App-Based Relaxation Exercises for Patients With Chronic Neck Pain: Pragmatic Randomized Trial

Background Chronic neck pain is a highly prevalent condition. Learning a relaxation technique is recommended by numerous guidelines for chronic neck pain. Smartphone apps can provide relaxation exercises; however, their effectiveness, especially in a self-care setting, is unclear. Objective The aim of this pragmatic randomized trial is to evaluate whether app-based relaxation exercises, including audio-based autogenic training, mindfulness meditation, or guided imagery, are more effective in reducing chronic neck pain than usual care alone. Methods Smartphone owners aged 18 to 65 years with chronic (>12 weeks) neck pain and the previous week’s average neck pain intensity ≥4 on the Numeric Rating Scale (0=no pain to 10=worst possible pain) were randomized into either an intervention group to practice app-based relaxation exercises or a control group (usual care and app for data entry only). For both groups, the follow-up data were collected using app-based diaries and questionnaires. The primary outcome was the mean neck pain intensity during the first 3 months based on daily measurements. Secondary outcomes included neck pain based on weekly measurements, pain acceptance, neck pain–related stress, sick-leave days, pain medication intake, and adherence, which were all measured until the 6-month follow-up. For the primary analysis, analysis of covariance adjusted for baseline neck pain intensity was used. Results We screened 748 participants and enrolled 220 participants (mean age 38.9, SD 11.3 years; mean baseline neck pain 5.7, SD 1.3 points). The mean neck pain intensity in both groups decreased over 3 months; however, no statistically significant difference between the groups was found (intervention: 4.1 points, 95% CI 3.8-4.4; control: 3.8 points, 95% CI 3.5-4.1; group difference: 0.3 points, 95% CI −0.2 to 0.7; P=.23). In addition, no statistically significant between-group differences regarding neck pain intensity after 6 months, responder rate, pain acceptance, pain medication intake, or sick-leave days were observed. There were no serious adverse events that were considered related to the trial intervention. In week 12, only 40% (44/110) of the participants in the intervention group continued to practice the exercises with the app. Conclusions The study app did not effectively reduce chronic neck pain or keep the participants engaged in exercising in a self-care setting. Future studies on app-based relaxation interventions should take into account the most recent scientific findings for behavior change techniques. Trial Registration ClinicalTrials.gov NCT02019134; https://clinicaltrials.gov/ct2/show/NCT02019134 International Registered Report Identifier (IRRID) RR2-10.1186/1745-6215-15-490

Utilising Virtual Reality in Pain Management: A Systematic Review

Virtual reality (VR) offers patient with a drug free supplement, an alternative or complementary therapy to traditional pain management. VR technology allowing its use in a wide variety of settings in the medicine world. So, we would like to evaluate the current existing evidence supporting VR in pain management. We conducted a systematic review of interventional and observational studies that examined VR applications in pain management between 2010 and 2019. We used Scopus databases, PubMed, Web of Science, Ovid MEDLINE and EBSCOhost to identify the studies using keywords “patient”, “virtual reality”, “medicine” and “pain management”. Data was obtained by two investigators and agreement was reached with the involvement of a third and fourth investigator. Narrative synthesis for all research was done. A total of 451 citations were identified, among which 12 studies met the criteria for inclusion. Studies involve various countries with participant age ranging from 6 to 75 years old. Studies were small, employed different design, instrument and measure for outcome. Studies addressed experimental, acute and chronic pain with four categories of condition which are burn injury, orthopedic diseases and chronic headache. VR was effective during the procedure in experimental and acute pain management. Majority of studies involving VR in painful physical rehabilitation therapy found VR reduced chronic pain and some provide evidence of lasting analgesia effect of VR after therapy. The usage of VR in chronic pain in term of psychological and cognitive behavioral therapy (CBT) showed improvement of positive mood, emotional and motivation that could lead to improvement of quality of life. VR also useful to elicit findings during painful cervical kinematics assessment in chronic neck pain. VR is a promising technology to be applied in managing chronic and acute pain. Some research showed that VR usage is able to provide lasting effect of analgesia even after VR session. However, there is a need for long term, larger sample sizes and well controlled studies to show clinical and cost-effectiveness for this technology to be used in clinical settings.

Effect of Combined Manual Therapy and Therapeutic Exercise Protocols on the Postural Stability of Patients with Non-Specific Chronic Neck Pain. A Secondary Analysis of Randomized Controlled Trial

Postural stability is a little-studied factor in non-specific chronic neck pain; the causes that can alter it are unknown. The relationship with chronic pain could be a determining factor for its deficit. The aim of this study was to investigate the relationship between sustained pain and a postural stability deficit. A randomized and blinded clinical trial (double-blind; placebo control; 12 weeks follow-up) was conducted with a total of 69 subjects divided into three groups, two experimental (manual therapy and specific exercise) and a control treatment, and carried out over a treatment period of three weeks with a follow-up after 12 weeks. Their postural stability was assessed through the overall balance index (OBI). The postural stability of subjects with non-specific chronic neck pain improved in the experimental treatments. There were no statistically significant differences between the experimental groups. This trial found that manual therapy and therapeutic exercise significantly improved OBI compared to the control group. Trial registration: Brazilian Clinical Trial Registry, RBR-2vj7sw.

A Comparative Study of the Effectiveness of Pharmacopuncture Therapy for Chronic Neck Pain: A Pragmatic, Randomized, Controlled Trial

Background: This two-arm, parallel, pragmatic, multicenter, clinical randomized, controlled trial with a 12-week follow-up period aimed to compare the effectiveness of pharmacopuncture therapy and physical therapy strategies for chronic neck pain. Methods: Eight sessions of pharmacopuncture therapy or physical therapy were administered within 2 weeks. The primary outcome was the visual analogue scale (VAS) score for neck pain. The secondary outcomes were the scores of the Northwick Park questionnaire (NPQ), VAS score for radiating arm pain, numeric rating scale (NRS) for neck and arm bothersomeness, neck disability index (NDI), patient global impression of change (PGIC), 12-item short form health survey (SF-12), and EuroQoL 5-dimension 5-level (EQ-5D-5L) instrument. The protocol was registered with Clinicaltrials.gov (NCT04035018) and CRIS (KCT0004243). Results: We randomly allocated 101 participants with chronic neck pain to the pharmacopuncture therapy (n = 50) or physical therapy group (n = 51). At the primary endpoint (week 5) the pharmacopuncture therapy group showed significantly superior effects regarding VAS score for neck pain and arm bothersomeness, NRS for neck pain, NDI, NPQ, and PGIC compared with the physical therapy group. These effects were sustained up to 12 weeks after follow-up. Conclusion: Compared with physical therapy, pharmacopuncture therapy had superior effects on the pain and functional recovery of patients with chronic neck pain.

Effect of Muscle Energy Technique in Patient with Chronic Neck Pain- A Case Report

Introduction: Chronic neck pain might lead to a change in muscle tissue fibres. Neck discomfort is a serious and prevalent sickness. It is common in the general population, and it frequently results in severe impairment. These alterations have an impact on the cervical spine's capacity to govern 3-D movement efficiently. A range of manual therapy approaches are available to assist relieve pain and impairment while also cervical spine range of motion enhancement and everyday mobility. More evidence for Muscle Energy Technique (MET) in treating such a condition was found. This case report describes muscular energy technique's effect on a patient who has been suffering from neck pain for a long time. Case Presentation: At the previous three months, a 27-year-old female accountant in a hospital with extended periods of sitting while working on a computer presented to our facility with neck pain. Increase in pain with looking up. Discussion: The therapy was well embraced through this patient to muscle energy technique resulting in a high degree of flexibility in the cervical spine, reduce pain and improves flexibility and strength. Conclusion: Physiotherapy has a significant effect Pain, strength, and range of motion are all factors to consider. The findings of this case study indicate that a specific muscle energy technique It's possible that a routine will help to alleviate the problem of neck pain, improves strength and functional ability.

Analysis of The Global Posture of College Students With Chronic Neck Pain

Background: Chronic neck pain (CNP) is common, but methods that focus on the cervical spine have not met the patients' medical expectations.Objective: To investigate the global postural difference between students with CNP and healthy people.Design: Cross-sectional study.Methods: Twenty-seven healthy college students without neck pain and 31 students with CNP were recruited and allocated into a control group and a CNP group. Differences in standing postural indicators between the two groups were compared.Results: Compared to the control group, the leg length discrepancy and the right rearfoot angle were larger and the anterior lower limb alignment angle was smaller. In the sagittal plane, the left sagittal lower limb alignment and right cervical alignment angles were larger, while the left and right sagittal body alignment angles in the CNP group were smaller. The odds ratio calculation for the trunk forward lean, right foot valgus, and knee flexion on both sides indicated that these are risk factors for CNP, while knee varus is not a risk factor for CNP. The remaining abnormal postures were shown not to be associated with CNP.Limitation: This study did not conduct in-depth research on the physiological state of the muscles, joints, and other structures, and we did not apply these theories to practice.Conclusions: Abnormal posture in students with CNP is mainly concentrated in the sagittal plane. Trunk forward lean, foot valgus, and knee flexion on both sides are risk factors for CNP.