Neck Solutions Blog

May 30, 2010

Transcutaneous electrical nerve stimulation of upper cervical nerve for the treatment of somatic tinnitus

Filed under: Tinnitus — Administrator @ 10:45 am

Transcutaneous electrical nerve stimulation (TENS) of upper cervical nerve (C2) for the treatment of somatic tinnitus

From: Exp Brain Res. 2010 May 28. [Epub ahead of print]

Somatic tinnitus has been defined as tinnitus temporally associated to a somatic disorder involving the head and neck. Several studies have demonstrated the interactions between the somatosensory and auditory system at the dorsal cochlear nucleus, inferior colliculus, and parietal association areas. The objective is to verify the effect of transcutaneous electrical nerve stimulation of the upper cervical nerve (C2) in the treatment of somatic tinnitus. As electrical stimulation of C2 increases activation of the dorsal cochlear nucleus through the somatosensory pathway and enlarges the inhibitory role of the dorsal cochlear nucleus on the central nervous system, C2 TENS can be considered for tinnitus modulation. A total of 240 patients in whom tinnitus is modulated by somatosensory events (e.g., tinnitus change with rotation, retro- and antiflexion of neck) or modulated by pressure on head or face were included in this study. Both a real and a sham TENS treatment were applied for 30 min (10 min of 6 Hz, followed by 10 min of 40 Hz and 10 min of sham). Significant tinnitus suppression was found. Only 17.9% (N = 43) of the patients with tinnitus responded to C2 TENS. They had an improvement of 42.92%, and six patients had a reduction of 100%.

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May 29, 2010

Effects of Traction on Structural Properties of Degenerated Disc Using an In Vivo Rat-Tail Model

Filed under: Back Pain,Disc Problems — Administrator @ 5:50 am

Effects of Traction on Structural Properties of Degenerated Disc Using an In Vivo Rat-Tail Model

From: Spine (Phila Pa 1976). 2010 May 25. [Epub ahead of print]

An in vivo rat-tail model was adopted to study the structural changes of degenerated intervertebral disc after different traction protocols to investigate the effects of traction with different modes and magnitudes on disc with simulated degeneration.

Traction has been commonly used in clinical practice for treating low back pain. Its effects on disc with degeneration have not been fully investigated. Forty-seven mature rats were used. Continuous static compression of 11 N was applied to the rat caudal 8-9 disc for 2 weeks to simulate disc degeneration. Tractions with different modes (static or intermittent) and magnitudes (1.4 N or 4.2 N) were applied to the degenerated disc for 3 weeks. The disc height was quantified in vivo on days 4, 18, and 39. The treated discs were then harvested for morphologic analysis.

Significant decrease in disc height with degenerative morphologic changes was observed after the application of the static compression. The changes in disc height after the application of traction were found to be magnitude dependent. Continuous decrease in disc height was observed after 4.2-N traction, whereas the disc height maintained after traction of 1.4 N. However, no obvious morphologic change was found in comparison with the degenerated discs without traction.

Although traction was not demonstrated to have restored disc with degeneration, traction with relatively low magnitude was found to have significant beneficial effect in maintaining disc height of degenerated disc, and it might be a potential intervention to slow down the process of degeneration. Future studies of the effects of low-magnitude traction on degenerated disc are recommended.

May 28, 2010

Comorbidity of fibromyalgia and cervical myofascial pain syndrome

Filed under: Chronic Pain,Neck Pain — Administrator @ 2:59 am

Comorbidity of fibromyalgia and cervical myofascial pain syndrome.

From: Clin Rheumatol. 2010 Apr;29(4):405-11.

The aims of this study are to determine the frequency of fibromyalgia syndrome in patients with chronic cervical myofascial pain and to investigate the fibromyalgia syndrome characteristics in chronic cervical myofascial pain patients. Ninty-three patients with chronic cervical myofascial pain and 30 age-matched healthy women were included in this study. Main outcome measures included visual analog scale, Beck Depression Inventory, and pain pressure thresholds. Chronic cervical myofascial pain patients were evaluated for the existence of fibromyalgia syndrome. The severity of fibromyalgia syndrome was assessed with total myalgic score and control point score. Most common clinical characteristics of fibromyalgia syndrome were noted. Of the 93 chronic cervical myofascial pain subjects, 22 (23.6%) patients fulfilled the classification criteria for fibromyalgia syndrome. Number of tender points were higher, while total myalgic score and control point score values were lower in comorbid chronic cervical myofascial pain and fibromyalgia syndrome patients than regional chronic cervical myofascial pain group. There were statistically significant differences between regional chronic cervical myofascial pain patients and comorbid chronic cervical myofascial pain and fibromyalgia syndrome patients regarding presence of fatigue and irritable bowel syndrome. There was no statistically significant difference between patient groups regarding visual analog scale values. Beck Depression Inventory values of the regional chronic cervical myofascial pain were significantly lower than comorbid chronic cervical myofascial pain and fibromyalgia syndrome patients. In conclusion, the authors found that nearly a quarter of chronic cervical myofascial pain patients were comorbid with fibromyalgia syndrome, and psychological and comorbid symptoms were more prominent in comorbid patients. The authors thought that, these two syndromes might be overlapping conditions and as a peripheral pain generator or inducer of central sensitisation, myofascial pain syndrome might lead to fibromyalgia syndrome or precipitate and worsen the fibromyalgia syndrome symptoms.

May 26, 2010

The association between lumbar disc degeneration and low back pain: the influence of age, gender, and individual radiographic features

Filed under: Arthritis,Back Pain,Disc Problems — Administrator @ 2:12 pm

The association between lumbar disc degeneration and low back pain: the influence of age, gender, and individual radiographic features.

From: Spine (Phila Pa 1976). 2010 Mar 1;35(5):531-6.

Back pain is one of the most common musculoskeletal complaints of the elderly, with a point prevalence of 26.9% in the Netherlands. Van Tulder et al performed a systematic review and reported that lumbar disc degeneration could be a possible risk factor for back pain in adults. However, the review reported that the methodologic quality of most of these studies was low and the studies were difficult to compare due to difference in gender frequencies, age groups, settings, radiographic grading systems, and definitions for lumbar disc degeneration.

Lumbar disc degeneration is characterized radiologic by the presence of osteophytes, endplate sclerosis, and disc space narrowing. In 1993, Lane et al presented a reliable grading system for these individual radiographic features. In a recent review, this grading system was recommended for use in epidemiologic studies. There have been a number of recent studies that have used the classification of the individual radiographic features of disc degeneration defined by Lane et al. One of these studies described the occurrence of these separate features and their relationship with back pain in the open population, but only in a limited sample.

However, it is still unknown how to combine the individual radiographic features and how to define a clinically relevant definition for lumbar disc degeneration. Currently there is no consensus about whether the lumbosacral disc should be scored. Some studies have included the lumbosacral level in their definition of lumbar disc degeneration, while others have not. Currently within the literature, there have been no studies that have explored different definitions of lumbar disc degeneration and their association with low back pain within one study sample.

The purpose of this study was to explore the association of the different individual radiographic features, including osteophytes and disc space narrowing, with self-reported low back pain. Different definitions of lumbar disc degeneration with self-reported low back pain and disability were considered in a large open population sample. Furthermore, in order to disentangle the discrepancies in reported strength of the associations, the authors characterized the frequency of the different individual radiographic features of lumbar disc degeneration and definitions of lumbar disc degeneration, as well as their association with low back pain status, by age, gender, and vertebral level.

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May 24, 2010

Determinants of the intention for using a lumbar support among home care workers with recurrent low back pain

Filed under: Back Pain — Administrator @ 3:04 am

Determinants of the intention for using a lumbar support among home care workers with recurrent low back pain.

From: Eur Spine J. 2010 May 19. [Epub ahead of print]

In most effectiveness studies on lumbar supports for patients with low back pain, insufficient data are reported about adherence. In a secondary preventive RCT, we found beneficial effects and a good adherence among home care workers with low back pain. To target the use of lumbar supports on those patients who can benefit optimally from usage, we need to know why people are adherent. We used the attitude, social support and self-efficacy model to identify determinants for prolonged adherence to wearing a lumbar support. The strongest predictor for intending sustained use of a lumbar support was a positive attitude towards lumbar supports, explaining 41% of the variance. Social support and self-efficacy played a minor role. The intention for prolonged use of a lumbar support for workers with recurrent back pain was mainly explained by a positive attitude. The discomfort of a lumbar support was outweighed by perceived benefit.

In Spine (Phila Pa 1976). 2009 Feb 1;34(3):215-20. Effectiveness of a lumbar belt in subacute low back pain: an open, multicentric, and randomized clinical study. It was concluded “Lumbar belt wearing is consequent in subacute low back pain to improve significantly the functional status, the pain level, and the pharmacologic consumption.”

May 23, 2010

Risk Factors Predicting the Development of Widespread Pain From Chronic Back or Neck Pain

Filed under: Back Pain,Neck Pain — Administrator @ 5:01 am

Risk Factors Predicting the Development of Widespread Pain From Chronic Back or Neck Pain.

From: J Pain. 2010 May 18. [Epub ahead of print]

Emerging evidence suggests that some individuals with regional pain disorders go on to develop chronic widespread pain. However, the mechanism behind this transition and the nature of risk factors that predispose a person to develop chronic widespread pain remain to be elucidated. The purpose of this study was to describe the frequency with which participants with chronic back or neck pain develop chronic widespread pain and to determine the risk factors associated with this development.

In a sample of 512 individuals, we found that nearly a quarter (22.6%) of subjects who presented with regional back or neck pain in 2001/2002 had developed chronic widespread pain by 2007. Logistic regression indicated that 7 factors were associated with the transition to chronic widespread pain: moderate or severe pain intensity, female gender, history of abuse, family history of chronic widespread pain, severe interference with general activity, having 1 or more central sensitivity syndromes, and using more pain management strategies. History of abuse was not significant in multivariate analysis. Notably, number of depressive symptoms endorsed, pain duration, age, body mass index, number of medication classes used, and receipt of disability benefits were not significantly associated with this transition.

This study offers insight into risk factors associated with the development of chronic widespread pain. This information not only offers clues as to the mechanism behind the expansion of pain sensitivity from a regional pain locus to a widespread pain disorder but also provides insight as to how clinicians might mitigate this transition.

May 21, 2010

Conservative interventions provide short-term relief for non-specific neck pain: a systematic review

Filed under: Neck Pain — Administrator @ 3:26 am

Conservative interventions provide short-term relief for non-specific neck pain: a systematic review.

From: J Physiother. 2010;56(2):73-85

Question: Which interventions for non-specific neck pain are effective in reducing pain or disability? Design: Systematic review with meta-analysis of randomised controlled trials. Participants: Adults with non-specific neck pain. All interventions for neck pain that were evaluated in trials with a placebo, minimal- or no-intervention control. Outcome measures: Pain and disability outcomes (0-100 scale) at the conclusion of a course of treatment (short term), and in the medium (3 to 9 months) and long (> 9 months) term.

33 trials were identified. The interventions with significant short-term effects on pain were manipulation, multimodal intervention, specific exercise, combination orphenadrine/paracetamol, and manual therapy. There was a significant short-term effect on disability for acupuncture and manual therapy. Treatment with laser therapy resulted in better pain outcomes at medium-term follow-up but not at short-term follow-up. No other intervention demonstrated medium- or long-term effects.

Some conservative interventions for neck pain are effective in the short term. Few interventions that have been investigated have shown longer term effects that are better than placebo or minimal intervention.

May 20, 2010

The Course of Symptoms for Whiplash-Associated Disorders in Sweden: 6-Month Followup Study

Filed under: Neck Pain,Whiplash — Administrator @ 2:53 am

The Course of Symptoms for Whiplash-Associated Disorders in Sweden: 6-Month Followup Study

J Rheumatol. 2010 May 15. [Epub ahead of print]

To describe symptom patterns and the course for recovery in persons with whiplash associated disorders over 6 months after a car collision, and to investigate associated gender differences. The study population was based on insurance claimants, 18-74 years of age, who reported whiplash associated disorders after a collision, between January 2004 and January 2005. At baseline and again 6 months later they were asked to complete a questionnaire that included questions about presence and severity of pain and other possible whiplash associated disorders symptoms. It also included measurements of posttraumatic stress as well as anxiety and depression.

A total of 1105 persons were studied. The most common symptoms at baseline after neck pain were reduced cervical range of motion (in 83.9% of men, 82.2% of women), headache (61.0% and 69.3%, respectively), and low back pain (35.9% and 36.1%). Some symptoms were already transient at baseline and symptoms such as neck pain, reduced cervical range of motion, headache, and low back pain decreased further over the 6 months. Baseline prevalence of depression was around 5% in both women and men, whereas posttraumatic stress and anxiety were more common in women (19.7% and 11.7%, respectively) compared to men (13.2% and 8.6%). The majority of all reported associated symptoms were mild at both baseline and followup. The findings support that the symptom pattern of whiplash associated disorders and the prevalence for many of the symptoms decreased over a 6-month period.

May 19, 2010

The prevalence of headache may be related with the latitude: a possible role of Vitamin D insufficiency?

Filed under: General Health,Headaches — Administrator @ 2:31 am

The prevalence of headache may be related with the latitude: a possible role of Vitamin D insufficiency?

From: J Headache Pain. 2010 May 13. [Epub ahead of print]

According to recent observations, there is worldwide vitamin D insufficiency in various populations. A number of observations suggest a link between low serum levels of vitamin D and higher incidence of chronic pain. A few case reports have shown a beneficial effect of vitamin D therapy in patients with headache disorders. Serum vitamin D level shows a strong correlation with the latitude. Here, we review the literature to delineate a relation of prevalence rate of headaches with the latitude. The authors noted a significant relation between the prevalence of both tension-type headache and migraine with the latitude. There was a tendency for headache prevalence to increase with increasing latitude. The relation was more obvious for the lifetime prevalence for both migraine and tension-type headache. One year prevalence for migraine was also higher at higher latitude.

There were limited studies on the seasonal variation of headache disorders. However, available data indicate increased frequency of headache attacks in autumn-winter and least attacks in summer. This profile of headache matches with the seasonal variations of serum vitamin D levels. The presence of vitamin D receptor, 1alpha-hydroxylase and vitamin D-binding protein in the hypothalamus further suggest a role of vitamin D deficiency in the generation of head pain.

May 16, 2010

Effect of neck strength training on health-related quality of life in females with chronic neck pain

Filed under: Chronic Pain,Neck Pain — Administrator @ 7:53 am

Effect of neck strength training on health-related quality of life in females with chronic neck pain: a randomized controlled 1-year follow-up study.

From: Health Qual Life Outcomes. 2010 May 14;8(1):48. [Epub ahead of print]

Chronic neck pain is a common condition associated not only with a decrease in neck muscle strength, but also with decrease in health-related quality of life (HRQoL). While neck strength training has been shown to be effective in improving neck muscle strength and reducing neck pain, HRQoL among patients with neck pain has been reported as an outcome in only two short-term exercise intervention studies. Thus, reports on the influence of a long-term neck strength training intervention on HRQoL among patients with chronic neck pain have been lacking.

Neck pain is one of the most common musculoskeletal disorders in Western societies. Along with considerable costs for the individual and the society, neck pain is a frequent source of disability causing humane suffering and affecting the well-being of individuals. Just as health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, the outcome measures of an intervention ought to be multidimensional and include the subjective experience of the patient. This can be achieved using a health-related quality of life (HRQoL) measurement tool.

Since neck pain is associated with a decrease in neck muscle strength, neck strength training has been one means in seeking cure for neck pain. In addition to gaining neck muscle strength, neck strength training has been shown to be effective in reducing neck pain and the disability associated with it. In a recent best-evidence synthesis and Cochrane review it was concluded that interventions that involved exercise combined with manual therapy were more effective in treating patients with neck pain than were alternative strategies.

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