minimal variation from 1990 to 2019. Compared with 2019, the incident cases, prevalent cases, and YLDs counts of neck pain were projected to increase by 134%, 142%, and 140% by 2044. The global burden of neck pain has persisted at a relatively elevated level from 1990 to 2019, with projections indicating a continuing upward trend. Future research is urgently needed to better understand the predictors and clinical course of neck pain and to enhance prevention and management strategies.

Cervical Spine Pain and the Impact on the Quality of Life of Patients with Multiple Sclerosis

Background and Objectives: The main aim of this study was to evaluate the impact of cervical pain on the quality of life of patients with multiple sclerosis in comparison with a group of healthy people (without diseases of the Central Nervous System). Materials and Methods: Data were collected at the Specialist Hospital St. Łukasz in Końskie (Poland) in the period from November 2023 to August 2024. The inclusion criteria for this study were as follows: age (20-50 years), women and men, healthy people (without diseases of the Central Nervous System) and people suffering from multiple sclerosis. People from the study group were diagnosed according to the McDonald criteria and tested with the EDSS. The mobility of the cervical spine was measured, and neck pain was assessed using the following: Visual Analogue Scale (VAS), Laitinen Scale and the Neck Disability Index (NDI). All participants self-assessed their quality of life using EuroQol 5D-5L (EQ-5D-5L). Results: 80 people took part in this study, the vast majority of whom were women (71.3%). The most common form of multiple sclerosis was relapsing-remitting (75.0%), and the average EDSS score was higher in the male group (1.6 ± 1.8). Cervical spine pain was reported by 27 people from the study group (67.5%) and 16 people from the control group (40.0%). In both groups, the cervical spine mobility was lower in people with neck pain. The level of cervical spine pain was statistically significantly (p < 0.05) higher in women, people living in small towns and in people with multiple sclerosis, depending on the type of disease and its duration. Cervical spine pain in people with multiple sclerosis was higher in all three scales (VAS mean = 5.7, ES = 0.79; Laitinen Scale mean = 10.1, ES = 0.60; and NDI Scale mean = 21.1, ES = 0.89). The study group obtained significantly higher scores on the EQ-5D scale (mean = 15.3; ES = 0.79) and EQ-VAS (mean = 53.2; ES = 0.94). Conclusions: This study proved that cervical spine pain is more common among people with multiple sclerosis. In these people, this problem is rarely diagnosed and properly treated.

Therapeutic expectancy in physiotherapy

In health sciences, including physical therapy, communication techniques are a critical part of the success in the therapeutic process. Managing the patient's beliefs, perceptions, and the narrative of their problems, becomes an essential part of the therapeutic process. This is the key to achieving real changes regarding how the patient copes with pain, illness, dysfunction, as well as the ability to develop adequate resources for facing them. We call this "Therapeutic expectancy" a new concept that originates from the well-known Therapeutic alliance and incorporates practices from the field of Motivational interviewing and Strategic dialogue. The Therapeutic expectancy starts from the first interaction with the patient and continues throughout the different stages of the therapeutic process. This article describes the structure of the relationship with the patient and some verbal communication techniques to generate an effective physical therapist-patient interaction, building Therapeutic expectancy, through a "centered on the patient's narrative" strategy. Expectancy constitutes a desirable goal in any patient and in any pathological condition as it pursues a change in an individual's perception of their state of health, thereby enhancing the desire for healing and empowerment.

Diagnostic Accuracy of Ultrasound Imaging and Shear Wave Elastography to Discriminate Patients with Chronic Neck Pain from Asymptomatic Individuals

OBJECTIVES

The aim of this study was to determine and compare the capability of several B-mode ultrasound (US) and shear wave elastography (SWE) metrics to differentiate subjects with chronic non-specific neck pain from asymptomatic subjects.

METHODS

A diagnostic accuracy study recruiting a sample of patients with chronic neck pain and asymptomatic controls was conducted. Data collection included sociodemographic information (i.e., gender, age, height, weight and body mass index), clinical information (pain intensity assessed using the Visual Analogue Scale and pain-related disability using the Neck Disability Index) and B-mode ultrasound and shear wave elastography features of the cervical multifidus muscle (cross-sectional area, perimeter, mean echo intensity, fat infiltration, shear wave speed and Young's modulus). After analyzing between-group differences for left/right sides, cases and controls, and males and females, the area under the receiver operating characteristic (ROC) curve, the optimal cut-off point, the sensitivity, the specificity, the positive likelihood ratio (LR) and negative LR for each metric were calculated. A total of 316 individuals were recruited in this study (n = 174 cases with neck pain and n = 142 asymptomatic controls).

RESULTS

No significant differences (p > 0.05) were found between cases and controls for most variables, except for fatty infiltration, which was significantly higher in chronic neck pain cases (p < 0.001). Gender differences were significant across all US and SWE metrics (all, p < 0.001 except p = 0.015 for fatty infiltrates). A slight asymmetry was observed between the left and right sides for area (p = 0.038). No significant interactions between group, gender and side (all metrics, p > 0.008) were identified. Fatty infiltration was the most effective discriminator, with a ROC value of 0.723, indicating acceptable discrimination. The optimal cut-off point for fatty infiltration was 25.77, with a moderate balance between sensitivity (59.8%) and specificity (20.5%). However, its positive likelihood ratio (LR) of 0.75 suggests limited usefulness in confirming the condition.

CONCLUSIONS

Fatty infiltration was significantly higher in individuals with chronic idiopathic neck pain compared to those without symptoms, while other muscle metrics were similar between both groups. However, since fat infiltration had moderate diagnostic accuracy and the other metrics showed poor discriminatory power, US cannot be used solely to discriminate patients with idiopathic neck pain.

Effects of Kinesio Taping on Neck Pain: A Meta-Analysis and Systematic Review of Randomized Controlled Trials

INTRODUCTION

Neck pain constitutes a prevalent and burdensome health issue, substantially impairing patients' quality of life and functional capabilities. Kinesio taping (KT), a commonly employed intervention within physical therapy, holds promise for mitigating such symptoms; however, a comprehensive evaluation of its efficacy and evidence base is lacking. Therefore, this study endeavors to systematically investigate the therapeutic effects of KT on both subjective neck pain intensity and objective measures of physical activity limitations through a rigorous meta-analytic approach. By synthesizing existing literature and scrutinizing methodological nuances, we aim to furnish healthcare practitioners with evidence-informed insights, facilitating more judicious clinical decision-making and optimizing patient outcomes.

METHODS

According to the PRISMA guidelines, we conducted searches on PubMed, Cochrane Library, Embase, and Web of Science for randomized controlled trials (RCTs) investigating the efficacy of KT in treating neck pain. Screening was performed based on predefined inclusion and exclusion criteria. Characteristics of the included RCTs were extracted. Trial heterogeneity was assessed using the I2 statistic. Meta-analysis was conducted using Stata 17 software. Risk of bias and methodological quality were evaluated using the Cochrane Risk of Bias 2 tool and the PEDro scale, respectively.

RESULTS

In our analysis of 10 RCTs involving 620 patients meeting our inclusion criteria, KT demonstrated significant beneficial effects on neck pain, notably surpassing conventional treatment (weighted mean difference = -0.897, 95% CI -1.30 to -0.49, P < 0.001). Subgroup analysis further revealed that KT exhibited particularly pronounced efficacy in the treatment of nonspecific neck pain and mechanical neck pain, with a more substantial effect observed after 4 weeks of KT intervention compared to 1 week. Moreover, KT demonstrated superior efficacy in alleviating pain symptoms compared to both conventional treatment and sham interventions.

CONCLUSION

KT has demonstrated efficacy in reducing neck pain and improving cervical dysfunction among patients. Prolonged KT treatment or its combination with other therapeutic modalities may potentially enhance therapeutic outcomes.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42024524685.

Comparing the effects of neck stabilization exercises versus dynamic exercises among patients having nonspecific neck pain with forward head posture: a randomized clinical trial

BACKGROUND

Nonspecific neck pain (NSNP) is a well-established global burden affecting. It is also a common problem in Pakistan. The burden of neck pain is also increasing day by day due to poor work ergonomics, and increased use of computers and mobiles after the pandemic. An individual's poor posture is often associated with forward head posture (FHP). Limited evidence is available about the effects of neck stabilization (NSE) and dynamic exercises (NDE) for nonspecific neck pain particularly in patients with FHP. This aimed to compare the effects of NSE versus NDE among patients having NSNP with FHP in reducing pain, disability, forward head posture and improving neck range of motion.

METHODS

It is a single-blinded randomized clinical trial with 60 patients aged 18-40 years, with moderate intensity NSNP for > 3 weeks and < 6 months along with FHP with a moderate disability on neck disability index (NDI) randomly assigned to the treatment groups. Group 1 was doing NSE and group 2 was doing NDE. Transcutaneous Electical Nerve Stimulation, cold packs, and stretching exercises were given to both groups. A total of 9 sessions (3 sessions/ week) were given to participants. NDI questionnaire, Visual analogue scale (VAS), goniometry, and plumb line measurement tool were used as baseline and assessment at the end of 3rd week. The data was analyzed on SPSS version 21. Descriptive analysis was performed. Independent t-test was used for between group comparison and paired t-test used for within group comparison. A p-value less than 0.05 was considered statistically significant.

RESULTS

After treatment within-group analysis of both NSE and NDE showed significant (p < 0.001) improvement in pain on VAS, all ROMs of the neck including flexion, extension, left and right lateral flexion and left rotation, plumb line and NDI score with very large effect size. However, between-group analysis showed non-significant differences (p > 0.05) for post-treatment mean VAS, neck ROM, NDI and plumb line measurement.

CONCLUSION

Between NSE and NDE, no one is more beneficial than another. Both are equally effective in alleviating pain, increasing ROM, decreasing functional disability, and improving forward head posture in patients with NSNP.

TRIAL REGISTRATION

Registered trial at ClinicalTrials.gov Identifier: NCT05298631, 28/03/2022, prospectively registered.

Effect of thoracic manipulation on neck pain in the mobility group: A randomized controlled trial

Background and aims

Thoracic spine manipulation (TSM) increases the thoracic spine's range of motion (ROM), effectively reducing pain intensity and disability in patients with mechanical neck pain. We aimed to determine the effect of TSM on neck pain intensity and functional impairment in patients classified under the "mobility" category in Childs' classification.

Methods

In this randomized controlled trial, patients with mechanical neck pain who met the inclusion criteria were randomly assigned to either the TSM (n = 21) or sham manipulation (n = 20) group. The primary outcomes were pain during neck rotation and subjective improvement assessed using the Numerical Pain Rating Scale (NPRS) and Global Rating of Change (GROC), respectively. The secondary outcomes were NPRS at rest, disability (assessed using the Neck Disability Index [NDI]), and ROM of the cervical and thoracic spine rotation. Outcome measurements were performed at baseline, immediately after treatment, 1 week after treatment, and at the 4-week follow-up. Linear mixed models were used to analyze the NPRS, NDI, and ROM. The GROC was analyzed using a chi-square test for the percentage recording ≥+4; the means of each group were compared using an unpaired t-test.

Results

The NPRS with neck rotation, neck and thoracic ROM, and NDI showed significant interactions between the groups. The NPRS with neck rotation was significantly lower in the TSM group than in the sham group at all time points after the treatment (p < 0.001). There was no difference between the groups in the proportion showing moderate (≥+4) improvement according to the GROC; however, there was a significant difference in the mean values (p = 0.013).

Conclusion

Incorporating TSM into treatment protocols may improve clinical outcomes in patients with neck pain, potentially leading to better pain management and functional recovery. Therefore, physiotherapists should consider TSM as a viable and effective intervention to improve patient outcomes in neck pain rehabilitation.

Prevalence of Spinal Segmental Sensitization Syndrome in Outpatients Attending Physical Medicine and Rehabilitation Centers for Chronic Musculoskeletal Pain: A Multicenter Study

OBJECTIVE

To determine the prevalence of spinal segmental sensitization (SSS) syndrome, a regional pain disorder, among patients visiting physical medicine and rehabilitation centers (PM&RCs) for chronic musculoskeletal pain (CMSP).

DESIGN

An observational, descriptive, cross-sectional study conducted from March to July 2023.

SETTING

Seven PM&RCs from 5 cities, representing 3 care systems: Social Security (SS), Ministry of Health (MH), and private practice (PP).

PARTICIPANTS

All patients, regardless of age, attending a physiatry consultation for CMSP for the first time and who provided informed consent to participate were included. Nonprobabilistic sampling was employed.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

We estimated the overall prevalence of SSS syndrome as a percentage among patients with CMSP, stratified by health care institution, sex, age, and occupation type. We also recorded the spinal segments involved and any concomitant painful disorders (CPDs). SSS syndrome was diagnosed using standardized criteria.

RESULTS

Of the eligible participants, 319 with CMSP were enrolled; 73.4% were women, and the median age of participants was 56.9 (range, 13-89y) years. The overall prevalence of SSS syndrome was 53.3%. Of these, 69.1%, 42.2%, and 13.8% were in the SS, MH, and PP systems, respectively. The most affected were female participants (56.4%), those aged 50-64 years (60.4%), and those with active jobs (58.8%). Most commonly, the lumbosacral and lumbar segments were affected, followed by the lower and middle cervical levels. Spine pathologies were the most common CPDs.

CONCLUSION

The prevalence of SSS syndrome was high among patients who visited PM&RCs for CMSP and varied according to the care system. Further research on SSS syndrome is warranted to relieve the burden it poses on patients with CMSP and ensure proper diagnosis in clinical practice.

The effectiveness of telerehabilitation-based structured exercise therapy for chronic nonspecific neck pain: A randomized controlled trial

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.

The effects of neck exercise in comparison to passive or no intervention on quantitative sensory testing measurements in adults with chronic neck pain: A systematic review

BACKGROUND

Previous systematic reviews have identified the benefits of exercise for chronic neck pain on subjective reports of pain, but not with objective measures such as quantitative sensory testing (QST). A systematic review was conducted to identify the effects of neck specific exercise on QST measures in adults with chronic neck pain to synthesise existing literature and provide clinical recommendations.

METHODS

The study protocol was registered prospectively with PROSPERO (PROSPERO CRD42021297383). For both randomised and non-randomised trials, the following databases and trial registries were searched: AMED, CINAHL, Embase, Google Scholar, Medline, PEDro, PubMed, Scopus, SPORTDiscus, Science Citation Index and Social Science Citation Index from Web of Science Core Collection, clinicaltrials.gov, GreyOpen, and ISRCTN registry. These searches were conducted from inception to February 2022 and were updated until September 2023. Reference lists of eligible studies were screened. Study selection was performed independently by two reviewers, with data extraction and quality appraisal completed by one reviewer and independently ratified by a second reviewer. Due to high heterogeneity, narrative synthesis was performed with results grouped by exercise type.

FINDINGS

Three trials were included. Risk of bias was rated as moderate and the certainty of evidence as low or moderate for all studies. All exercise groups demonstrated statistically significant improvement at an intermediate-term follow-up, with progressive resistance training combined with graded physical training demonstrating the highest certainty of evidence. Fixed resistance training demonstrated statistically significant improvement in QST measures at a short-term assessment.

INTERPRETATION

Fixed resistance training is effective for short-term changes in pain sensitivity based on low-quality evidence, whilst moderate-quality evidence supports progressive resistance training combined with graded physical training for intermediate-term changes in pain sensitivity.

Chronic nonspecific multiple-sites pain [CNMSP] of unknown etiology: Biopsychosocial method of evaluation for the primary care level

Background

Understanding and dealing with chronic nonspecific pain (CNP) is the important entity at primary care hospital. Chronic nonspecific multiple-site pain [CNMSP] of unknown etiology creates diagnostic and therapeutic challenges for primary care physicians due to lack of guidance regarding evaluation and treatment.

Aims and Objectives

To classify and formulate the evaluation, treatment strategies, and prediction of prognosis of patients with CNMSP of unknown etiology.

Methods

Patients present with CNMSP of more than 3-month duration without any obvious medical cause. The biopsychosocial [BPS] model with 3P model was applied to see the biological, psychological, and social factors behind persistence. Finally, patients were classified into four groups for evaluation response to treatment and relapse rates in 12-month follow-up.

Results

Of the total 243 patients of CNMSP, 243 [96.3%] were females. Sixty [24.7%] patients had short duration, and 183 [75.3%] had long duration. Headache was in 115 [47%], low back pain ± leg pain in 96 [39.4%], cervical pain ± shoulder/arm pain in 83 [34.1%], and diffuse body pain in 50 [20.5%] in various combinations. A total of 155 [63.8%] patients had high somatization-sensitization index (SSI), and 144 [59.3%] had low ferritin level. Group 1 [high SSI and low ferritin] had 37.9% of patients, group 2 [high SSI and normal ferritin] had 25.9% of patients, group 3 [low to medium SSI with low ferritin] had 21.4% of patients, and group 4 [low to medium SSI with normal ferritin] had 14.8% of patients. Response to pain symptoms was better in group 1, and relapse rate was higher in group 2.

Conclusion

CNMSP of unknown etiology itself is a heterogeneous entity, and assessment based on the BPS model can be very useful to understand the treatment plan and outcome of these patients.

The epidemiology of neck and low back pain in Iran: a national and sub-national analysis from 1990 to 2019

Background

Neck pain (NP) is a condition influenced by multiple factors. It places a significant burden on individuals suffering from NP and on social and economic systems. On a global scale, low back pain (LBP) stands out as a significant contributor to years lost to disability, and this burden is on the rise due to population growth and aging.

Methods

The Global Burden of Disease database was used to collect data on the prevalence, incidence, and years lived with disability (YLD) of NP and LBP between 1990 and 2019. Various factors, including age group, gender, Iran, and its 31 provinces, were used to classify the data.

Results

Iran accounted for 0.86 million incident cases of NP in 2019, with age-standardized incident rate per 100 000 population of 934.1. Tehran has the maximum age-standardized prevalence, incidence, and YLD. Iran accounted for the age-standardized incidence rate for LBP per 100 000 population of 3492.9, and it reduced to -8.35% from 1990. Mazandaran exhibits the highest levels of prevalence, incidence, and YLD for LBP in 2019. In Iran, the point prevalence of NP in 2019 was higher in females and increased with age up to 50-54 years for females and 70-74 years for males. However, there is only a slight difference between females and males in Iran regarding LBP prevalence.

Conclusions

In this study, the authors report the prevalence, incidence, YLD, and age-standardized rates for NP and LBP in the world's general population and Iran's population based on its sub-nations in 1990 and 2019.

Accuracy and efficacy of ultrasound-guided puncture (vs. computed tomography-guided) in cervical medial branch blocks for cervicogenic pain: A randomized controlled study

Cervical medial branch block (CMBB) has been recognized as an effective treatment for cervicogenic pain. Previous studies mostly used ultrasound-guided out-of-plane puncture for CMBB, while this prospective study was designed to investigate the efficacy of ultrasound-guided in-plane puncture, specifically focusing on the new target of CMBB for cervical pain. This study includes two parts: the accuracy study (N = 15, CMBB was completed by ultrasound and confirmed by computed tomography [CT], in which a good distribution percentage of the analgesic solution was observed) and the efficacy study (N = 40, CMBB was completed by ultrasound or CT, while the proportion of pain relief (numerical rating scale) decrease by more than 50% postoperatively was analyzed). The results showed that the good distribution percentage of the analgesic solution was 97.8%. Furthermore, in the early period (30 min and 2 h postoperatively), the proportion of patients with pain relief was lower in the ultrasound group than that in the CT group, especially at 2 h postoperatively (52% vs. 94%). However, at 24 h postoperatively and later, the proportion of patients with pain relief gradually stabilized to about 60%-70%, and lasted for about 2 weeks to 1 month. Therefore, the new target for CMBB, guided by ultrasound in-plane, offers high visibility and accuracy. A single CMBB performed under ultrasound guidance resulted in pain relief comparable to that of a CT-guided procedure (1 day to 1 month postoperatively). This study indicated that CMBB guided by ultrasound in-plane could be regarded as a promising approach for treatment of cervicogenic pain.

Effect of myofascial release and muscle energy technique on patients with chronic neck pain: a scoping review

PURPOSE

To identify the effects of muscle energy techniques and myofascial release in patients with chronic neck pain.

METHODS

To conduct a literature search and identification; PRISMA-ScR guidelines were followed. Relevant articles were searched for from the following medical and health sciences electronic databases: PubMed, EBSCOhost, CENTRAL of the Cochrane Library, and the Physiotherapy Evidence-Based Database (PEDro). Patients with chronic neck pain were eligible for the scoping review.

RESULTS

Seven articles were included in this review. This scoping review found that there is heterogeneity in the prescription of MFR and MET and a greater tendency to check three major physical dimensions (pain, range of motion, and disability). Various studies have opted for distinct intervention regimens, resulting in disparities in the frequency of weekly interventions, which can range from biweekly to five times a week. These inconsistencies may lead to perplexity among practitioners, as each intervention modality demonstrates favorable outcomes for individuals with persistent cervical discomfort. Moreover, a significant proportion of research projects have employed the numeric pain rating scale (NPRS) and visual analog scale (VAS) for data quantification.

CONCLUSION

According to results, majority of the studies were focused on pain and missing components of range of motion and quality of life. Work-related factors can act as risk factors for chronic neck pain. Future investigations should adopt a comprehensive methodology and incorporate QoL assessments of quality of life.

Impact of Musculoskeletal Pain on Health-Related Quality of Life Among Adults in Saudi Arabia

Background Musculoskeletal pain (MSP) is widely recognized as a prevalent public health issue that affects individuals of various genders and age groups. The aim of this study is to assess the influence of musculoskeletal pain on the quality of life (QoL) of adult individuals living in Saudi Arabia. Method This is a cross-sectional study using an online-administered questionnaire that was distributed via online platforms in Saudi Arabia for the duration between January and August 2023. Three questionnaire instruments were used in this study. The 36-item Short Form Health Survey questionnaire (SF-36), The 5-level EQ-5D version (EQ-5D-5L), and Roland-Morris Disability Questionnaire. Binary logistic regression analysis was used to identify predictors of better QoL and having mild to moderate disability. Results A total of 8359 participants were involved in this study. The most commonly reported sites of musculoskeletal pain were the lower back, neck, and shoulder, accounting for 36.8% (n= 3072), 30.5% (n= 2549), and 30.1% (n= 2514), respectively. The mean pain score for the study participants was 4.3 (SD: 2.3), which indicates mild degree of pain. The median EQ-5D-5L index value for the study participants was 0.827 (0.756-1.00), which demonstrates a high quality of life. The mean SF-36 score for the study participants was 63.11 (17.4), which demonstrates moderate quality of life. The median Roland-Morris Disability score for the study participants was 1.00 (0.00-7.00), which demonstrates a low level of pain-related disability. Male gender, younger age (30-39 years), having higher education attainment, having higher monthly income (more than SAR 20000), and having lower BMI (less than 25.8 kg/cm2) were predictors of better QoL (p<0.05). Conclusion Musculoskeletal pain is a multifactorial condition influenced by structural, physical, psychological, social, lifestyle, and comorbid health elements. It ranges from acute to chronic pain and, despite rarely being fatal, has a significant impact on QoL. Musculoskeletal discomfort varies in terms of intensity, affected regions, and demographic and lifestyle factors. This study sheds light on the multifaceted nature of MSP, its impact on QoL, and the significance of early intervention and individualized management strategies to improve the QoL of those affected.

Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

Neck pain is a highly prevalent condition that leads to considerable pain, disability, and economic cost. We present the most current estimates of neck pain prevalence and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) by age, sex, and location, with forecasted prevalence to 2050.

METHODS

Systematic reviews identified population-representative surveys used to estimate the prevalence of and YLDs from neck pain in 204 countries and territories, spanning from 1990 to 2020, with additional data from opportunistic review. Medical claims data from Taiwan (province of China) were also included. Input data were pooled using DisMod-MR 2.1, a Bayesian meta-regression tool. Prevalence was forecast to 2050 using a mixed-effects model using Socio-demographic Index as a predictor and multiplying by projected population estimates. We present 95% UIs for every metric based on the 2·5th and 97·5th percentiles of 100 draws of the posterior distribution.

FINDINGS

Globally, in 2020, neck pain affected 203 million (95% uncertainty interval [UI] 163-253) people. The global age-standardised prevalence rate of neck pain was estimated to be 2450 (1960-3040) per 100 000 population and global age-standardised YLD rate was estimated to be 244 (165-346) per 100 000. The age-standardised prevalence rate remained stable between 1990 and 2020 (percentage change 0·2% [-1·3 to 1·7]). Globally, females had a higher age-standardised prevalence rate (2890 [2330-3620] per 100 000) than males (2000 [1600-2480] per 100 000), with the prevalence peaking between 45 years and 74 years in male and female sexes. By 2050, the estimated global number of neck pain cases is projected to be 269 million (219-322), with an increase of 32·5% (23·9-42·3) from 2020 to 2050. Decomposition analysis of the projections showed population growth was the primary contributing factor, followed by population ageing.

INTERPRETATION

Although age-standardised rates of neck pain have remained stable over the past three decades, by 2050 the projected case numbers are expected to rise. With the highest prevalence in older adults (higher in females than males), a larger effect expected in low-income and middle-income countries, and a rapidly ageing global population, neck pain continues to pose a challenge in terms of disability burden worldwide. For future planning, it is essential we improve our mechanistic understanding of the different causes and risk factors for neck pain and prioritise the consistent collection of global neck pain data and increase the number of countries with data on neck pain.

FUNDING

Bill & Melinda Gates Foundation and Global Alliance for Musculoskeletal Health.

Exercise-induced hypoalgesia in chronic neck pain: A narrative review

Chronic neck pain (CNP) is a worldwide health problem with several risk factors. One of the most widely used treatments for managing this condition is therapeutic exercise, which could generate a response called exercise-induced hypoalgesia (EIH). There is no consensus on the best exercise modality to induce hypoalgesia. Therefore, this review aims to analyze and synthesize the state-of-the-art about the hypoalgesic effect of exercise in subjects with CNP. We included articles on EIH and CNP in patients older than 18 years, with pain for more than three months, where the EIH response was measured. Articles that studied CNP associated with comorbidities or measured the response to treatments other than exercise were excluded. The studies reviewed reported variable results. Exercise in healthy subjects has been shown to reduce indicators of pain sensitivity; however, in people with chronic pain, the response is variable. Some investigations reported adverse effects with increased pain intensity and decreased pain sensitivity, others found no clinical response, and some even reported EIH with decreased pain and increased sensitivity. EIH is an identifiable, stimulable, and helpful therapeutic response in people with pain. More research is still needed on subjects with CNP to clarify the protocols and therapeutic variables that facilitate the EIH phenomenon. In addition, it is necessary to deepen the knowledge of the intrinsic and extrinsic factors that influence EIH in people with CNP.

Prevalence of text neck syndrome, its impact on neck dysfunction, and its associated factors among medical students: A cross-sectional study

BACKGROUND

Students increasingly rely on digital devices, leading to text neck syndrome, a common overuse syndrome caused by repetitive forward neck flexion.

OBJECTIVE

This study aimed to determine the prevalence of text neck syndrome among medical students and the resulting neck dysfunction and to investigate the possible associated factors.

METHODS

This cross-sectional study used an online self-developed questionnaire among medical students. Students' characteristics and data about smartphone usage were evaluated for diagnosis. Individuals with at least 3 of the 6 text neck syndrome symptoms and a history of more than four hours a day spent on a smartphone were diagnosed with text neck syndrome. Neck dysfunction was measured using the neck disability index. Descriptive statistics and the chi-square test were used. P values < 0.05 were considered statistically significant.

RESULTS

The study found that 31.7% of students with text neck syndrome have mild neck disabilities, with a higher proportion of females (40%). The characteristics that have a significant relation to text neck syndrome include being female (p < 0.0001), overweight (p = 0.025), being right-handed (p = 0.001), using four digital devices or more (p = 0.002), having low levels of physical activity (P = 0.018), and spending more than three hours a day sitting down (P = 0.027).

CONCLUSION

More than a quarter of medical students had text neck syndrome, and most of them had a mild neck disability. Text Neck Syndrome was linked to an increased number of gadgets used, low exercise, and more time spent in a sitting position.

Assessing Non-Specific Neck Pain through Pose Estimation from Images Based on Ensemble Learning

BACKGROUND

Mobile phones, laptops, and computers have become an indispensable part of our lives in recent years. Workers may have an incorrect posture when using a computer for a prolonged period of time. Using these products with an incorrect posture can lead to neck pain. However, there are limited data on postures in real-life situations.

METHODS

In this study, we used a common camera to record images of subjects carrying out three different tasks (a typing task, a gaming task, and a video-watching task) on a computer. Different artificial intelligence (AI)-based pose estimation approaches were applied to analyze the head's yaw, pitch, and roll and coordinate information of the eyes, nose, neck, and shoulders in the images. We used machine learning models such as random forest, XGBoost, logistic regression, and ensemble learning to build a model to predict whether a subject had neck pain by analyzing their posture when using the computer.

RESULTS

After feature selection and adjustment of the predictive models, nested cross-validation was applied to evaluate the models and fine-tune the hyperparameters. Finally, the ensemble learning approach was utilized to construct a model via bagging, which achieved a performance with 87% accuracy, 92% precision, 80.3% recall, 95.5% specificity, and an AUROC of 0.878.

CONCLUSIONS

We developed a predictive model for the identification of non-specific neck pain using 2D video images without the need for costly devices, advanced environment settings, or extra sensors. This method could provide an effective way for clinically evaluating poor posture during real-world computer usage scenarios.

Effects of exercise therapy using elastic bands on strength and pain in women with non-specific neck pain: A randomised controlled trial

Background

Cervical pain has a high incidence and worldwide socio-economic effect. Its incidence is lower in men than in women. Conservative and non-pharmacological therapeutic options include strength training. Elastic bands are commonly used in physiotherapy clinics for strength work in patients. Consequently, the objective of this research was to analyse the efficacy of an exercise therapy programme using elastic bands on decreasing pain and increasing strength of the neck flexor musculature, cervical extensor, and scapular stabilizing musculature in women suffering from non-specific cervical pain.

Methods

A randomised clinical trial was carried out with 35 subjects with non-specific neck pain (age = 51.7 ± 9.5 and baseline intensity of pain in Visual Analogue Scale = 52.4 ± 9.6). The experimental group (n = 18) performed the exercise programme with elastic bands, consisting of a total of 16 sessions that lasted 45 min. The control group, consisting of 27 participants, reported that they maintained their usual lifestyle throughout the study. The evaluation tools used in this research included the Visual Analogue Scale, Neck Flexor Endurance Test, Neck Extensor Muscle Endurance Test, and Scapular Muscle Endurance Test.

Results

The experimental group obtained significant improvements in the measurements taken using the Visual Analogue Scale (p < 0.001, d = 4.2), the Neck Flexor Endurance Test (p < 0.001, d = 3.4), the Neck Extensor Endurance Test (p < 0.001, d = 6.3), in the Scapular Muscle Endurance Test (p = 0.016, d = 0.9).

Conclusions

The assessed exercise therapy program utilizing elastic bands demonstrated favorable outcomes in managing non-specific neck discomfort. This intervention resulted in pain reduction and enhanced endurance of the cervical flexor and extensor muscles, along with improved endurance of the scapular stabilizing muscles.Protocol registration in ClinicalTrials.gov: NCT05433649 (registered prospectively, date of registration: June 27, 2022).

Sedentary behavior and neck pain in adults: A systematic review and meta-analysis

Sedentary lifestyle is an imperative risk for musculoskeletal pain. We sought to investigate the association between different types of sedentary behaviors (SBs) and neck pain (NP) among adults. A systematic search was conducted in PubMed, Web of Science, Embase, Scopus, and Google Scholar up to the end of April 2023. The odds ratio (95% CI) was considered as the desired effect size for the association between SBs and the NP. Among 1881 records found by primary search, 46, and 27 reports were included in the qualitative and quantitative analysis respectively. All included studies qualified as good or fair. Our results indicated that SB is a risk factor for NP among adults (OR = 1.5, [1.29, 1.76]). Computer and mobile phone use were also found to be considerable risk factors for NP (OR = 1.3, [1.12, 1.53], and OR = 2.11, [1.32, 3.42] respectively). However, sitting time showed an insignificant association with NP (OR = 1.33, [0.86, 2.07]). Subgroup analysis revealed that SBs are a significant risk factor for NP among university students (OR = 1.58, [1.27, 1.97]), but the association among office workers was marginally insignificant (OR = 1.36, [0.98, 1.89]). According to the meta-regression results, the male gender was found to increase the risk of NP. Meanwhile, Egger's test revealed the presence of publication bias (p-value <0.0001). A sedentary lifestyle as well as computer and mobile phone use is associated with a considerable risk of NP among adults, especially university students. Further, longitudinal studies are needed to better clarify the causality relationships.

Coexistence of Cervical Disc Herniation and Shoulder Soft Tissue Pathologies and the Effect of Sleeping Positions and Orthopedic Pillows

Background/aim This study investigates the degree of coexistence of cervical disc herniation and shoulder soft tissue pathology, as well as the effect of sleeping positions and orthopedic pillow use. Materials and methods This present study was conducted on 72 patients with shoulder/arm pain operated on for cervical disc herniation. Two groups were examined according to the presence of shoulder soft tissue pathology, four common sleeping positions, and the use of an orthopedic pillow. Preoperative and postoperative shoulder/arm visual analog scale (VAS) scores were compared. Results The preoperative VAS values were 7.35, while the postoperative VAS values were 3.32. Twenty-one patients (29.2%) had a disc at the C3-4 level, a rate equal to that for the C5-6 level. Twenty-four patients (33.3%) had a disc at the C4-5 level. Thirty-two cases (44.4%) slept in a side-lying position on the same side as their disc herniation. Among those with a herniated disc at the C3-4 level, 8 (53.3%) preferred sleeping side-lying on the opposite side of the disc. In contrast, those with a herniated disc at the C4-5 level more frequently (40.6%) slept side-lying on the same side as the disc. Mean VAS scores were significantly higher in cases with shoulder soft tissue pathology and were significantly lower in the group that used orthopedic pillows (p<0.001). Conclusion Shoulder soft tissue pathologies should be considered in postoperative shoulder pain. The use of orthopedic pillows is effective in preoperative and postoperative pain. Sleeping positions do not affect the shoulder/arm pain before and after the operation, but they affect the level of cervical disc herniations.

Risk factors for neck pain in college students: a systematic review and meta-analysis

BACKGROUND

During the COVID-19 epidemic, the prevalence of neck pain among college students has increased due to the shift from offline to online learning and increasing academic and employment pressures. Therefore, this systematic review aimed to identify the personal, occupational, and psychological factors associated with the development of neck pain to promote the development of preventive strategies and early intervention treatment.

METHODS

Seven electronic databases were searched from inception to December 2022 for cross-sectional studies, cohort studies, case----control studies, and randomized controlled trials (RCTs) on neck pain. The quality of the selected studies were assessed by American Agency for Healthcare Research and Quality (AHRQ) or the Newcastle-Ottawa Scale (NOS). Pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated to evaluate the effects of the included risk factors on neck pain.

RESULTS

Thirty studies were included, including 18,395 participants. And a total of 33 potentially associated risk factors were identified. Ultimately, 11 risk factors were included in the meta-analysis after assessing, and all results were statistically significant (P < 0.05). The factors supported by strong evidence mainly include the improper use of the pillow (OR = 2.20, 95% CI: 1.39 to 3.48), lack of exercise (OR = 1.88, 95% CI: 1.53 to 2.30), improper sitting posture (OR = 1.97, 95% CI: 1.39 to 2.78), history of neck and shoulder trauma (OR = 2.32, 95% CI: 1.79 to 3.01), senior grade (OR = 2.86, 95% CI: 2.07 to 3.95), staying up late (OR = 1.80, 95% CI: 1.35 to 2.41), long-time electronic product usage daily (OR = 1.53, 95% CI: 1.33 to 1.76), long-time to bow head (OR = 2.04, 95% CI: 1.58 to 2.64), and emotional problems (OR = 2.09; 95% CI: 1.66  to 2.63). Risk factors supported by moderate evidence were high stress (OR = 1.61, 95% CI: 1.02 to 2.52) and female gender (OR = 1.69, 95% CI: 1.52 to 1.87).

CONCLUSION

This study obtained 11 main risk factors affecting college students neck pain, including improper use of the pillow, lack of exercise, improper sitting posture, history of neck and shoulder trauma, senior grade, staying up late, long-term electronic product usage daily, long time to bow head, high stress, emotional problems and female gender.

The one-week prevalence of neck pain and low back pain in post-secondary students at two Canadian institutions

BACKGROUND

Low back and neck pain are common in the general population, but the prevalence among Canadian post-secondary students is not well known. We aimed to determine the one-week prevalence of neck pain (NP) and low back pain (LBP) among postsecondary students in Canada.

METHODS

We conducted a cross-sectional study of students enrolled in the Faculty of Health Sciences and Faculty of Education at Ontario Tech University, and the Canadian Memorial Chiropractic College (CMCC) in the Fall of 2017. Neck and low back pain intensity in the past week were measured with the 11-point numerical rating scale. We report the cumulative, gender- and institution-specific one-week prevalence (95% CI) of any pain (1-10/10) and moderate to severe pain (≥ 3/10).

RESULTS

The one-week prevalence of any neck pain ranged from 45.4% (95% CI: 38.4, 52.4) in the Faculty of Education to 76.9% (95% CI: 72.9, 80.4) at CMCC. The one-week prevalence of neck pain ≥3/10 ranged from 44.4% (95% CI: 37.5, 51.4) in the Faculty of Education to 58.4% (95% CI: 54.0, 62.7) at CMCC. The one-week prevalence of any low back pain ranged from 60.9% (95% CI: 53.8, 67.5) in the Faculty of Education to 69.0% (95% CI: 64.8, 73.0) at CMCC, and the one-week prevalence of low back pain ≥ 3/10 ranged from 47.8% (95% CI: 43.4, 52.2) at CMCC to 55.1% (95% CI: 51.2, 58.9) in the Faculty of Health Sciences. The prevalence of any back or neck pain and pain ≥ 3/10 was consistently higher in females than males, with the largest difference seen for neck pain at CMCC.

CONCLUSION

Most post-secondary students in our samples experienced LBP and NP in the past week. Overall, the one-week prevalence of NP and LBP was higher among chiropractic students and among females. This study should draw attention to school administrators about the burden of NP and LBP in post-secondary students.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Prolonged slumped sitting causes neck pain and increased axioscapular muscle activity during a computer task in healthy participants - A randomized crossover study

INTRODUCTION

Sitting posture may contribute to spinal pain. Effects of postures on pain, sensitivity and muscle activity during computer tasks were investigated.

METHODS

Twenty-five healthy participants, seated at a workstation without backrest, completed four, 15-min typing tasks: A)Upright with forearm-support; B)Upright without forearm-support; C)Slumped with forearm-support; D)Slumped without forearm-support. Participants rated pain every minute on a numerical rating scale (NRS). RMS-EMG was recorded from upper/lower trapezius (UT, LT), serratus anterior and anterior/middle deltoid. At baseline and after tasks, pressure pain thresholds (PPTs) were recorded bilaterally over the head, UT, and leg.

RESULTS

All tasks caused clinically relevant increased NRS (≥2/10) compared to baseline (P < 0.001). NRS was higher in Task-D (P < 0.003) and lower in Task-B (P < 0.005) than others. PPTs did not change from baseline. Task-D caused higher UT and LT RMS-EMG (P < 0.02) than other tasks.

CONCLUSION

A 15-min task caused pain irrespective of posture with some causing larger changes than others.

Do lifestyle factors influence pain prognosis? A 1-year follow-up study

Objective

The aim of this observational longitudinal study was to investigate the impact of lifestyle factors on the prognosis of patients with pain.

Methods

This study was part of a large prospective longitudinal study conducted in general practice (GP). Participants completed questionnaires at baseline (T0) and one year later (T1). Outcomes analysed were the EQ-5D index, presence of pain and the ability to perform a light work for 1 hour without difficulty.

Results

Among 377 individuals with pain at T0, 294 still reported pain at T1. This subgroup had a significantly higher BMI, more painful sites, higher pain intensity, more sleep problems, poorer general self-rated health (GSRH) and higher Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) score at T0 than pain-free individuals at T1. There were no differences in age, sex, physical activity and smoking. In multivariable analyses, the number of painful sites, GSRH, sleep problems, pain duration, pain intensity and 2 short-form 10-item Örebro musculoskeletal pain questionnaire (SF-ÖMPSQ) items were independently associated with at least one outcome 1 year later. Only GSRH was strongly associated with all outcomes. The accuracy of GSRH at T0 to classify participants according to dichotomous outcomes was overall moderate (0.7 < AUC <0.8).

Conclusions

Lifestyle factors appear to have little influence on the outcome of patients with pain in GP. Conversely, poorer GSRH - which probably integrates the subjects' perception of several factors - could be considered a negative prognostic factor in patients with pain.

How to reduce the risk of cervicalgia and low back pain in obese individuals: A mendelian randomization study

Obesity is associated with cervicalgia and low back pain (LBP), but the specific role and how to reduce the risk of neck pain and low back pain are not clear. The Mendelian randomization analysis was used to investigate the causal relationship between obesity and cervicalgia and LBP, as well as the effect of possible mediating factors. Then, causal associations were estimated using sensitivity analysis. Educational level (odds ratio (OR) = 0.30, 0.23) was negatively associated with cervicalgia and LBP; Heavy physical work (HPW) (OR = 3.24, 2.18), major depression (MD) (OR = 1.47, 1.32), body mass index (BMI) (OR = 1.36, 1.32), and waist circumference (WC) (OR = 1.32, 1.35) were positively associated with cervicalgia and LBP; Leisure sedentary behavior (LSB) (OR = 1.96), smoking (OR = 1.32), and alcohol intake frequency (OR = 1.34) were positively associated only with LBP, but not with cervicalgia. Ranked by mediated proportions of selected mediators, the largest causal mediator from BMI and WC to cervicalgia was educational level (38.20%, 38.20%), followed by HPW (22.90%, 24.70%), and MD (9.20%, 17.90%); However, the largest causal mediator from BMI and WC to LBP was LSB (55.10%, 50.10%), followed by educational level (46.40%, 40.20%), HPW (28.30%, 20.90%), smoking initiation (26.60%, 32.30%), alcohol intake frequency (20.40%, 6.90%), and MD (10.00%, 11.40%). For obese individuals, avoiding HPW and maintaining a stable mood may be an effective approach to prevent cervicalgia; Additionally, reducing LSB, avoiding HPW, quitting smoking and drinking, and maintaining a stable mood may be an effective approach to prevent LBP.

Assessment of shoulder proprioception in patients with chronic mechanical cervical pain: A comparative study

BACKGROUND

Chronic mechanical cervical pain (CMCP) is a common disabling problem worldwide, interfering with upper extremities function. However studying the impact of CMCP on shoulder proprioception is still lacking.

OBJECTIVE

To investigate the impact of CMCP on shoulder proprioception in young adults compared with normal control (NC) individuals.

METHODS

A comparative study was conducted between two groups; 40 patients with CMCP (mean age 32.28 ± 6.586) and 40 age and sex matched NC (mean age 33.43 ± 9.021). The Biodex isokinetic dynamometer was used to assess shoulder active sense of position at 30∘ external and internal rotations. The absolute angular error was calculated for the dominant and non-dominant shoulders.

RESULTS

The absolute angular error was significantly increased only in the CMCP at both rotation angles for both shoulders, showing a remarkable increase on the dominant shoulder and in the external rotation range compared with NC.

CONCLUSIONS

CMCP can significantly impair shoulder proprioception, particularly on the dominant side and in external rotation range. This could emphasize the careful examination of shoulder proprioception for the early detection of shoulders at risk, to eliminate the possibility of shoulder instability and/or injury in young adults with CMCP.

Sedentary behavior and neck pain in children and adolescents; a systematic review and meta-analysis

Background: Sedentary behavior (SB) is considered a risk factor for musculoskeletal pain. We aimed to explore the association of sedentary behavior indicators with neck pain among children and adolescents. Methods: A comprehensive review was performed in different databases until the end of January 2022. Odds ratios (ORs) with 95% confidence intervals were used as desired effect sizes to evaluate the association between prolonged screen time or mobile phone (MP) usage and neck pain risk. Results: Among 1651 records, 15 cross-sectional studies were included in the systematic review, and 7 reports were included in the meta-analysis. Our results suggested a significant relationship between prolonged MP use and neck pain (OR=1.36, 95% CI=1.001-1.85, I²=40.8%, P value for heterogeneity test=0.119). Furthermore, a marginally insignificant association was found between prolonged screen time and neck pain (OR=1.13, 95% CI=0.98-1.30, I²=60.3%, P value=0.01); however, after sensitivity analysis and removing one study, this association became significant (OR=1.30, 95% CI=1.03-1.64). Moreover, a significant association between prolonged sitting time and neck pain was reported in two studies. Conclusion: Available good-quality evidence reveals a significant mild association between sedentary behavior and the risk of neck pain among children and adolescents. However, longitudinal studies with objective measurement tools are warranted. In particular, potential preventive educational programs are suggested for pediatrics to reduce sedentary behavior and neck pain.

Physical activity, sitting time, neck disability and posture in workers using visual display terminals (VDT)

BACKGROUND

Musculoskeletal pain represents a major public health problem. Workers who use visual display terminals (VDT) have suffered an increase in neck pain in recent decades.

OBJECTIVE

The aim of this study was to analyze the relationship between physical activity (PA), sitting time, posture, and neck disability in a population of employed adults who use a computer at work.

METHODS

In this descriptive-correlational study, 88 workers with a mean age of 48.31 years participated. All of the participants filled out the Self-Report Habit Index (SRHI), International Physical Activity Questionnaire (IPAQ), and Neck Disability Index (NDI). The postural situation was also assessed with Posture Assessment Software (PAS/SAPO).

RESULTS

A significant and inverse relationship was observed between the habit of PA practice and the Body Mass Index (BMI). A total of 59.1% of the participants have a moderate PA index. There was a statistically significant relationship between the NDI and the time that workers spend sitting in a workday. A significance level of p≤0.05 was established for all the statistical analyses.

CONCLUSION

The increase in sitting time produces an increase in neck disability among workers and there are no significant differences between the level of PA and the cervical angles analyzed. The promotion of leisure-time PA and the reduction of prolonged uninterrupted sitting time at work could be one of the means to reduce musculoskeletal morbidity in the working population.

The Association Between Upper Disorders and Psychological Well-Being and its Implication in Text Neck Syndrome: A Systematic Review

Objective

Non-specific/chronic musculoskeletal disorder in neck, head or low back (that we called Upper Disorders; UD) are widely common health problem in high-income, urban, and industrialized countries, especially for sedentary people who use electronic devices. This systematic review aims to analyse the association between UD and psychological disease.

Method

The database searches were conducted in 8 different databases, using relevant keywords. According to PRISMA Statements, full-text peer-reviewed articles in English which analysed the association between UD and indicators of psychological disease (i.e., mood disturbance, anxiety, depression, stress, social support, and alexithymia) in non-clinical sample were included.

Results

Of 8798 abstracts and titles, 10 full-text papers were included. The overall results showed a strong association between UD and mood disturbance, anxiety, depression, stress, alexithymia, and low social support. Thus, high levels of UD were associated with high levels of psychological disease.

Conclusions

The results supported the assessment of physical and psychological symptoms in a holistic perspective. Their implications in terms of holistic care and text neck syndrome were discussed.

Rapid Improvement in Neck Disability, Mobility, and Sleep Quality with Chronic Neck Pain Treated by Fu’s Subcutaneous Needling: A Randomized Control Study

Background

Chronic neck pain is a common musculoskeletal disorder caused by overuse of neck and upper back muscles or poor posture, and it is commonly combined with a limited range of motion in the neck and shoulders. Most cases will recover within a few days; however, the symptoms often recur easily. Fu's subcutaneous needling (FSN) is a new therapeutic approach used to treat patients with chronic neck pain. However, there is no solid evidence to support the effectiveness of FSN on chronic neck pain and disability.

Methods

Participants (n = 60) with chronic neck pain for more than 2 months with pain intensity scored by visual analog scale (VAS) more than five were enrolled in this trial. Participants were equally randomized into the FSN or transcutaneous electrical nerve stimulation (TENS) group who received interventions once a day on day 1, day 2, and day 4. They were assessed by outcome measurements during pre- and post-treatment and followed up for 15 days.

Results

The VAS was immediately reduced in the FSN and TENS groups and sustained for 15 days of follow-up (all P < 0.001). The immediate effects were also observed as the pressure pain threshold increased in the FSN group on day 2 (P=0.006) and day 4 (P=0.023) after treatment, and tissue hardness decreased by FSN on day 1 and day 2 after treatment (both P < 0.001). FSN and TENS treatment improved neck disability and mobility; moreover, FSN promoted participants to receive better sleep quality, as determined by PSQI assessment (P=0.030). TENS had no benefit on sleep quality.

Conclusion

FSN was able to relieve pain and relax muscle tightness. Notably, FSN significantly improved neck disability and mobility and enhanced sleep quality. These findings demonstrated that FSN could be an effective alternative treatment option for patients with chronic neck pain. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03605576, registered on July 30, 2018.

Sex differences in factors associated with neck pain among undergraduate healthcare students: a cross-sectional survey

Background

Neck pain is widespread among students in healthcare-related fields. Although neck pain is more prevalent in females, since most research involves mixed-sex samples we know very little about sex differences in contributors to neck pain. Thus, this study sought to explore sex differences in the risk factors for neck pain in this high-risk population.

Methods

This cross-sectional study was conducted in China in 2021 and included a sample of 1921 undergraduate healthcare students (693 males, 1228 females) from 7 health professional schools at Fujian Medical University. We collected data on neck pain symptoms, demographics, behavioral and psychological factors. Multiple regression analysis was conducted to examine sex differences in the risk factors of neck pain.

Results

The overall prevalence of neck pain was 41.6% with female students having a higher prevalence than male students (44.4% vs. 36.7%, respectively). The adjusted analyses showed that self-study time ≥ 6 h/day (OR = 1.44, 95% CI:1.13-1.83), flexed neck posture >20 degrees (OR = 2.19, 95% CI: 1.28-3.74), static duration posture >2 h (OR = 1.42, 95% CI: 1.02-1.97), and psychological distress (high: OR = 2.04, 95% CI:1.42-2.94; very high: OR = 2.50, 95% CI:1.57-3.74; respectively) were independent factors for neck pain in females. Among males, self-study time ≥ 6 h/day (OR = 1.43, 95% CI: 1.02-2.01) and psychological distress (moderate: OR = 2.04, 95% CI:1.28-3.25; high: OR = 2.37, 95% CI:1.49-3.79; very high: OR = 2.97, 95% CI:1.75-5.02; respectively) were significant risk factors for neck pain.

Conclusions

These findings suggest that the risk profiles of neck pain differ between females and males. The modifiable risk factors for neck pain, such as prolonged self-study time and elevated psychological distress, as well as poor posture among females, could be targeted through health promotion interventions in university settings.

Global, regional, and national neck pain burden in the general population, 1990–2019: An analysis of the global burden of disease study 2019

Background

This study describes the global epidemiology and trends associated with neck pain. Global Burden of Disease data collected between 1990 and 2019 were used to determine the global burden of neck pain in the general populations of 204 countries.

Methods

Global, regional, and national burdens of neck pain determined by prevalence, incidence, and years lived with a disability (YLD) from 1990 to 2019 were comprehensively analyzed according to age, gender, and socio-demographic index using the Global Burden of Disease Study 1990 and 2019 data provided by the Institute for Health Metrics and Evaluation.

Results

Globally, in 2019, the age-standardized rates for prevalence, incidence, and YLD of neck pain per 100,000 population was 2,696.5 (95% uncertainty interval [UI], 2,177.0 to 3,375.2), 579.1 (95% UI, 457.9 to 729.6), and 267.4 (95% UI, 175.5 to 383.5) per 100,000 population, respectively. Overall, there was no significant difference in prevalence, incidence, or YLD of neck pain between 1990 and 2019. The highest age-standardized YLD of neck pain per 100,000 population in 2019 was observed in high-income North America (479.1, 95% UI 323.0 to 677.6), Southeast Asia (416.1, 95% UI 273.7 to 596.5), and East Asia (356.4, 95% UI 233.2 to 513.2). High-income North America (17.0, 95% UI 9.0 to 25.4%) had the largest increases in YLD of neck pain per 100,000 population from 1990 to 2019. At the national level, the highest age-standardized YLD of neck pain was found in the Philippines (530.1, 95% UI 350.6 to 764.8) and the highest change age-standardized YLD between 1990 and 2019 was found in the United States (18.4, 95% UI 9.9 to 27.6%). Overall, the global burden of neck pain increased with age until the age of 70–74 years, and was higher in women than men. In general, positive associations between socio-demographic index and burden of neck pain were found.

Conclusions

Because neck pain is a major public health burden with a high prevalence, incidence, and YLD worldwide, it is important to update its epidemiological data and trends to cope with the future burden of neck pain.

Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation

BACKGROUND

To better understand biomechanical factors that affect intervertebral alignment throughout active therapeutic exercise, it is necessary to determine spinal kinematics when subjects perform spinal exercises. This study aims to investigate the outcomes of active cervical therapeutic exercise on intervertebral foramen changes in neck pain patients with disc herniation.

METHODS

Thirty diagnosed C4/5 and/or C5/6 disc-herniated patients receiving an 8-week cervical therapeutic exercise program were followed up with videofluoroscopic images. The dynamic changes in the foramen were computed at different timepoints, including the neutral position, end-range positions in cervical flexion-extension, protrusion-retraction, and lateral flexion movements.

RESULTS

The results showed that the active cervical flexion, retraction, and lateral flexion away from the affected side movements increased the area of the patients' intervertebral foramen; while the active extension, protrusion, and lateral flexion toward the affected side reduced the areas of intervertebral foramen before treatment. After the treatment, the active cervical flexion significantly increased the C2/3, C3/4, and C6/7 foramen area by 5.02-8.67% (p = 0.001 ~ 0.029), and the extension exercise significantly reduced the C2/3 and C4/5 area by 5.12-9.18% (p = 0.001 ~ 0.006) compared to the baseline. Active retraction movement significantly increased the foramen area from C2/3 to C6/7 by 3.82-8.66% (p = 0.002 ~ 0.036 with exception of C5/6). Active lateral flexion away from the affected side significantly increased the foramen by 3.71-6.78% (p = 0.007 ~ 0.046 with exception of C6/7).

CONCLUSIONS

The 8-week therapeutic exercises including repeated cervical retraction, extension, and lateral flexion movements to the lesion led to significant changes and improvements in intervertebral foramen areas of the patients with disc herniation.

TRIAL REGISTRATION

ISRCTN61539024.

Educational intervention for the prevention of occupational neck pain: protocol of randomized trial

Background

Neck pain is one of the most common work-related musculoskeletal disorders (WMSDs). It has important social and economic consequences such as reduced productivity due to absenteeism, leave, and early retirement and financial losses due to medical expenses for the workforce especially teachers. This study aims to evaluate whether a model-based social media intervention could change the high-risk behaviors that cause work-related neck pain among teachers.

Methods

This is a randomized controlled trial that will be done in three steps. The first stage is a qualitative study to obtain the items and areas of the researcher-made questionnaire based on the health belief model (HBM), the second stage is the psychometric evaluation of the questionnaire, and the third stage is designing and implementation of model-based educational intervention in social media context. The study population is teachers who working in junior high school in the 19th district of education minister in Tehran, Iran, which are randomly divided into two groups of intervention and control. The intervention group receives training packages on social media, and the control group does not receive any training. The educational intervention tries to improve the knowledge, attitude, skills, and self-efficacy in adopting neck pain prevention behaviors among teachers. The study will also assess whether the intervention can promote preventive neck pain behavior among teachers.

Discussion

Work-related neck pain can have a negative impact on teachers’ health. This study is an attempt to investigate the impact of developed interventions in promoting preventive behavior regarding work-related neck pain through social media context.

Trial registration

Iranian registry of Clinical Trial (IRCT) IRCT20210301050542N1. Registered on 16 March 2021

Ethics code: IR.MODARES.REC.1399.163

Measurement properties of smartphone applications for the measurement of neck range of motion: a systematic review and meta analyses

Background

Smartphone applications offer an accessible and practical option to measure neck range of motion (ROM) and are becoming more commonly used in clinical practice. We assessed the validity, reliability, and responsiveness of smartphone applications (apps) to measure neck ROM in people with and without neck pain.

Methods

A comprehensive electronic search strategy of the main electronic databases was conducted from inception until June 2021. The identified studies investigated apps which measured neck ROM, and evaluated their validity, reliability, or responsiveness, in adult participants with neck pain or asymptomatic individuals. Two independent reviewers determined eligibility and risk of bias following COSMIN guidelines. The quality of evidence was assessed according to the GRADE approach.

Results

Eleven studies, with a total of 376 participants were included. Three types of apps were identified: clinometer apps, compass apps, and other apps of ‘adequate’ to ‘doubtful’ risk of bias. A meta-analysis revealed ‘good’ to ‘excellent’ intra-rater and inter-rater reliability across the three types of apps. The overall validity was rated from ‘moderate’ to ‘very high’ across all apps. The level of evidence was rated as ‘low’ to ‘very low’.

Conclusion

Smartphone applications showed sufficient intra-rater reliability, inter-rater reliability, and validity to measure neck ROM in people with and without neck pain. However, the quality of evidence and the confidence in the findings are low. High-quality research with large sample sizes is needed to further provide evidence to support the measurement properties of smartphone applications for the assessment of neck ROM.

Study registration

Following indications of Prisma-P guidelines, this protocol was registered in PROSPERO on 1/05/2021 with the number CRD42021239501.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05066-6.

Neck pain: global epidemiology, trends and risk factors

BACKGROUND

Neck pain is one of the most common musculoskeletal disorders, having an age-standardised prevalence rate of 27.0 per 1000 population in 2019. This literature review describes the global epidemiology and trends associated with neck pain, before exploring the psychological and biological risk factors associated with the initiation and progression of neck pain.

METHODS

The PubMed database and Google Scholar search engine were searched up to May 21, 2021. Studies were included that used human subjects and evaluated the effects of biological or psychological factors on the occurrence or progression of neck pain, or reported its epidemiology.

RESULTS

Psychological risk factors, such as long-term stress, lack of social support, anxiety, and depression are important risk factors for neck pain. In terms of the biological risks, neck pain might occur as a consequence of certain diseases, such as neuromusculoskeletal disorders or autoimmune diseases. There is also evidence that demographic characteristics, such as age and sex, can influence the prevalence and development of neck pain, although further research is needed.

CONCLUSIONS

The findings of the present study provide a comprehensive and informative overview that should be useful for the prevention, diagnosis, and management of neck pain.

Localised manual therapy treatment has a preferential effect on the kinematics of the targeted motion segment

AIM

An observational cohort study to determine whether localised manual therapy results in a preferential increase in mobility of the targeted motion segment.

METHOD

Eighteen participants with mechanical neck pain had three MRIs of their cervical spine. The first two were taken prior to treatment in neutral and at the end of active rotation in their more limited rotation. Participants received localised manual therapy targeting a motion segment deemed to be relevant to their presentation until either their range increased by > 10° or 8 min, whichever came first. A third MRI was performed immediately after treatment with their head in the same rotated position as pre-treatment. In the images, each vertebra was segmented using a semi-automated process. Movement between neutral and rotated positions was calculated as Euler angles and distance of facet translations for each motion segment.

RESULTS

Rotation and lateral flexion at the targeted location increased by 40% (mean 0.86° (CI: 0.24-1.48) and 15% (mean 0.52° (CI: 0.17-1.21) respectively with only the CIs for rotation not containing zero. The mean changes for the non-targeted locations were less than 0.1° for each axis and all CIs contained zero. Facet translations at the targeted location increased by 25% (0.419 mm) and decreased by >4% (>0.01 mm) at the untreated locations but the wide CIs both contained zero.

CONCLUSION

Localised manual therapy seems to have a preferential effect on mobility of the targeted motion segment. The findings support considering segmental dysfunction in clinical reasoning and the use of specifically targeted manual therapy interventions.

Risk factors and risk profiles for neck pain in young adults: Prospective analyses from adolescence to young adulthood-The North-Trøndelag Health Study

The objective was to investigate risk factors and risk profiles associated with neck pain in young adults using longitudinal data from the North-Trøndelag Health Study (HUNT). Risk factors were collected from adolescents (13-19 years of age), and neck pain was measured 11 years later. The sample was divided into two: Sample I included all participants (n = 1433), and Sample II (n = 832) included only participants who reported no neck/shoulder pain in adolescence. In multiple regression analyses in Sample I, female sex (OR = 1.9, 95% CI [1.3-2.9]), low physical activity level (OR = 1.6, 95% CI [1.0-2.5]), loneliness (OR = 2.0, 95% CI [1.2-3.5]), headache/migraine (OR = 1.7, 95% CI [1.2-2.6]), back pain (OR = 1.5, 95% CI [1.0-2.4]) and neck/shoulder pain (OR = 2.0, 95% [CI 1.3-3.0]) were associated with neck pain at the 11-year follow-up. Those with a risk profile including all these risk factors had the highest probability of neck pain of 67% in girls and 50% in boys. In Sample II, multiple regression analyses revealed that female sex (OR = 2.2, 95% CI [1.3-3.7]) and perceived low family income (OR = 2.4, 95% CI [1.1-5.1]) were associated with neck pain at the 11-year follow-up. Girls and boys with a perceived low family income had a 29% and 17% higher probability of neck pain than adolescents with a perceived high family income. The risk profiles in both samples showed that co-occurrence of risk factors, such as headache/migraine, neck/shoulder pain, back pain, low physical activity level, loneliness, and perceived low family income cumulatively increased the probability of neck pain in young adulthood. These results underline the importance of taking a broad perspective when studying, treating, and preventing neck pain in adolescents.

Pain Prevalence, Management and Interference Among University Students in South Korea: An Exploratory Cross-Sectional Study

BACKGROUND

Pain is a global health issue with a significant impact on young adults. Adverse effects caused by inappropriate pain management among university students are related to poor mental/physical health. This study aimed to explore pain prevalence, management, and interference among university students in South Korea.

METHODS

Pain intensity, painful body areas, pain management, and pain interference were measured in a convenience sample of 404 students. Descriptive statistics are reported, and a multivariable binomial logistic regression was conducted to reveal factors associated with pain interference.

RESULTS

The prevalence of acute and chronic pain was 73.5%, while 7.8% reported chronic pain (≥ 3 months). Half of university students who experienced pain reported at least four painful body areas. The average pain intensity during the past 6 months was 4.8/10. About 56% of university students who experienced pain used over-the-counter pain pills for pain management. Rest and massage were the most used non-pharmacological pain management strategies. Mood was the most reported pain interference complaint amongst university students. Greater pain interference was associated with longer pain duration, more painful body areas, and greater pain intensity.

DISCUSSION

Pain is highly prevalent among South Korean university students. Pain management programs, including education about appropriate methods of pain relief, should be developed for university students. Attention should be given to university students with widespread acute and chronic pain of high intensity to mitigate the negative impacts caused by pain interference.

Sources of Individual Differences in Pain

Pain is an immense clinical and societal challenge, and the key to understanding and treating it is variability. Robust interindividual differences are consistently observed in pain sensitivity, susceptibility to developing painful disorders, and response to analgesic manipulations. This review examines the causes of this variability, including both organismic and environmental sources. Chronic pain development is a textbook example of a gene-environment interaction, requiring both chance initiating events (e.g., trauma, infection) and more immutable risk factors. The focus is on genetic factors, since twin studies have determined that a plurality of the variance likely derives from inherited genetic variants, but sex, age, ethnicity, personality variables, and environmental factors are also considered.

The contemporary management of neck pain in adults

Neck pain is a common condition with a high prevalence worldwide. Neck pain is associated with significant levels of disability and is widely considered an important public health problem. Neck pain is defined as pain perceived between the superior nuchal line and the spinous process of the first thoracic vertebra. In some types of neck conditions, the pain can be referred to the head, trunk and upper limbs. This article aims to provide an overview of the available evidence on prevalence, costs, diagnosis, prognosis, risk factors, prevention and management of patients with neck pain.

Recovery expectations of neck pain patients do not predict treatments outcome in manual therapy

Patient recovery expectations can predict treatment outcome. Little is known about the association of patient recovery expectations on treatment outcome in patients with neck pain consulting a manual therapist. This study evaluates the predictive value of recovery expectations in neck pain patients consulting manual therapists in the Netherlands. The primary outcome measure 'recovery' is defined as 'reduction in pain and perceived improvement'. A prospective cohort study a total of 1195 neck pain patients. Patients completed the Patient Expectancies List (PEL) at baseline (3 item questionnaire, score range from 3 to 12), functional status (NDI), the Global Perceived Effect (GPE) for recovery (7-points Likert scale) post treatment and pain scores (NRS) at baseline and post treatment. The relationship between recovery expectancy and recovery (dichotomized GPE scores) was assessed by logistic regression analysis. Patients generally reported high recovery expectations on all three questions of the PEL (mean sumscores ranging from 11.3 to 11.6). When adjusted for covariates the PEL sum-score did not predict recovery (explained variance was 0.10 for the total PEL). Separately, the first question of the PEL showed predictive potential (OR 3.7; 95%CI 0.19-73.74) for recovery, but failed to reach statistical significance. In this study patient recovery expectations did not predict treatment outcome. Variables predicting recovery were recurrence and duration of pain. The precise relationship between patient recovery expectations and outcome is complex and still inconclusive. Research on patient expectancy would benefit from more consistent use of theoretical expectancy and outcome models.