Cervical radiofrequency neurotomy in patients with chronic whiplash: a study of multiple outcome measures

2006 ◽  
Vol 4 (5) ◽  
pp. 365-373 ◽  
Author(s):  
Tamara Prushansky ◽  
Evgeny Pevzner ◽  
Carlos Gordon ◽  
Zeevi Dvir
Keyword(s):  
Outcome Measures ◽  
Whiplash Injury ◽  
Neck Disability Index ◽  
Pressure Pain Threshold ◽  
Self Report ◽  
Radiofrequency Neurotomy ◽  
Symptom Check List ◽  
Chronic Whiplash ◽  
Neck Disability ◽  
Rate Of Success

Object Cervical radiofrequency neurotomy (CRFN) is used in the treatment of patients with chronic pain and disability due to whiplash injury. Confirmation of its efficiency has, however, been based solely on pain and psychological distress factors. The aim of the present study was to extend the assessment of CRFN efficacy by adding other outcome measures to shed light on neuromotor-functional-psychological interactions by undertaking comparison of pre- and 1-year postintervention data. Methods Forty patients with chronic whiplash injury–associated disorders were evaluated prior to and at two separate sessions after CRFN. The evaluation included Neck Disability Index, cervical range of motion, isometric cervical muscle strength, cervical pressure pain threshold, Symptom Check List–90-Revised, and subjective Self-Report of Improvement (SRI). The authors found that the CRFN had a significantly positive effect on all measured parameters. A case-by-case analysis revealed improvement in 70% of the patients at the final follow-up examination. Using stringent cutoff values, between 30 and 60% of the patients experienced measurable improvement. Evaluation of SRI results indicated that more than 80% of the patients were satisfied with the procedure. Conclusions Approximately 1 year after intervention, CRFN was associated with an acceptable rate of success, as reflected by objective and subjective outcome measures.

scholarly journals Pulsed Shortwave Therapy in Cervical Osteoarthritis: an NSAID- Controlled, Randomized Clinical Trial

2021 ◽  
Author(s):  
A. Rachid El Mohammad ◽  
Sree Koneru ◽  
Richard Staelin ◽  
Kenneth McLeod ◽  
Omar Tabbouche ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Outcome Measures ◽  
Neck Disability Index ◽  
Primary Outcome Measure ◽  
Pain Medication ◽  
Secondary Outcome ◽  
Pain Duration ◽  
Cox 2 ◽  
Neck Disability ◽  
Pain At Rest

AbstractAssess treatment superiority of pulsed shortwave therapy (PSWT) against COX-2 NSAID therapy, in reducing disability and pain due to cervical osteoarthritis. Two hundred chronic pain suffers (average pain duration about 2 years) diagnosed with cervical osteoarthritis by radiological imaging were randomized into one of two treatment arms: COX-2 NSAID treatment; etoricoxib 60 mg/day for 4 weeks; or PSWT treatment worn 24 h/day for 4 weeks. The primary outcome measure was the 4-week score on the Neck Disability Index (NDI), a 10-question assessment on a 50-point scale. Secondary outcome measures included pain (at rest and during activity) measured on a visual analog scale (VAS) of 0–100 mm, dose count of rescue pain medication (paracetamol) use, and a treatment satisfaction rating. These 4-week scores were compared across the two arms to assess superiority. After 4 weeks of treatment, subjects in both study arms reported statistically significant (p < 0.0001) reductions in NDI, with final scores of 11.24-NSAID and 9.34-PSWT, VASrest, with final scores of 30.08-NSAID; 22.76-PSWT, and VASactivity, with final scores of 36.40-NSAID; 27.42-PSWT. The absolute reduction from baseline in NDI was significantly greater in the PSWT arm than NSAID arm (3.66 points; 95% CI 2.3 to 5.02; p < 0.0001). Similarly, the reductions from baseline in VASrest and VASactivity were significantly greater in the PSWT arm than NSAID arm (10.89 mm; 95% CI 6.90 to 14.87; p < 0.0001; and 12.05 mm; 95% CI 7.76 to 16.33; p < 0.0001, respectively). The PSWT arm used 50% less rescue pain medication. Eleven adverse effects were reported in the NSAID arm and zero in the PSWT arm. Both NSAID and PSWT treatments resulted in statistically significant improvements in quality of life (NDI) and reduction in pain (VAS) resulting from cervical osteoarthritis. However, the PSWT intervention showed superior improvements in all outcome measures when compared to the NSAID arm with no adverse effects. Clinicaltrials.gov (NCT03542955).

scholarly journals Correlations between Ratings of Pain, Disability and Impairment in Chronic Whiplash-Associated Disorder

1997 ◽  
Vol 2 (4) ◽  
pp. 207-213 ◽  
Author(s):  
Howard Vernon
Keyword(s):  
Rating Scale ◽  
Neck Disability Index ◽  
Physical Impairment ◽  
P Value ◽  
Pain Disability ◽  
Pain Scores ◽  
Disability Rating ◽  
Chronic Whiplash ◽  
Neck Disability ◽  
Whiplash Associated Disorder

OBJECTIVE: To investigate the level of correlation among pain, disability and physical impairment scores in chronic whiplash-associated disorder patients.SUBJECTS: Adults with chronic whiplash-associated disorder referred for secondary independent assessment.METHODS: Forty-four subjects (16 males, 28 females) were included in the sample. Self-rated pain was measured on a five-point verbal rating scale. Self-rated disability was measured using the Neck Disability Index (NDI) and the Disability Rating Index (DRI). Physical impairment was measured as active cervical ranges of motion obtained with a cap goniometer. Descriptive statistics were reported and Pearson product moment correlations were obtained with the P value at 0.01.RESULTS: Mean ± SD age of the subjects was 36.4±8.7 years. Mean duration of complaint was 15.2±12.3 months. Mean pain score out of 5 was 2.5±1.2. Mean NDI and DRI scores were 23.2±9.3 out of 50 and 21.6±9.1 out of 48, respectively. These scores correlated very highly (r=0.89, P=0.0001). The average reduction of ranges of motion compared with published norms was approximately 25%. The correlations among ranges of motion, NDI, DRI and pain scores ranged from -0.32 to -0.66 (P<0.05 to P=0.0001). Age and duration of complaint correlated poorly with ranges of motion.CONCLUSIONS: The self-ratings of pain and disability obtained from these chronic whiplash-associated disorder sufferers appear to be consistent with, and correlate reasonably well with, levels of physical impairment. Physical impairment ratings do not appear to correlate well with duration, which suggests that factors related to pain and physical impairment may play an important role in the development of chronicity in whiplash-associated disorder.

scholarly journals The presence of aura is not related to changes in the cervical performance and mobility of patients with migraine

2020 ◽  
Author(s):  
Gabriela F Carvalho ◽  
Samuel S Lodovichi ◽  
Carina F Pinheiro ◽  
Mariana T Benatto ◽  
Lidiane L Florencio ◽  
...  
Keyword(s):  
Neck Pain ◽  
Migraine With Aura ◽  
Neck Disability Index ◽  
Self Report ◽  
Clinical Aspects ◽  
Migraine Aura ◽  
Headache Clinic ◽  
Neck Disability ◽  
Disability Severity ◽  
Flexion Test

Abstract Background: Migraine is related to musculoskeletal impairment of the neck and the chronicity of migraine is related to greater disability levels. However, it is not known if other forms of migraine, such as migraine with aura, is related to a different pattern of neck impairment.Objective: To assess the musculoskeletal and clinical aspects of the neck in patients with migraine with and without aura.Methods: Up to 125 consecutive patients diagnosed with migraine according to the ICHD-III were recruited from a tertiary headache clinic. Patients were classified by the presence of aura into two groups: migraine with aura (MA, n=37) and migraine without aura (MoA, n=88). The self-report of neck pain was assessed and patients completed the Neck Disability Index (NDI) questionnaire. Furthermore, patients performed the Flexion Rotation Test (FRT) and the Cranio-Cervical Flexion Test (CCFT). Results of all outcomes were contrasted between groups through Mann-Whitney and Qui-square tests.Results: There was no association between the presence of aura and self-report of neck pain (x²: 1.32, p=0.25). No differences were verified between groups regarding presence of neck disability (MA: 10.73, SD: 6.22; MoA: 9.63, SD:8.13, p=0.25) or disability severity (x²=6.17, p=0.10). Groups did not differ regarding the FRT (MA: 35.07°, SD: 7.90 and MoA: 34.60°, SD: 8.70, t=-0.22, p=0.83) and there was no association between positive FRT and presence of aura (x²=3.35, p=0.07). The CCFT did not demonstrate differences among the two groups either (x²=1.65, p=0.80).Conclusion: There is no association between migraine aura and presence or disability of neck pain, reduced superior cervical mobility or reduced neck performance. It is expected to find similar neck profile during the clinical assessment of patients with migraine with and without aura.

Incidence and predictors of chronic headache attributed to whiplash injury

Cephalalgia ◽  
2009 ◽  
Vol 30 (5) ◽  
pp. 528-534 ◽  
Author(s):  
M Obermann ◽  
K Nebel ◽  
A Riegel ◽  
D Thiemann ◽  
M-S Yoon ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Chronic Headache ◽  
Whiplash Injury ◽  
Task Force ◽  
Neck Disability Index ◽  
Primary Headache ◽  
Control Group ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Neck Disability

We identified clinical, demographic and psychological predictive factors that may contribute to the development of chronic headache associated with mild to moderate whiplash injury [Quebec Task Force (QTF) ≤ II] and determined the incidence of this chronic pain state. Patients were recruited prospectively from six participating accident and emergency departments. While 4.6% of patients developed chronic headache attributed to whiplash injury according to the International Classification of Headache Disorders, 2nd edn criteria, 15.2% of patients complained about headache lasting > 42 days (QTF criteria). Predictive factors were pre-existing facial pain [odds ratio (OR) 9.7, 95% confidence interval (CI) 2.1, 10.4; P = 0.017], lack of confidence to recover completely (OR 5.5, 95% CI 2.0, 13.2; P = 0.005), sore throat (OR 5.0, 95% CI 1.5, 8.9; P = 0.013), medication overuse (OR 4.2, 95% CI 1.4, 12.3; P = 0.009), high Neck Disability Index (OR 4.0, 95% CI 1.3, 12.6; P = 0.019), hopelessness/anxiety (OR 3.8, 95% CI 1.3, 8.7; P = 0.024), and depression (OR 3.3, 95% CI 1.2, 9.4; P = 0.024). The lack of a control group limits the conclusions that can be drawn from this study. Identified predictors closely resemble those found in chronic primary headache disorders.

scholarly journals Do measures of physical function enhance the prediction of persistent pain and disability following a whiplash injury? Protocol for a prospective observational study in Spain

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e035736
Author(s):  
Ahmed Alalawi ◽  
Alejandro Luque-Suarez ◽  
Manuel Fernandez-Sanchez ◽  
Alessio Gallina ◽  
David Evans ◽  
...  
Keyword(s):  
Observational Study ◽  
Physical Function ◽  
Predictive Factors ◽  
Whiplash Injury ◽  
Prospective Observational Study ◽  
Neck Disability Index ◽  
Persistent Pain ◽  
Physical Factors ◽  
Post Injury ◽  
Neck Disability

IntroductionNot all factors that predict persistent pain and disability following whiplash injury are known. In particular, few physical factors, such as changes in movement and muscle behaviour, have been investigated. The aim of this study is to identify predictive factors that are associated with the development of persistent pain and disability following a whiplash injury by combining contemporary measures of physical function together with established psychological and pain-related predictive factors.Methods and analysisA prospective observational study will recruit 150 consecutive eligible patients experiencing whiplash-related symptoms, admitted to a private physiotherapy clinic in Spain within 15 days of their whiplash injury. Poor outcome will be measured using the Neck Disability Index (NDI), defined as an NDI score of 30% or greater at 6 months post injury. Candidate predictors, including demographic characteristics, injury characteristics, pain characteristics, self-reported psychosocial factors and physical factors, will be collected at baseline (within 15 days of inception). Regression analyses will be performed to identify factors that are associated with persistent neck pain and disability over the study period.Ethics and disseminationThe project has been approved by the Ethics Committee of the province of Malaga, Spain (#30052019). The results of this study will be published in peer-reviewed journals.

scholarly journals Pulsed Shortwave Therapy in Cervical Osteoarthritis: An NSAID- Controlled, Randomized Clinical Trial

2020 ◽  
Author(s):  
Rachid El Mohameed ◽  
Sree Koneru ◽  
Richard Staelin ◽  
Kenneth McLeod ◽  
Omar Tabbouche ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Outcome Measures ◽  
Neck Disability Index ◽  
Primary Outcome Measure ◽  
Pain Medication ◽  
Secondary Outcome ◽  
Pain Duration ◽  
Cox 2 ◽  
Neck Disability ◽  
Pain At Rest

Abstract Objective Assess treatment superiority of Pulsed Shortwave Therapy (PSWT) against COX-2 NSAID therapy, in reducing disability and pain due to cervical osteoarthritis.Design 200chronic pain suffers (average pain duration about 2 years)diagnosed with cervical osteoarthritis by radiological imaging were randomized into one of two treatmentarms: COX-2 NSAID treatment: Etoricoxib 60mg/day for 4 weeks; or, PSWT treatmentworn 24 hours/day for 4 weeks. The primary outcome measure was the 4-week score on the Neck Disability Index (NDI): a 10-question assessment on a 50-point scale. Secondary outcome measures included pain(at rest and during activity)measured on a Visual Analog Scale (VAS)of0-100 mm, dose count of rescue pain medication (paracetamol)use and a treatment satisfaction rating. These 4-week scores were compared across the two arms to assess superiority.Results After 4 weeks of treatment,subjects in both study arms reported significantly lower (p<0.0001) 4-week measures (11.24-NSAID;9.34-PSWT; 0-50 points),VASrest (30.08-NSAID;22.76-PSWT; 0-100 mm) and VASactivity (36.40-NSAID; 27.42-PSWT; 0-100 mm).The absolute reduction from baseline in NDI was significantly greater in the PSWT arm than NSAID arm(by 3.66 points; 95% CI 2.3 to 5.02; p<0.0001). Similarly, the reductions from baseline inVASrest and VASactivitywere significantly greater in the PSWT arm than NSAID arm(by 10.89 mm;95% CI 6.90 to 14.87; p<0.0001 and 12.05 mm;95% CI 7.76 to 16.33; p<0.0001 respectively).The PSWT arm used 50% less rescue pain medication. Eleven adverse effects were reported in the NSAID arm and zero in the PSWT arm.Conclusion Both NSAID and PSWT treatments resulted in clinically meaningful increases in quality of life(NDI) and decreases in pain (VAS) associated with cervicalosteoarthritis. However, the PSWT armshowed superior improvements in all outcome measures when compared to the NSAID armwith no adverse effects.

Postural and clinical outcomes of sustained natural apophyseal glides treatment in cervicogenic dizziness patients: A randomised controlled trial

2021 ◽  
pp. 026921552110124
Author(s):  
Alessandro Micarelli ◽  
Andrea Viziano ◽  
Ivan Granito ◽  
Pasquale Carlino ◽  
Riccardo Xavier Micarelli ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Controlled Trial ◽  
Neck Disability Index ◽  
Post Treatment ◽  
Self Report ◽  
Rehabilitation Centre ◽  
Cervical Range Of Motion ◽  
Randomised Controlled ◽  
Neck Disability ◽  
Cervicogenic Dizziness

Objective: To evaluate how self-report and posturographic measures could be affected in patients with cervicogenic dizziness undergoing sustained natural apophyseal glides. Design: Randomised controlled single-blind study. Setting: Tertiary rehabilitation centre. Subjects: Patients affected by cervicogenic dizziness, diagnosed by applying accepted criteria. Forty-one patients (19 male, 22 female: mean age 44.3 ± 14.8 years) receiving treatment, and 39 patients (18 male, 21 female: mean age 43.8 ± 13.9 years) receiving placebo were included in the study. Interventions: The treatment group underwent sustained natural apophyseal glides, while the placebo was constituted by a detuned laser. Both groups received their interventions six times over 4 weeks. Main measures: Outcomes were tested by means of self-report measures such as perceived dizziness, neck disability, anxiety and depression. Also, cervical range of motion and posturography testing with power spectra frequency were analysed. Results: When compared to placebo, treated patients demonstrated a significant decrease in perceived dizziness (post-treatment total Dizziness Handicap Inventory score 20.5 ± 5.3 as compared to 26.2 ± 6 baseline), neck disability and pain (Neck Disability Index and Neck Pain Index post-treatment scores 12.5 ± 4.3 and 45.6 ± 15.1, respectively, as compared to baseline scores of 15.1 ± 4.8 and 62.5 ± 14.3), as well as significant improvement in cervical range of motion and some posturographic parameters. Conclusion: Sustained natural apophyseal glides may represent a useful intervention in reaching short-term beneficial effects in patients with cervicogenic dizziness, with respect to self-perceived symptoms, proprioceptive integration and cervical range of motion improvement.

Psychological Factors in the Use of the Neck Disability Index in Chronic Whiplash Patients

Spine ◽  
2010 ◽  
Vol 35 (1) ◽  
pp. E16-E21 ◽  
Author(s):  
Howard Vernon ◽  
Rocco Guerriero ◽  
Shawn Kavanaugh ◽  
David Soave ◽  
Jesse Moreton
Keyword(s):  
Psychological Factors ◽  
Neck Disability Index ◽  
Chronic Whiplash ◽  
Neck Disability

scholarly journals C.01 Neck and arm pain after surgery for cervical myelopathy: outcomes and predictors of improvement

2019 ◽  
Vol 46 (s1) ◽  
pp. S12
Author(s):  
A Dakson ◽  
S Christie ◽  
B Jacobs ◽  
M Johnson ◽  
C Bailey ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Cervical Myelopathy ◽  
Severe Pain ◽  
Neck Disability Index ◽  
Surgical Decompression ◽  
Research Network ◽  
Arm Pain ◽  
Visual Analogue Scales ◽  
Neck Disability ◽  
Analogue Scales

Background: Cervical sponylotic myelopathy (CSM) may present with neck and arm pain. This study investiagtes the change in neck/arm pain post-operatively in CSM. Methods: This ambispective study llocated 402 patients through the Canadian Spine Outcomes and Research Network. Outcome measures were the visual analogue scales for neck and arm pain (VAS-NP and VAS-AP) and the neck disability index (NDI). The thresholds for minimum clinically important differences (MCIDs) for VAS-NP and VAS-AP were determined to be 2.6 and 4.1. Results: VAS-NP improved from mean of 5.6±2.9 to 3.8±2.7 at 12 months (P&lt;0.001). VAS-AP improved from 5.8±2.9 to 3.5±3.0 at 12 months (P&lt;0.001). The MCIDs for VAS-NP and VAS-AP were also reached at 12 months. Based on the NDI, patients were grouped into those with mild pain/no pain (33%) versus moderate/severe pain (67%). At 3 months, a significantly high proportion of patients with moderate/severe pain (45.8%) demonstrated an improvement into mild/no pain, whereas 27.2% with mild/no pain demonstrated worsening into moderate/severe pain (P &lt;0.001). At 12 months, 17.4% with mild/no pain experienced worsening of their NDI (P&lt;0.001). Conclusions: This study suggests that neck and arm pain responds to surgical decompression in patients with CSM and reaches the MCIDs for VAS-AP and VAS-NP at 12 months.

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