Neck Solutions Blog

January 27, 2012

Lack of Endogenous Pain Inhibition During Exercise in People With Chronic Whiplash Associated Disorders

Filed under: Chronic Pain,Whiplash — Administrator @ 10:14 am

Lack of Endogenous Pain Inhibition During Exercise in People With Chronic Whiplash Associated Disorders: An Experimental Study.

From: J Pain. 2012 Jan 24. [Epub ahead of print]

A controlled experimental study was performed to examine the efficacy of the endogenous pain inhibitory systems and whether this (mal)functioning is associated with symptom increases following exercise in patients with chronic whiplash associated disorders. In addition, 2 types of exercise were compared. Twenty-two women with chronic whiplash associated disorders and 22 healthy controls performed a submaximal and a self-paced, physiologically limited exercise test on a cycle ergometer with cardiorespiratory monitoring on 2 separate occasions. Pain pressure thresholds, health status, and activity levels were assessed in response to the 2 exercise bouts.

In chronic whiplash associated disorders, pain pressure thresholds decreased following submaximal exercise, whereas they increased in healthy subjects. The same effect was established in response to the self-paced, physiologically limited exercise, with exception of the pain pressure thresholds at the calf which increased. A worsening of the chronic whiplash associated disorders symptom complex was reported post-exercise. Fewer symptoms were reported in response to the self-paced, physiologically limited exercise.

These observations suggest abnormal central pain processing during exercise in patients with chronic whiplash associated disorders. Submaximal exercise triggers post-exertional malaise, while a self-paced and physiologically limited exercise will trigger less severe symptoms, and therefore seems more appropriate for chronic whiplash associated disorders patients.

The results from this exercise study suggest impaired endogenous pain inhibition during exercise in people with chronic whiplash associated disorders. This finding highlights the fact that one should be cautious when evaluating and recommending exercise in people with chronic whiplash associated disorders, and that the use of more individual, targeted exercise therapies is recommended.

November 15, 2011

Fluctuation of pain by weather change in musculoskeletal disorders

Filed under: Chronic Pain,General Health — Administrator @ 5:35 am

Fluctuation of pain by weather change in musculoskeletal disorders

From: Mymensingh Med J. 2011 Oct;20(4):645-51.

In order to find out the fluctuation of pain by weather change, a descriptive cross-sectional study was conducted among 138 individuals having musculoskeletal disorders (MSDs) attending the out patient department (OPD) of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, during March 2004 to June 2004. Data were collected by face to face interview employing a pre-tested interview schedule containing structured questions. Among 138 respondents, male were predominant (52.2%). Mean age of the respondents was 39.42±10.79 years, while the most common age group was found as ’31 to 40 years’. By occupation, majority were housewives (40.58%), followed by businessmen (29.71%), service holder (15.22%), laborer (7.97%), and students (6.52%). The primary sites of pain were back and low back (38.4%), knee (24.6%), leg (8.7%), ankle and heel (8.0%), hand and wrist (6.5%), neck (5.8%), shoulder (5.8%), and elbow (2.2%). Highest number (47.8%) patients reported aching pain, while one fifth (20.3%) of them experienced burning pain.

About 36.2 percent respondents mentioned ‘prolonged standing’ as the main cause of pain aggravation, while almost half (48.6%) of the patients perceived that ‘application of heat’ was the key relieving factor of their pain. About two third (63%) of the respondents were sensitive to weather change; among them 56.3 percent reported that their pain increased during cold weather. Moreover, more than two third (67.4%) study-patients experienced deterioration of pain due to seasonal variation; of them 59.1 percent reported that their pain was exacerbated in winter season. Of all respondents, less than one third (30.4%) experienced aggravation of pain due to lunar change; of them majority (85.7%) experienced increased pain during dark fortnights. The study concluded that weather change might have an important role in fluctuation of pain among individuals having musculoskeletal disorders.

November 12, 2011

Unpacking the burden: Understanding the relationships between chronic pain and comorbidity in the general population

Filed under: Arthritis,Back Pain,Chronic Pain,Neck Pain — Administrator @ 6:11 am

Unpacking the burden: Understanding the relationships between chronic pain and comorbidity in the general population

From: Pain. 2011 Nov 7. [Epub ahead of print]

The authors investigated the association of chronic pain with physical and mental comorbidity in the New Zealand population by measuring chronic pain status separate from comorbid conditions. Models of allostatic load provided a conceptual basis for considering multi-morbidity as accumulated comorbid load and for using both discrete conditions and cumulative measures in analyses. The nationally representative cross-sectional survey data included self-reported doctor-diagnosed chronic physical and mental health conditions, Kessler 10-item scale scores, an independent measure of chronic pain, and sociodemographic characteristics.

The population prevalence of chronic pain is 16.9%, and a quarter (26%) of the population report 2 or more comorbid physical conditions statistically associated with chronic pain. Results indicate that accumulated comorbid load is independently associated with chronic pain. Six physical conditions independently associated with chronic pain increase the risk of chronic pain in an additive manner, and residual accumulated load further increases risk for 2 or more conditions.

Anxiety and depression interacts synergistically with arthritis and neck and back disorders to increase the odds of reporting chronic pain beyond an additive model. This synergistic effect is not apparent for other conditions or for additional comorbid load. Results imply that measurement of chronic pain independent of comorbid conditions and adjustment for comorbid conditions is important for more accurate prevalence estimates and understanding relationships between conditions. Future epidemiological research might usefully incorporate independent measurement of chronic pain alongside adjustment for specific physical and mental health conditions as well as accumulated comorbid load.

October 14, 2011

muscle pain psychological status in women with chronic non-traumatic neck-shoulder pain

Filed under: Chronic Pain,Neck Pain,Shoulder Pain — Administrator @ 6:23 am

An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain

From: BMC Musculoskelet Disord. 2011 Oct 12;12(1):230

Neck shoulder pain remains a major problem in work tasks with high exposure to awkward working positions, repetitive movements and movements with high precision demands. The trapezius muscle is considered particularly affected. The prevalence of chronic neck shoulder pain appears to be higher in women than in men. It causes high socioeconomic costs and significant loss of quality of life for the individual. Because of limited knowledge of the mechanisms involved in transition from acute to chronic pain, attempts to develop effective treatments have had limited success. The clinical manifestations of chronic pain conditions include both somatic (e.g., sensory disturbances, facilitated pain responses in association with movements, tense muscles with hyperalgesia for mechanical pressure/manual palpation) and psychological symptoms (e.g., sleeping problems, anxiety, and depressive symptoms).

Sensory hypersensitivity (central sensitization is sometimes used as a synonym while others use central sensitization as a term for specific mechanisms in the central nervous system (CNS)) is a common feature of several chronic neck shoulder pain conditions, particularly those with higher levels of pain intensity and disability. At the clinical examination, this can be manifested as increased sensitivity to manual palpation (i.e., pressure), but increased sensitivity to other sensory modalities, e.g., heat or cold, have also been described. Hypersensitivity to mechanical pressure or thermal pain is sometimes confined to the neck shoulder area but may also be present in remote pain-free areas, even though the clinical routine examination does not reveal clinical anatomical widespread pain and/or generalized hyperalgesia for different types of stimuli. Widespread deep tissue hyperalgesia has been found in patients with fibromyalgia, tension–type headache, whiplash associated disorders, idiopathic neck pain, epicondylalgia, low back pain, pelvic pain syndrome, and osteoarthritis.

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September 13, 2011

Effect of Therapeutic Exercise Versus Manual Therapy on Athletes With Chronic Low Back Pain

Filed under: Back Pain,Chronic Pain — Administrator @ 8:08 am

Effect of Therapeutic Exercise Versus Manual Therapy on Athletes With Chronic Low Back Pain

From: J Sport Rehabil. 2011 Aug 8. [Epub ahead of print]

Rehabilitation professionals treat individuals suffering from chronic low back pain using a variety of treatment approaches including manual therapy and the prescription of therapeutic exercises. The use of manual therapy, specifically joint mobilization of the lumbar spine, may significantly decrease a patient’s pain and contribute to improvement in his or her functioning. Exercise may also improve pain and functioning, with some patients reporting gains up to 1 year after the last treatment session. Numerous investigations have assessed the potential benefits associated with either joint mobilization or therapeutic exercise for patients with acute or subacute low back pain or chronic low back pain.

Despite the literature to guide clinical decision making, clinicians often struggle to successfully or expeditiously treat patients with low back pain. A recent trend reported in the literature has been to use treatment-based classifications or clinical prediction rules. These reports provide evidence or clinical suggestions for treating patients with acute or subacute low back pain.

To the best of the authors’ knowledge, there is a lack of these types of reports that address evaluation and treatment for patients with chronic low back pain. When treating patients with chronic low back pain it is not uncommon for some rehabilitation professionals to use 1 treatment approach primarily or exclusively. Using a treatment program supported by the research literature should generate the most effective outcomes for patients with chronic low back pain.

August 29, 2011

Sagittal spino-pelvic alignment in chronic low back pain

Filed under: Back Pain,Chronic Pain — Administrator @ 10:43 am

Sagittal spino-pelvic alignment in chronic low back pain

From: Eur Spine J. 2011 Aug 26. [Epub ahead of print]

The eitiology of low back pain is usually multifactoral. Based on previous literature reviews, it was found that there are three main risk factors for recurrent and chronic low back pain: 1) history of low back pain with associated limitations and treatments, 2) dissatisfaction at work, and 3) poor general medical condition. Other risk factors such as socioeconomic and employment status, psychological status, and physically demanding work are also suggested.

The differences in sagittal spino-pelvic alignment between adults with chronic low back pain and the normal population are still poorly understood. In particular, it is still unknown if particular patterns of sagittal spino-pelvic alignment are more prevalent in chronic low back pain. The current study helps to better understand the relationship between sagittal alignment and low back pain.

To compare the sagittal spino-pelvic alignment of patients with chronic low back pain with a cohort of asymptomatic adults. Sagittal spino-pelvic alignment was evaluated in prospective cohorts of 198 patients with chronic low back pain and 709 normal subjects. The two cohorts were compared with respect to the sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, lumbar tilt, lordotic levels, thoracic kyphosis, thoracic tilt, kyphotic levels, and lumbosacral joint angle. Correlations between parameters were also assessed.

Sagittal spino-pelvic alignment is significantly different in chronic low back pain with respect to sacral slope, pelvic incidence, lumbar tilt, lordotic levels, thoracic kyphosis, thoracic tilt and lumbosacral joint angle, but not pelvic tilt, lumbar lordosis, and kyphotic levels. Correlations between parameters were similar for the two cohorts. As compared to normal adults, a greater proportion of patients with low back pain presented low sacral slope and lumbar lordosis associated with a small pelvic incidence, while a greater proportion of normal subjects presented normal or high sacral slope associated with normal or high pelvic incidence.

Sagittal spino-pelvic alignment was different between patients with chronic low back pain and controls. In particular, there was a greater proportion of chronic low back pain patients with low sacral slope, low lumbar lordosis and small pelvic incidence, suggesting the relationship between this specific pattern and the presence of chronic low back pain.

August 27, 2011

DNA methylation of SPARC and chronic low back pain

Filed under: Back Pain,Chronic Pain,Disc Problems — Administrator @ 8:12 am

DNA methylation of SPARC and chronic low back pain

From: Mol Pain. 2011 Aug 25;7(1):65. [Epub ahead of print]

Chronic low back pain is a complex continuum of painful conditions that includes both axial and radicular pain: Axial low back pain is defined as spontaneous or movement-evoked pain or discomfort localized to the spine and low back region. Non-axial, radiating low back pain is pain in one or both legs. Often referred to as radicular pain or sciatica, it usually follows the course of the sciatic nerve. Current diagnostic and therapeutic approaches to chronic back pain are limited by our narrow understanding of the underlying biological mechanisms. There are many potential causes of chronic low back pain including degenerative disc disease. While natural age-related degeneration of intervertebral discs is common, chronic low back pain is associated with increased signs of disc degeneration. Like most other conditions, back pain is the product of genetic and environmental influences.

SPARC (secreted protein, acidic, rich in cysteine; aka osteonectin or BM-40) is an evolutionarily conserved collagen-binding protein present in intervertebral discs. SPARC is known to influence bone remodeling, collagen fibrillogenesis, and wound repair. Decreased expression of SPARC has been associated with aging and degeneration in human intervertebral discs. Furthermore, targeted deletion of the SPARC gene results in accelerated disc degeneration in the aging mouse and a behavioral phenotype resembling chronic low back pain in humans. The genetic evidence from mice and the clinical observation that SPARC is down-regulated in humans with disc degeneration suggests that long-term down-regulation of SPARC expression may play a critical role in chronic low back pain. What are the mechanisms that could lead to lasting down-regulation of genes such as SPARC?

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June 26, 2011

The temporal development of Fatty infiltrates in the neck muscles following whiplash injury: an association with pain and posttraumatic stress

Filed under: Chronic Pain,Neck Pain,Whiplash — Administrator @ 3:18 am

The temporal development of Fatty infiltrates in the neck muscles following whiplash injury: an association with pain and posttraumatic stress

From: PLoS One. 2011;6(6):e21194. Epub 2011 Jun 16

Whiplash associated disorders are a well-documented health outcome following a motor vehicle crash. Nearly 50% report persistent symptoms up to two years post injury. Resultant costs for medical and rehabilitative care in the western-world are high. Despite such a large socio-economic problem, reasons for the high rate of transition to chronic pain remain elusive.

Factors associated with poor recovery are not conclusive and rather limited to self-report measures. These include initial higher levels of pain, recognised as the most consistent predictor of poor outcome, with measures of sensory hyperalgesia and posttraumatic stress also showing some prognostic capacity. By virtue of their self-report nature, these factors are open to bias, but no verifiable structural changes (e.g. radiological findings) have shown to be associated with the transition to chronicity. This has contributed to the scepticism surrounding the whiplash condition.

However, recent data has demonstrated structural muscle changes in patients with chronic whiplash associated disorders. Muscle fatty infiltrates on magnetic resonance imaging (MRI) were found in the neck extensor muscles of participants with chronic whiplash associated disorder. These findings were not present in those with chronic non-traumatic neck pain or in healthy controls; suggesting traumatic factors play a role in their development. It is possible the presence of widespread muscle fatty infiltrates is in some way associated with the development of chronic pain following whiplash injury. As the muscle changes have been only established in chronic whiplash associated disorders, it is necessary to now determine how soon following injury they occur and whether they uniquely manifest in those who transition.

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June 11, 2011

Headache and musculoskeletal complaints among subjects with self reported whiplash injury

Filed under: Chronic Pain,Headaches,Neck Pain,Whiplash — Administrator @ 4:35 am

Headache and musculoskeletal complaints among subjects with self reported whiplash injury. The HUNT-2 study.

From: BMC Musculoskelet Disord. 2011 Jun 8;12(1):129. [Epub ahead of print]

Whiplash injury occurs due to an acceleration-deceleration energy transfer to the neck resulting from motor-vehicle collisions, and the term whiplash associated disorders was introduced in order to describe the sign and symptoms associated with the injury.

The prognosis of whiplash injuries show highly variable results and may be due to differences in study populations and definitions of outcome. Usually the prognosis of whiplash is favorable and self-limited. The natural course for those that report symptoms after a whiplash trauma will in most cases be rapid improvement of pain and disability the first three months. Beyond three months there is usually little improvement. It is not clear which patients are at risk of delayed recovery following whiplash injury, but a slow or poor recovery of neck pain seems to be associated with psychological factors, compensation or legal factors and initial self reported symptom severity. The course of recovery in whiplash associated disorders is very similar to the course of neck pain in the general population.

Headache, neck pain and other subjective complaints are common in the general population, and both headache and neck pain are equally frequent in patients with and without a history of whiplash. Headache is commonly reported after a whiplash trauma, but the validity of the acute and chronic whiplash headache included in the ICHD-2 criteria are questionable and represents most likely occurrences of pre-accidental primary headaches like migraine and tension type headache, The prognosis of headache after a whiplash trauma is good and similar to non-traumatized controls.

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June 5, 2011

How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: Practice guidelines

Filed under: Chronic Pain — Administrator @ 3:59 am

How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: Practice guidelines

From: Man Ther. 2011 May 30. [Epub ahead of print]

Central sensitization provides an evidence-based explanation for many cases of ‘unexplained’ chronic musculoskeletal pain. Prior to commencing rehabilitation in such cases, it is crucial to change maladaptive illness perceptions, to alter maladaptive pain cognitions and to reconceptualise pain. This can be accomplished by patient education about central sensitization and its role in chronic pain, a strategy known as pain physiology education. Pain physiology education is indicated when: 1) the clinical picture is characterized and dominated by central sensitization; and 2) maladaptive illness perceptions are present. Both are prerequisites for commencing pain physiology education. Face-to-face sessions of pain physiology education, in conjunction with written educational material, are effective for changing pain cognitions and improving health status in patients with various chronic musculoskeletal pain disorders. These include patients with chronic low back pain, chronic whiplash, fibromyalgia and chronic fatigue syndrome. After biopsychosocial assessment pain physiology education comprises of a first face-to-face session explaining basic pain physiology and contrasting acute nociception versus chronic pain (Session 1). Written information about pain physiology should be provided as homework in between session 1 and 2. The second session can be used to correct misunderstandings, and to facilitate the transition from knowledge to adaptive pain coping during daily life. Pain physiology education is a continuous process initiated during the educational sessions and continued within both the active treatment and during the longer term rehabilitation program.

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