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Association of Subclinical Neck Pain With Altered Multisensory Integration

By |March 11, 2018|Chronic Neck Pain|

Association of Subclinical Neck Pain With Altered Multisensory Integration at Baseline and 4-Week Follow-up Relative to Asymptomatic Controls

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SOURCE:   J Manipulative Physiol Ther. 2018 (Feb); 41 (2): 81–91

Bassem Farid, BHSc (Hons), Paul Yielder, PhD, Michael Holmes, PhD, Heidi Haavik, PhD, Bernadette A. Murphy, DC, PhD

Health Sciences,
University of Ontario Institute of Technology,
Oshawa, Ontario, Canada.


 

OBJECTIVE:   The purpose of this study was to test whether people with subclinical neck pain (SCNP) had altered visual, auditory, and multisensory response times, and whether these findings were consistent over time.

METHODS:   Twenty-five volunteers (12 SCNP and 13 asymptomatic controls) were recruited from a Canadian university student population. A 2-alternative forced-choice discrimination task with multisensory redundancy was used to measure response times to the presentation of visual (color filled circles), auditory (verbalization of the color words, eg, red or blue), and multisensory (simultaneous audiovisual) stimuli at baseline and 4 weeks later.

RESULTS:   The SCNP group was slower at both visual and multisensory tasks (P = .046, P = .020, respectively), with no change over 4 weeks. Auditory response times improved slightly but significantly after 4 weeks (P = .050) with no group difference.

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Are Manual Therapies, Passive Physical Modalities, or Acupuncture Effective for the Management of Patients with Whiplash-associated Disorders or Neck Pain and Associated Disorders?

By |March 10, 2018|Chronic Neck Pain|

Are Manual Therapies, Passive Physical Modalities, or Acupuncture Effective for the Management of Patients with Whiplash-associated Disorders or Neck Pain and Associated Disorders? An Update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa Collaboration

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SOURCE:   Spine J. 2016 (Dec); 16 (12): 1598-1630

Jessica J. Wong, BSc, DC, FCCS(C); Heather M. Shearer, DC, MSc, FCCS(C); Silvano Mior, DC, PhD; Craig Jacobs, BFA, DC, MSc, FCCS(C); Pierre Côté, DC, PhD; Kristi Randhawa, BHSc, MPH; Hainan Yu, MBBS, MSc; Danielle Southerst, BScH, DC, FCCS(C); Sharanya Varatharajan, BSc, MSc; Deborah Sutton, BScOT, MEd, MSc; Gabrielle van der Velde, DC, PhD; Linda J. Carroll, PhD; Arthur Ameis, FRCPC, DESS, FAAPM&R; Carlo Ammendolia, DC, PhD; Robert Brison, MD, MPH; Margareta Nordin, Dr. Med. Sci.; Maja Stupar, DC, PhD; Anne Taylor-Vaisey, MLS

UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation,
University of Ontario Institute of Technology (UOIT) and
Canadian Memorial Chiropractic College (CMCC);
Department of Graduate Studies,
Canadian Memorial Chiropractic College.


BACKGROUND CONTEXT:   In 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) found limited evidence on the effectiveness of manual therapies, passive physical modalities, or acupuncture for the management of whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD).

PURPOSE:   This review aimed to update the findings of the Neck Pain Task Force, which examined the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of WAD or NAD.

STUDY DESIGN/SETTING:   This is a systematic review and best evidence synthesis.

SAMPLE:   The sample includes randomized controlled trials, cohort studies, and case-control studies comparing manual therapies, passive physical modalities, or acupuncture with other interventions, placebo or sham, or no intervention.

OUTCOME MEASURES:   The outcome measures were self-rated or functional recovery, pain intensity, health-related quality of life, psychological outcomes, or adverse events.

METHODS:   We systematically searched five databases from 2000 to 2014. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were stratified by the intervention’s stage of development (exploratory vs. evaluation) and synthesized following best evidence synthesis principles. Funding was provided by the Ministry of Finance.

RESULTS:   We screened 8,551 citations, and 38 studies were relevant and 22 had a low risk of bias. Evidence from seven exploratory studies suggests that (1) for recent but not persistent NAD grades I-II, thoracic manipulation offers short-term benefits; (2) for persistent NAD grades I-II, technical parameters of cervical mobilization (eg, direction or site of manual contact) do not impact outcomes, whereas one session of cervical manipulation is similar to Kinesio Taping; and (3) for NAD grades I-II, strain-counterstrain treatment is no better than placebo. Evidence from 15 evaluation studies suggests that (1) for recent NAD grades I-II, cervical and thoracic manipulation provides no additional benefit to high-dose supervised exercises, and Swedish or clinical massage adds benefit to self-care advice; (2) for persistent NAD grades I-II, home-based cupping massage has similar outcomes to home-based muscle relaxation, low-level laser therapy (LLLT) does not offer benefits, Western acupuncture provides similar outcomes to non-penetrating placebo electroacupuncture, and needle acupuncture provides similar outcomes to sham-penetrating acupuncture; (3) for WAD grades I-II, needle electroacupuncture offers similar outcomes as simulated electroacupuncture; and (4) for recent NAD grades III, a semi-rigid cervical collar with rest and graded strengthening exercises lead to similar outcomes, and LLLT does not offer benefits.

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Advancements in the Management of Spine Disorders

By |February 11, 2018|Chronic Neck Pain, Spinal Pain|

Advancements in the Management of Spine Disorders

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SOURCE:   Best Pract Res Clin Rheumatol. 2012 (Apr); 26 (2): 263–280

Scott Haldeman, MD, Professor, Deborah Kopansky-Giles, DC, MSc, Eric L. Hurwitz, DC, PhD, Damian Hoy, BAppSc (Physio), MPH, PhD, W. Mark Erwin, DC, PhD, Simon Dagenais, DC, PhD, MSc, Greg Kawchuk, DC, PhD, Björn Strömqvist, MD, PhD, Nicolas Walsh, MD

Department of Neurology,
University of California,
Irvine, USA.


Spinal disorders and especially back and neck pain affect more people and have greater impact on work capacity and health-care costs than any other musculoskeletal condition. One of the difficulties in reducing the burden of spinal disorders is the wide and heterogeneous range of specific diseases and non-specific musculoskeletal disorders that can involve the spinal column, most of which manifest as pain. Despite, or perhaps because of its impact, spinal disorders remain one of the most controversial and difficult conditions for clinicians, patients and policymakers to manage. This paper provides a brief summary of advances in the understanding of back and neck pain over the past decade as evidenced in the current literature. This paper includes the following sections: a classification of spinal disorders; the epidemiology of spine pain in the developed and developing world; key advancements in biological and biomechanical sciences in spine pain; the current status of potential methods for the prevention of back and neck pain; rheumatological and systemic disorders that impact the spine; and evidence-based surgical and non-surgical management of spine pain.

The final section of this paper looks to the future and proposes actions and strategies that may be considered by the international Bone and Joint Decade (BJD), by providers, institutions and by policymakers so that we may better address the burden of spine disorders at global and local levels.


From the FULL TEXT Article:

Introduction

Spinal pain and its associated disorders affect more people and have greater impact on work capacity and health-care costs than any other musculoskeletal condition. Recent studies suggest that, in many societies, spinal disorders are a greater source of disability and impact the consumption of more health-care resources than any other class of diseases or health problems. [1] Despite, or perhaps because of its impact, spinal disorders remain one of the most controversial and difficult conditions for clinicians, patients and policymakers to manage.

One of the difficulties in reducing the impact of spinal pain is the wide and heterogeneous range of specific diseases and non-specific musculoskeletal disorders that can involve the spinal column, most of which manifest as spinal pain. These disorders have been classified in multiple ways but the most widely accepted classification includes four well-defined clinical categories as noted in Table 1.

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Provider and Patient Perspectives on Opioids and Alternative Treatments for Managing Chronic Pain

By |October 28, 2017|Chronic Low Back Pain, Chronic Neck Pain, Chronic Pain|

Provider and Patient Perspectives on Opioids and Alternative Treatments for Managing Chronic Pain:
A Qualitative Study

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SOURCE:   BMC Fam Pract. 2017 (Mar 24); 17 (1): 164

Lauren S. Penney, Cheryl Ritenbaugh, Lynn L. DeBar,
Charles Elder and Richard A. Deyo

South Texas Veterans Health Care System,
7400 Merton Minter Blvd,
San Antonio, TX, 78229, USA


BACKGROUND:   Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues.

METHODS:   Qualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1.

RESULTS:   We identified four themes around opioid use:

(1)   attitudes toward use of opioids to manage chronic pain;

(2)   the limited alternative options for chronic pain management;

(3)   the potential of acupuncture and chiropractic (A/C) care as a tool to help manage pain; and

(4)   the complex system around chronic pain management.

Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants’ perceived A/C care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment.

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Chronic Neck Pain Patients With Traumatic or Non-traumatic Onset: Differences in Characteristics

By |September 8, 2017|Chronic Neck Pain|

Chronic Neck Pain Patients With Traumatic or Non-traumatic Onset: Differences in Characteristics.
A Cross-sectional Study

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SOURCE:   Scand J Pain. 2017 (Jan); 14: 1-8

Inge Ris, Birgit Juul-Kristensen, Eleanor Boyle,
Alice Kongsted, Claus Manniche, Karen Søgaard

Research Unit for Musculoskeletal Function and Physiotherapy,
Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Campusvej 55, 5230 Odense M, Denmark;


BACKGROUND AND AIMS:   Patients with chronic neck pain can present with disability, low quality of life, psychological factors and clinical symptoms. It is unclear whether patients with a traumatic onset differ from those with a non-traumatic onset, by having more complex and severe symptoms. The purpose of this study was to investigate the clinical presentation of chronic neck pain patients with and without traumatic onset by examining cervical mobility, sensorimotor function, cervical muscle performance and pressure pain threshold in addition to the following self-reported characteristics: quality of life, neck pain and function, kinesiophobia, depression, and pain bothersomeness.

METHODS:   This cross-sectional study included 200 participants with chronic neck pain: 120 with traumatic onset and 80 with non-traumatic onset. Participants were recruited from physiotherapy clinics in primary and secondary health care. For participants to be included, they were required to be at least 18 years of age, have had neck pain for at least 6 months, and experienced neck-related activity limitation as determined by a score of at least 10 on the Neck Disability Index. We conducted the following clinical tests of cervical range of motion, gaze stability, eye movement, cranio-cervical flexion, cervical extensors, and pressure pain threshold. The participants completed the following questionnaires: physical and mental component summary of the Short Form Health Survey, EuroQol-5D, Neck Disability Index, Patient-Specific Functional Scale, Pain Bothersomeness, Beck Depression Inventory-II, and TAMPA scale of kinesiophobia. The level of significance for all analyses was defined as p<0.01. Differences between groups for the continuous data were determined using either a Student’s t-test or Mann Whitney U test.

RESULTS:   In both groups, the majority of the participants were female (approximately 75%). Age, educational level, working situation and sleeping patterns were similar in both groups. The traumatic group had symptoms for a shorter duration (88 vs. 138 months p=0.001). Participants in the traumatic group showed worse results on all measures compared with those in the non-traumatic group, significantly on neck muscle function (cervical extension mobility p=0.005, cranio-cervical flexion test p=0.007, cervical extensor test p=0.006) and cervical pressure pain threshold bilateral (p=0.002/0.004), as well on self-reported function (Neck Disability Index p=0.001 and Patient-Specific Functional Scale p=0.007), mental quality of life (mental component summary of the Short Form Health Survey p=0.004 and EuroQol-5D p=0.001) and depression (Beck Depression Inventory-II p=0.001).

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Short Term Treatment Versus Long Term Management of Neck and Back Disability in Older Adults Utilizing Spinal Manipulative Therapy and Supervised Exercise

By |August 30, 2017|Chronic Low Back Pain, Chronic Neck Pain, exercise|

Short Term Treatment Versus Long Term Management of Neck and Back Disability in Older Adults Utilizing Spinal Manipulative Therapy and Supervised Exercise: A Parallel-group Randomized Clinical Trial Evaluating Relative Effectiveness and Harms

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SOURCE:   Chiropractic & Manual Therapies 2014 (Jul 23); 22: 26

Corrie Vihstadt, Michele Maiers,
Kristine Westrom, Gert Bronfort,
Roni Evans, Jan Hartvigsen and
Craig Schulz

Northwestern Health Sciencs University,
Wolfe-Harris Center for Clinical Studies,
2501 W 84th Street,
Bloomington 55431, MN, USA.


BACKGROUND:   Back and neck disability are frequent in older adults resulting in loss of function and independence. Exercise therapy and manual therapy, like spinal manipulative therapy (SMT), have evidence of short and intermediate term effectiveness for spinal disability in the general population and growing evidence in older adults. For older populations experiencing chronic spinal conditions, long term management may be more appropriate to maintain improvement and minimize the impact of future exacerbations. Research is limited comparing short courses of treatment to long term management of spinal disability. The primary aim is to compare the relative effectiveness of 12 weeks versus 36 weeks of SMT and supervised rehabilitative exercise (SRE) in older adults with back and neck disability.

METHODS/DESIGN:   Randomized, mixed-methods, comparative effectiveness trial conducted at a university-affiliated research clinic in the Minneapolis/St. Paul, Minnesota metropolitan area.

PARTICIPANTS:   Independently ambulatory community dwelling adults ≥ 65 years of age with back and neck disability of minimum 12 weeks duration (n = 200).

INTERVENTIONS:   12 weeks SMT + SRE or 36 weeks SMT + SRE.

RANDOMIZATION:   Blocked 1:1 allocation; computer generated scheme, concealed in sequentially numbered, opaque, sealed envelopes.

BLINDING:   Functional outcome examiners are blinded to treatment allocation; physical nature of the treatments prevents blinding of participants and providers to treatment assignment.

PRIMARY ENDPOINT:   36 weeks post-randomization.

DATA COLLECTION:   Self-report questionnaires administered at 2 baseline visits and 4, 12, 24, 36, 52, and 78 weeks post-randomization. Primary outcomes include back and neck disability, measured by the Oswestry Disability Index and Neck Disability Index. Secondary outcomes include pain, general health status, improvement, self-efficacy, kinesiophobia, satisfaction, and medication use. Functional outcome assessment occurs at baseline and week 37 for hand grip strength, short physical performance battery, and accelerometry. Individual qualitative interviews are conducted when treatment ends. Data on expectations, falls, side effects, and adverse events are systematically collected.

PRIMARY ANALYSIS:   Linear mixed-model method for repeated measures to test for between-group differences with baseline values as covariates.

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