Local and Widespread Pressure Pain Hyperalgesia Is Not Side Specific in Females with Unilateral Neck Pain that Can Be Reproduced during Passive Neck Rotation

Influencing factors of pressure pain hypersensitivity of the upper trapezius in food service workers with nonspecific neck/shoulder myofascial pain: A cross-sectional study

It is unclear which factors contribute to the developing pressure pain hypersensitivity of the upper trapezius, a type of neurophysiological hyperexcitability. The present study investigated the relationship between physical and psychological factors and pressure pain hypersensitivity of the upper trapezius for each sex. In total, 154 individuals with neck/shoulder myofascial pain participated, among 372 food service workers. Participants completed a questionnaire (Beck Depression Inventory, and Borg Rating of Perceived Exertion scale) and were photographed to measure posture. Pressure pain sensitivity, 2 range of motions (cervical lateral bending and rotation), and 4 muscle strengths (serratus anterior, lower trapezius [LT], biceps, and glenohumeral external rotator) were measured by a pressure algometer, iPhone application, and handheld dynamometer, respectively. For each sex, forward multivariate logistic regression was used to test our a priori hypothesis among selected variables that a combination of psychosocial and physical factors contributed to the risk for pressure pain hypersensitivity. In multivariate analyses, LT strength (odds ratio = 0.94, 95% confidence interval = 0.91-0.97, P = .001) was the only significant influencing factor for pressure pain hypersensitivity in men. Dominant painful ipsilateral cervical rotation range of motion (odds ratio = 0.96, 95% confidence interval = 0.92-0.99, P = .037) was the only influencing factor for pressure pain hypersensitivity in women. LT strength and dominant painful ipsilateral cervical rotation range of motion could serve as guidelines for preventing and managing pressure pain hypersensitivity of the upper trapezius in food service workers with nonspecific neck/shoulder myofascial pain.

Effect of virtual reality technology as intervention for people with kinesiophobia: A meta-analysis of randomised controlled trials

AIMS AND OBJECTIVE

To explore the effectiveness of Virtual Reality Technology in reducing kinesiophobia in people.

BACKGROUND

Kinesiophobia is an important psychosocial factor affecting the pain experience and has a significant negative impact on rehabilitation. Virtual reality technology has been widely used in the treatment of phobias, mental disorders and anxiety disorders. However, the effect of virtual reality technology on people with kinesiophobia has been reported with inconsistent results.

DESIGN

A meta-analysis of randomised controlled trials.

METHODS

This study systematically searched PubMed, Web of Science, PsycINFO, CINAHL, Embase, Cochrane Library, Medline, Scopus and four Chinese databases. The standardised mean difference (SMD) was calculated using random-effects models, and the Cochrane Collaboration's tool was used to assess the risk of bias in each study. The PRISMA 2020 checklist provided by the EQUATOR network was used.

RESULTS

Eleven randomised controlled trials involving a total of 488 subjects were included. Meta-analysis showed the effect sizes of virtual reality intervention on kinesiophobia (SMD = -0.53, 95% CI [-0.90, -0.17], p = .004). Virtual reality intervention was more effective in reducing kinesiophobia in people with chronic low back pain (SMD = -1.00, 95% CI [-1.71, -0.29], p = .006). Compared with fully immersive virtual reality (SMD = -0.29, 95% CI [-0.62, 0.05], p = 0.09), non-immersive virtual reality was more effective in reducing kinesiophobia (SMD = -0.66, 95% CI [-1.24, -0.09], p = 0.02). Compared with virtual reality intervention alone (SMD = -0.35, 95% CI [-1.40, 0.71], p = 0.52), virtual reality combined with exercise was more effective in reducing kinesiophobia (SMD = -0.59, 95% CI [-0.95, -0.22], p = 0.002).

CONCLUSIONS

Virtual reality technology has the potential to reduce the degree of kinesiophobia in people. In addition, virtual reality technology was more effective in people with chronic low back pain; non-immersive virtual reality was more effective in reducing kinesiophobia; and virtual reality technology combined with exercise was more effective in reducing kinesiophobia than virtual reality intervention alone. Clinical nursing staff should be encouraged to use virtual reality to speed up patient recovery. However, to achieve immersion and apply this technology to different diseases, more studies are required to provide clearer suggestions.

RELEVANCE TO CLINICAL PRACTICE

This study suggests that healthcare staff should pay attention to kinesiophobia, and early identification and intervention of kinesiophobia can help patients recover their health and improve the quality of nursing.

Effect of pompage on pain, disability and craniocervical position of female teachers - Randomized clinical trial

Abstract Introduction: Education professionals are one of the most important occupational groups and represents one of the main parts of the economy of modern society. The vocal demands most mentioned by the teachers are talking while standing up, talking a lot and in a closed environment, which corresponds to the most frequent situations encountered in teaching. In addition, remaining in the standing position for a prolonged period may have repercussions on other systems and generate postural deviations, pain and reduced functionality. Objective: To verify changes in pressure pain threshold, in disability index and in craniocervical posture of female teachers with vocal and musculoskeletal complaints, and with normal larynx, after myofascial release - pompage. Methods: This study was a controlled and randomized clinical trial. The following procedures were performed: anamnesis, videolaryngoscopy, hearing screening, clinical and photogrammetric postural assessment using the SAPo® protocol, completion of the neck pain self-assessment protocol Neck Disability Index, and pain threshold in the cervical muscles using the Pain Pressure Threshold. Myofascial therapy with pompage had a total of 24 sessions of 40 min each, three times a week, in 28 teachers assigned to the study group (SG), and 28 to the control group (CG). Afterwards, the groups were reassessed. Results: The SG presented a significant improvement in the pain threshold of all the muscles evaluated, in the posture of most of the body segments evaluated, and in the cervical disability. In the CG there was a significant improvement in angle A2 after therapy. Conclusion: After myofascial release therapy with pompage, the subjects presented a reduction in cervical pain and in functional disability, an increase in pain threshold, and posture improvement.

Sensory, Motor, and Psychosocial Characteristics of Individuals With Chronic Neck Pain: A Case-Control Study

OBJECTIVE

Given the complex and unclear etiology of neck pain, it is important to understand the differences in central sensitization as well as psychosocial factors in individuals with chronic neck pain and healthy controls. The purpose of this study was to benchmark differences in central sensitization, psychosocial factors, and range of motion between people with nonspecific chronic neck pain and healthy controls and to analyze the correlation between pain intensity, neck disability, and psychosocial factors in people with chronic neck pain.

METHODS

Thirty individuals with chronic neck pain and 30 healthy controls were included in this case-control study. Outcome measures were as follows: central sensitization (pressure pain threshold, temporal summation, and conditioned pain modulation), psychosocial factors (depressive symptoms, pain catastrophizing, and quality of life), and active cervical range of motion.

RESULTS

People with neck pain had lower local pressure pain threshold, a decrease in conditioned pain modulation, more depressive symptoms, greater pain catastrophizing, lower quality of life, and reduced range of motion for neck rotation when compared with healthy controls. In people with neck pain, moderate correlations were observed between pain intensity and quality of life (ρ = -0.479), disability and pain catastrophizing (ρ = 0.379), and disability and quality of life (ρ = -0.456).

CONCLUSIONS

People with neck pain have local hyperalgesia, impaired conditioning pain modulation, depressive symptoms, pain catastrophizing, low quality of life, and reduced active range of motion during neck rotation, which should be taken into account during assessment and treatment.

IMPACT

This study shows that important outcomes, such as central sensitization and psychosocial factors, should be considered during assessment and treatment of individuals with nonspecific chronic neck pain. In addition, pain intensity and neck disability are correlated with psychosocial factors.

Enhanced amygdala-frontal operculum functional connectivity during rest in women with chronic neck pain: Associations with impaired conditioned pain modulation

BACKGROUND

Chronic neck pain is a leading cause of disability worldwide, affecting the lives of millions of people. Research investigating functional brain alterations in relation to somatosensory function is necessary to better understand mechanisms underlying pain development and maintenance in individuals with chronic neck pain, yet remains scarce. This case-control study aimed to examine resting-state functional connectivity alterations and associations with pain outcomes, self-reported central sensitization-related symptoms and quantitative sensory testing (QST) measures in patients with chronic non-traumatic (idiopathic/CINP) neck pain and chronic traumatic (whiplash associated/CWAD) neck pain compared to pain-free controls.

METHODS

Resting-state functional magnetic resonance images were acquired in 107 female participants (38 CINP, 37 CWAD, 32 healthy controls). After data pre-processing, seed-to-seed analyses were conducted focusing on resting-state functional connectivity involving pre-defined regions of interest that have previously been observed to be structurally or functionally altered and/or associated with pain-related measures in this patient population.

RESULTS

Findings demonstrate enhanced left amygdala functional coupling during rest with the left frontal operculum in women with CINP and CWAD compared to controls. This increased resting-state functional connectivity was associated with more self-reported symptoms related to central sensitization and decreased efficacy of conditioned pain modulation. Furthermore, enhanced connectivity between the left amygdala and left frontal orbital cortex, and between the left pallidum and the left frontal operculum was observed only in patients with CWAD compared to healthy controls. In patients, additional associations between local hyperalgesia and enhanced connectivity between the left superior parietal cortex and the left and right precentral gyrus were found.

CONCLUSIONS

In line with our hypotheses, patients with CWAD showed the most pronounced alterations in resting-state functional connectivity, encompassing subcortical limbic (amygdala) and basal ganglia (pallidum), and ventral frontal regions (frontal operculum, orbitofrontal cortex) when compared to CINP and controls. Findings are generally in line with the idea of a continuum, in absence of significant group differences across CINP and CWAD. Enhanced amygdala-frontal operculum functional connectivity was the most robust and only connectivity pair in the cluster that was associated with QST (i.e., dynamic QST; endogenous pain inhibition), and that was observed in both patient groups. In addition, independent of group differences, enhanced resting-state functional connectivity between superior parietal cortex (involved in attention) and primary motor cortex was associated with static QST (i.e., greater local hyperalgesia). Taken together, our findings show a key role for enhanced amygdala-ventral frontal circuitry in chronic neck pain, and its association with diminished endogenous pain inhibition further emphasizes the link between cognitive-affective and sensory modulations of pain in women with chronic non-traumatic and traumatic neck pain.

Enhanced Pronociceptive and Disrupted Antinociceptive Mechanisms in Nonspecific Chronic Neck Pain

OBJECTIVE

Evidence suggests altered pronociceptive and antinociceptive mechanisms in many chronic pain conditions. Knowledge about these mechanisms in nonspecific chronic neck pain (NSNP) would improve understanding of the causes and the design of more effective treatments. Pressure pain threshold (PPT) is often used to assess presence of altered nociceptive processing in NSNP; however, its usefulness to detect this is yet to be established. The purpose of this study was to determine the functional status of temporal summation of second pain (TSSP) and conditioned pain modulation (CPM) in NSNP and to characterize the association of both measures with PPT and clinical features of NSNP.

METHODS

Thirty-two participants with NSNP (mean [SD] age = 44 [11] years; 27 female) and 32 age- and sex-matched healthy controls were recruited. TSSP was assessed using an electrical stimulus at the dorsum of the hand, and CPM was evaluated with the Cold Pressor Test. PPT was assessed bilaterally at the neck and tibialis anterior muscles.

RESULTS

Participants with NSNP showed greater TSPP (mean difference = 0.23; 95% CI = 0.46-0.01; Cohen d = 0.51) and lower CPM (mean difference = 19.44; 95% CI = 10.42-28.46; Cohen d = 1.09). Pooled data from all participants showed lower PPTs at the neck than the tibialis anterior. However, PPT measures did not differ between groups at either location. PPT measures were not correlated with CPM and TSP.

CONCLUSION

NSNP is associated with enhanced pronociceptive and impaired antinociceptive mechanisms, which may explain long-lasting pain and failure of some treatments to resolve symptoms. However, due to the observational nature of this study, a clear cause-effect relationship cannot be established. Normal PPT values in the clinic should not be interpreted as absence of altered nociceptive processing.

IMPACT

This study fills in some gaps in knowledge. Changes in central nociceptive processing may explain persistent and recurrent symptoms in NSNP and failure of treatments to obtain long-lasting relief. Further research is required to ascertain if TSSP and CPM assessment in the clinic may help predict physical therapy treatment outcome. Whether symptomatic relief with physical therapy is mediated by an improvement in TSSP and CPM should also be explored. PPTs were unaltered in participants with NSNP despite evidence of impairment in the central pain modulatory systems. Normal PPTs should not be interpreted as evidence of unaltered central pain-related processing.

Effects of Virtual Reality versus Exercise on Pain, Functional, Somatosensory and Psychosocial Outcomes in Patients with Non-specific Chronic Neck Pain: A Randomized Clinical Trial

Background: Virtual reality (VR) applied to patients with neck pain is a promising intervention to produce positive effects when used alone or combined with exercise. Therefore, the objective of this manuscript is to compare the effects of VR versus exercise treatment on pain intensity, conditioned pain modulation (CPM), temporal summation (TS) and functional and somatosensory outcomes in patients with non-specific chronic neck pain (NS-CNP). Methods: A single-blinded, randomized clinical trial was carried out. A total sample of 44 patients with NS-CNP was randomized into a VR treatment group or neck exercises group. The intervention consisted of two treatment sessions per week, for four weeks and eight sessions. Four measurement moments (at baseline, immediately, 1 month, and 3 months after intervention) were considered. Pain intensity, CPM, TS, functional and somatosensory outcomes were measured. Results: Statistically significant differences were revealed for time factor (F = 16.40, p < 0.01, η_p² = 0.28) and group*time interaction for kinesiophobia (F = 3.89, p = 0.01, η_p² = 0.08) showing post-hoc differences in favor of the VR group at 3 months (p < 0.05, d = 0.65). Significant effects were shown for time factor (p < 0.05) but not for the group*time interaction (p > 0.05) for pain intensity, rotation range of motion (ROM), Neck Disability Index, pain catastrophizing, fear-avoidance beliefs, left side pressure pain threshold (PPT) and anxiety. Statistically significant differences were not found for time factor (p > 0.05) and neither in group*time interaction (p > 0.05) for CPM, TS, right side PPT, flexo-extension and lateral-flexion ROM. Conclusions: Kinesiophobia was the only outcome that showed differences between VR and exercise at 3 months. Nevertheless, pain intensity, CPM, TS, ROM, neck disability, pain catastrophizing, fear-avoidance beliefs, PPT and anxiety did not show differences between both interventions.

Immediate and Short-Term Effects of Upper Cervical High-Velocity, Low-Amplitude Manipulation on Standing Postural Control and Cervical Mobility in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

This study aimed to determine the immediate and short-term effects of a single upper cervical high-velocity, low-amplitude (HVLA) manipulation on standing postural control and cervical mobility in chronic nonspecific neck pain (CNSNP). A double-blinded, randomized placebo-controlled trial was performed. Forty-four patients with CNSNP were allocated to the experimental group (n = 22) or control group (n = 22). All participants were assessed before and immediately after the intervention, with a follow-up on the 7th and 15th days. In each evaluation, we assessed global and specific stabilometric parameters to analyze standing postural balance and performed the cervical flexion-rotation test (CFRT) to analyze upper cervical mobility. We obtained statistically significant differences, with a large effect size, in the limited cervical rotation and global stabilometric parameters. Upper cervical HVLA manipulation produced an improvement in the global stabilometric parameters, significantly decreasing the mean values of velocity, surface, path length, and pressure in all assessments (p < 0.001; ƞ 2 p = 0.323–0.856), as well as significantly decreasing the surface length ratio (L/S) on the 7th (−0.219 1/mm; p = 0.008; 95% confidence interval (CI): 0.042–0.395) and 15th days (−0.447 1/mm; p < 0.001; 95% CI: 0.265–0.629). Limited cervical rotation values increased significantly immediately after manipulation (7.409°; p < 0.001; 95% CI: 6.131–8.687) and were maintained during follow-up (p < 0.001). These results show that a single upper cervical HVLA manipulation produces an improvement in standing postural control and increases the rotational range of motion (ROM) in the upper cervical spine in patients with CNSNP.