Examination of Regional Interdependence Theory in Chronic Neck Pain: Interpretations from Correlation of Strength Measures in Cervical and Pain-Free Regions

Pain Medicine ◽  
2019 ◽  
Author(s):  
Leila Ghamkhar ◽  
Amir Massoud Arab ◽  
Mohammad Reza Nourbakhsh ◽  
Amir Hossein Kahlaee ◽  
Reyhaneh Zolfaghari
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Neck Disability Index ◽  
Chronic Neck Pain ◽  
Pain Intensity Score ◽  
Painful Condition ◽  
Asymptomatic Volunteers ◽  
Interdependence Theory ◽  
Regional Interdependence ◽  
Pain Patients

Abstract Objective Impairments present in chronic pain conditions have been reported not to be limited to the painful region. Pain-free regions have also been proposed to be adversely affected as a cause or consequence of the painful condition. The aim of this study was to investigate the association between muscle strength in painful and pain-free regions and chronic neck pain. Design A cross-sectional study. Setting Rehabilitation hospital laboratory. Subjects One hundred twenty-two patients with chronic neck pain (87 female) and 98 asymptomatic volunteers (52 female) were included in the study. Methods Maximal isometric strength measures of the neck, scapulothoracic, shoulder, trunk, and hip muscles were assessed using a hand-held dynamometer in all participants. Pain intensity and pain-related disability were also assessed in patients through visual analog scale and Neck Disability Index scores, respectively. Results Principal component analysis revealed one component for each of the studied regions. Multivariate analysis of variance found neck (d = 0.46), scapulothoracic (d = 0.46), shoulder (d = 0.60), trunk flexor (d = 0.38), extensor (d = 0.36), and hip (d = 0.51) strength components to be lower in the neck pain patients compared with asymptomatic participants (P < 0.01). Logistic and linear regression analyses found the shoulder strength component both to be a significant predictor for neck pain occurrence (β = 0.53, P < 0.01) and to have a considerable effect on pain intensity score (β=–0.20, P = 0.02), respectively. Conclusions The results found that some pain-free regions in addition to the cervical spine to exhibit lower levels of muscular strength in neck pain patients. These findings support the regional interdependence theory, which proposes that impairments are not limited to the painful area and are possibly mediated by central mechanisms.

scholarly journals Differences of Spinal Curvature, Thoracic Mobility, and Respiratory Strength Between Chronic Neck Pain Patients and People Without Cervical Pain

2020 ◽  
Vol 44 (1) ◽  
pp. 58-68
Author(s):  
Ji Hong Cheon ◽  
Na Na Lim ◽  
Geun Su Lee ◽  
Ki Hong Won ◽  
Sung Hoon Lee ◽  
...  
Keyword(s):  
Neck Pain ◽  
Neck Disability Index ◽  
Chronic Neck Pain ◽  
Spinal Curvature ◽  
Female Group ◽  
Cervical Pain ◽  
Pain Group ◽  
Significant Difference ◽  
Neck Disability ◽  
Pain Patients

Objective To investigate the differences of spinal curvature, thoracic sagittal mobility, and respiratory strength between patients with chronic neck pain (CNP) and people without cervical pain, and to determine the correlation between respiratory strength and thoracic mobility in CNP patients.Methods A total of 78 participants were finally included in this study, of whom 30 had no cervical pain and 48 had CNP. The Neck Disability Index (NDI), cervical lordotic curvature, thoracic kyphotic curvature, thoracic sagittal range of motion (ROM), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured and analyzed.Results In males, thoracic sagittal ROM<sub>MEP-MIP</sub> and MEP showed a significant difference between the no cervical pain group and the CNP group. In females, thoracic kyphotic curvature, thoracic sagittal ROM<sub>MEP-MIP</sub>, MIP, and MEP were significantly different between the no cervical pain group and the CNP group. Thoracic kyphotic curvature was significantly correlated with MEP and MIP in all population groups, and significantly correlated with NDI in the female group. Thoracic sagittal ROM<sub>MEP-MIP</sub> had a significant linear relationship with NDI, MEP, and MIP in all population groups.Conclusion The thoracic mobility during forced respiration was reduced in patients with CNP and was correlated with respiratory strength. Changes in the biomechanics of the cervicothoracic spine and rib cage due to CNP may contribute to impairment of respiratory strength.

scholarly journals Shi’s Daoyin Therapy for Neck Pain: A Randomized Controlled Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Huihao Wang ◽  
Enyu Jiang ◽  
Kuan Wang ◽  
Zhen Deng ◽  
Hongsheng Zhan ◽  
...  
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Isometric Force ◽  
Controlled Trial ◽  
Neck Disability Index ◽  
Short Term ◽  
Significant Difference ◽  
Pain Patients

Objective. To compare the immediate and short term effectiveness of Shi’s Daoyin therapy (DT) rather than the Melbourne Protocol (MP) in terms of pain, mobility, and isometric strength of cervical muscles in nonacute nonspecific neck pain patients. Material and Methods. A total of 114 nonacute nonspecific neck pain patients aged 20~50 years were recruited and randomly assigned to be treated by either Shi’s DT or the MP. 56 cases and 54 cases received treatment for 3 weeks and were evaluated before and after intervention and at 3-week follow-up in Shi’s DT group and MP group, respectively. The outcome measures were Chinese version of the Neck Disability Index (NDI), cervical range of motion (ROM), maximal voluntary isometric force (MVIF), and pain intensity (Numeric Pain Rating Scale, NPRS). Results. All outcomes of both groups showed statistically significant improvements after the intervention and at 3-week follow-up (P < 0.05), while no statistically significant difference was found in NDI between groups. When followed up after 3 weeks, the ROM in axial rotation was significantly greater in the Shi’s DT group (P < 0.05), and the NPRS in the Shi’s DT group was significantly lower than the MP group (P < 0.05). At the end of the treatment period, the MVIF in lateral bending in the Shi’s DT group had a lower value (P = 0.044) than in the MP group, but there was no significant difference in flexion and extension between the two groups. Conclusions. Both Shi’s DT and MP groups demonstrated an obvious reduction in pain intensity and improvements in neck mobility after a short term follow-up period. The improvement of Shi’s DT in disability and pain during functional activities is generally similar to that of the MP for the treatment of nonacute nonspecific neck pain.

Sensitization in office workers with chronic neck pain in different pain conditions and intensities

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Alexandre Nunes ◽  
Kristian Petersen ◽  
Margarida Espanha ◽  
Lars Arendt-Nielsen
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Neck Disability Index ◽  
Chronic Neck Pain ◽  
Office Workers ◽  
Moderate Pain ◽  
Pain Group ◽  
Trapezius Myalgia ◽  
Pain Pathways ◽  
Neck Disability

Abstract Objectives Office workers with chronic neck pain demonstrates signs of widespread hyperalgesia, less efficient descending pain modulation, which could indicate sensitization of central pain pathways. No studies have assessed a wide variety of office workers with different chronic neck pain disorders and assessed the impact of pain intensity on assessments of central pain pathways. This study aimed to assessed pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM) and to associate these with pain intensity and disability in subgroups of office workers. Methods One hundred-and-seventy-one office workers were distributed into groups of asymptomatic and chronic neck pain subjects. Chronic neck pain was categorized as chronic trapezius myalgia and chronic non-specific neck pain and as ‘mild-pain’ (Visual Analog Scale [VAS]≤3) and ‘moderate-pain’ (VAS>3) groups. PPTs, TSP, CPM, and Copenhagen Psychosocial Questionnaire II were assessed in all subjects. Neck Disability Index and Pain Catastrophizing Scale were assessed in all the symptomatic office workers. Results PPTs were lower in moderate pain (n=49) and chronic trapezius myalgia (n=56) compared with asymptomatic subjects (n=62, p<0.05). TSP was facilitated in moderate pain group compared with mild pain (n=60, p<0.0001) group and asymptomatic subjects (p<0.0001). No differences were found in CPM comparing the different groups (p<0.05). Multiple regression analysis identified Neck Disability Index and TSP as independent factors for prediction of pain intensity in chronic trapezius myalgia (R2=0.319) and chronic non-specific neck pain (R2=0.208). Somatic stress, stress and sleep as independent factors in chronic non-specific neck pain (R2=0.525), and stress in moderate pain group (R2=0.494) for the prediction of disability. Conclusions Office workers with chronic trapezius myalgia and moderate pain intensity showed significant signs of widespread pressure hyperalgesia. Moreover, the moderate pain group demonstrated facilitated TSP indicating sensitization of central pain pathways. Neck Disability Index and TSP were independent predictors for pain intensity in pain groups. Sleep and stress were independent predictors for disability.

scholarly journals Multidimensional features of pain in patients with chronic neck pain

2017 ◽  
Vol 30 (3) ◽  
pp. 569-577 ◽  
Author(s):  
Fabianna Resende de Jesus-Moraleida ◽  
Leani Souza Máximo Pereira ◽  
Cristiane de Melo Vasconcelos ◽  
Paulo Henrique Ferreira
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Neck Disability Index ◽  
Positive Association ◽  
Chronic Neck Pain ◽  
Mcgill Pain Questionnaire ◽  
Brazilian Version ◽  
Present Pain Intensity ◽  
Mild Disability ◽  
Neck Disability

Abstract Introduction: Chronic neck pain is associated with significant health costs and loss of productivity at work. Objective: to assess pain and disability in individuals with chronic neck pain. Methods: 31 volunteers with chronic neck pain, mean age 29, 65 years, were assessed using the McGill Pain Questionnaire in Brazilian version (Br-MPQ) and Neck Disability Index (NDI). The Br-MPQ analysis was performed based on the numerical values associated with the words selected to describe the experience of pain (Pain Rating Index - PRI), and present pain intensity (PPI). NDI was used to evaluate the influence of neck pain in performance of everyday tasks. Finally, we investigated the association between PPI and NDI. Results: PRI revealed that the most significant dimension was the sensory pain (70%), and the number of chosen words was 10 (2,62) out of 20 words. Mean PPI value was 1,23 (0,76) in five points; 40% of participants described pain intensity as moderate. NDI score was 9,77 (3,34), indicating mild disability. There was a positive association between disability and pain intensity (r = 0,36; p =0,046). Pain intensity and duration of pain were not associated. Conclusions: Findings of this study identified important information related to neck pain experienced by patients when suffering from chronic neck pain, moreover, the association between disability and pain intensity reinforces the importance of complementary investigation of these aspects to optimize function in them.

Chronic neck pain patients with traumatic or non-traumatic onset: Differences in characteristics. A cross-sectional study

2017 ◽  
Vol 14 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Inge Ris ◽  
Birgit Juul-Kristensen ◽  
Eleanor Boyle ◽  
Alice Kongsted ◽  
Claus Manniche ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Neck Pain ◽  
Pain Threshold ◽  
Neck Disability Index ◽  
Pressure Pain Threshold ◽  
Chronic Neck Pain ◽  
Traumatic Group ◽  
Neck Disability ◽  
Pain Patients

AbstractBackground and aimsPatients 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.MethodsThis 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 painthreshold.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.ResultsIn 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, craniocervical 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).ConclusionsThis study showed significant differences between chronic neck pain patients when differentiated into groups based on their onset of pain. However, no specific clinical test or self-reported characteristic could differentiate between the groups at an individual patient level.ImplicationsPressure pain threshold tests, cervical muscle performance tests and patient-reported characteristics about self-perceived function and psychological factors may assist in profilingchronic neck pain patients. The need for more intensive management of those with a traumatic onset compared with those with a non-traumatic onset should be examined further.

scholarly journals The Short-Form Neck Disability index has adequate measurement properties in chronic neck pain patients

2021 ◽  
Author(s):  
André Pontes-Silva ◽  
Mariana Arias Avila ◽  
Cid André Fidelis-de-Paula-Gomes ◽  
Almir Vieira Dibai-Filho
Keyword(s):  
Neck Pain ◽  
Short Form ◽  
Neck Disability Index ◽  
Chronic Neck Pain ◽  
Measurement Properties ◽  
Neck Disability ◽  
Pain Patients ◽  
Adequate Measurement

Effectiveness of Kinaesthetic Exercise program on Position Sense, Pain, and Disability in Chronic Neck Pain Patients with Cervical Spondylosis – A Randomized Comparative Trial

2020 ◽  
Author(s):  
Ravi Shankar Yerragonda Reddy ◽  
Arun G Maiya ◽  
Sharath Kumar Rao ◽  
Khalid A Alahmari ◽  
Jaya Shanker Tedla ◽  
...  
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Cervical Spondylosis ◽  
Chronic Neck Pain ◽  
Position Sense ◽  
Study Group ◽  
Position Errors ◽  
Flexion Extension ◽  
Comparative Group ◽  
Neck Disability

Abstract Background Chronic neck pain (CNP) is a significant health problem with only a few evidence-based treatment options. There is growing evidence for the effectiveness of kinaesthetic rehabilitation in musculoskeletal disorders. This study aims to assess kinaesthetic exercise programs' efficacy on cervical position sense, pain, and disability in subjects with cervical spondylosis (CS). Methods CNP subjects (>3 months) with a diagnosis of CS were randomly assigned to either a study group (n=125) who received kinesthetic exercises or to a comparative group (n=125) who received isometric neck exercises and deep cervical flexor (DCF) strengthening exercises. Both group subjects participated in the individualized training program for 24 sessions in 6 weeks. The outcome measures were cervical joint position errors (JPE’s) in flexion, extension, rotation left and right, pain intensity, and neck disability. Results All outcomes were improved significantly from baseline to post 24 sessions of intervention. When compared between groups, there was a significant reduction in JPE’s in flexion (mean difference [MD]= 071, CI=0.22–1.20, p=0.001), extension (MD=1.26, CI=0.70–1.81, p< 0.001) and right rotation (MD=1.08, CI=0.58–1.58, p<0.001), pain intensity (MD=1.58, CI=1.09–2.08, p<0.001), and neck disability (MD=10.27, CI=7.42–13.12, p<0.001) after 24 sessions of intervention favoring the study group. Conclusion Study group subjects who received kinesthetic rehabilitation showed more significant improvements in terms of improved proprioception, decreased pain intensity and disability following 24 sessions of interventions compared with the comparative group.

scholarly journals Effectiveness of Progressive Resisted Exercise along with Conventional Exercise and Conventional Exercise Program alone in Subjects with Text Neck Syndrome

2021 ◽  
pp. 536-542
Author(s):  
Divya Jain ◽  
Swapna Jawade ◽  
Neha Chitale
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Conventional Therapy ◽  
Rating Scale ◽  
Neck Disability Index ◽  
Exercise Program ◽  
Pain Rating ◽  
Numerical Pain Rating Scale ◽  
Neck Disability ◽  
Pain Rating Scale

Background: "Text neck" is a term coined to describe the posture created by leaning forward for lengthy periods of time, such as when reading and texting on a cellphone which has been linked to stress injuries. Neck pain, upper back discomfort, shoulder pain, frequent headaches, and greater curvature of the spine are all dangerous indications of text neck. According to a survey, 35% of smartphone users suffer from text neck syndrome. People between the ages of 15 and 18 are more likely to have neck pain. This protocol has been created that describes the design of comparative study to evaluate effectiveness of progressive resisted exercise along with conventional exercise and conventional exercise program alone in text neck syndrome. Methods: The participants (n=80) will be recruited in the study suffering from text neck syndrome and meeting the inclusion criteria. Two groups will be formed such that patients in group A will be treated with conventional therapy and group B will be treated with progressive resisted exercise (PRE) along with conventional therapy. The protocol will cover 4 weeks of treatment. In the rehabilitation period, we will evaluate the pain intensity, strength of neck muscles and functional activity. Our outcome measures will be- Numerical pain rating scale (NPRS) and Neck disability index (NDI). Discussion: Efficacy of the intervention will be evaluated by analyzing the pain intensity by using Numerical pain rating scale (NPRS) and level of functional disability by using Neck disability index (NDI). The result of the study will significantly provide affirmation on either using combination therapy of PRE with conventional exercise or conventional exercise alone.

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