UNLABELLED: Chronic neck pain is a major public health problem with very few evidence-based complementary treatment options. This study aimed to test the efficacy of 12 weeks of a partner-delivered home-based cupping massage, compared to the same period of progressive muscle relaxation in patients with chronic non-specific neck pain. Patients were randomly assigned to self-directed cupping massage or progressive muscle relaxation. They were trained and asked to undertake the assigned treatment twice weekly for 12 weeks. Primary outcome measure was the current neck pain intensity (0-100 mm visual analog scale; VAS) after 12 weeks. Secondary outcome measures included pain on motion, affective pain perception, functional disability, psychological distress, wellbeing, health-related quality of life, pressure pain thresholds and adverse events. Sixty one patients (54.1±12.7 years; 73.8%female) were randomized to cupping massage (n = 30) or progressive muscle relaxation (n = 31). After treatment, both groups showed significantly less pain compared to baseline however without significant group differences. Significant effects in favor of cupping massage were only found for wellbeing and pressure pain thresholds. In conclusion, cupping massage is no more effective than progressive muscle relaxation in reducing chronic non-specific neck pain. Both therapies can be easily used at home and can reduce pain to a minimal clinically relevant extent. Cupping massage may however be better than PMR in improving well-being and decreasing pressure pain sensitivity but more studies with larger samples and longer follow-up periods are needed to confirm these results.
TRIAL REGISTRATION: ClinicalTrials.gov NCT01500330.
STUDY DESIGN: Randomized clinical trial.
OBJECTIVE: To compare the effectiveness of cervical spine thrust manipulation to that of Kinesio Taping applied to the neck in individuals with mechanical neck pain, using self-reported pain and disability and cervical range of motion as measures.
BACKGROUND: The effectiveness of cervical manipulation has received considerable attention in the literature. However, because some patients cannot tolerate cervical thrust manipulation, alternative therapeutic options should be investigated.
METHODS: Eighty patients (36 women) were randomly assigned to 1 of 2 groups: the manipulation group, which received 2 cervical thrust manipulations, and the tape group, which received Kinesio Taping applied to the neck. Neck pain (11-point numeric pain rating scale), disability (Neck Disability Index), and cervical-range-of-motion data were collected at baseline and 1 week after the intervention by an assessor blinded to the treatment allocation of the patients. Mixed-model analyses of variance were used to examine the effects of the treatment on each outcome variable, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction.
RESULTS: No significant group-by-time interactions were found for pain (F = 1.892, P = .447) or disability (F = 0.115, P = .736). The group-by-time interaction was statistically significant for right (F = 7.317, P = .008) and left (F = 9.525, P = .003) cervical rotation range of motion, with the patients who received the cervical thrust manipulation having experienced greater improvement in cervical rotation than those treated with Kinesio Tape (P<.01). No significant group-by-time interactions were found for cervical spine range of motion for flexion (F = 0.944, P = .334), extension (F = 0.122, P = .728), and right (F = 0.220, P = .650) and left (F = 0.389, P = .535) lateral flexion.
CONCLUSION: Patients with mechanical neck pain who received cervical thrust manipulation or Kinesio Taping exhibited similar reductions in neck pain intensity and disability and similar changes in active cervical range of motion, except for rotation. Changes in neck pain surpassed the minimal clinically important difference, whereas changes in disability did not. Changes in cervical range of motion were small and not clinically meaningful. Because we did not include a control or placebo group in this study, we cannot rule out a placebo effect or natural changes over time as potential reasons for the improvements measured in both groups.
LEVEL OF EVIDENCE: Therapy, level 1b.
STUDY DESIGN: A randomized controlled trial with 3 and 6 months follow-up.
OBJECTIVE: To compare the effectiveness of acupuncture with simulated acupuncture in patients with subacute and chronic whiplash-associated disorders.
SUMMARY OF BACKGROUND DATA: Acupuncture is widely used for the treatment of neck and other musculoskeletal pain, and there is some evidence supporting its effectiveness for short-term pain relief. The effectiveness of acupuncture in the treatment of whiplash-associated disorders is not clear.
METHODS: A total of 124 patients between 18 and 65 years with chronic (85%) or subacute whiplash-associated disorders (Grade I or II) were randomly allocated to real or simulated electroacupuncture treatment for 12 sessions during a 6-week period. Both treatments involved skin penetration with acupuncture needles and were provided by a single university-trained acupuncturist in a University Clinic in Sydney, Australia. Primary outcome measures were pain intensity (10-cm visual analog scale), disability (Neck Disability Index), and health-related quality of life (SF-36). Secondary outcomes were patient-specific activity scales, and the McGill Pain Rating Index.
RESULTS: Mean initial pain intensity for all participants was 5.6 cm. Participants receiving the real electroacupuncture treatment had significantly greater reduction in pain intensity at 3 and 6 months, 0.9 cm (P = 0.05) and 1.3 cm (P = 0.007), respectively, in comparison to the sham electro-acupuncture group. After adjustment for baseline status, there was no significant reduction in disability, or improvement in health-related quality of life. There was an improvement in the activity scales of a similar size to the reduction in pain, but no difference in the McGill Index.
CONCLUSION: Real electroacupuncture was associated with a significant reduction in pain intensity over at least 6 months. This reduction was probably not clinically significant. There was no improvement in disability or quality of life.
OBJECTIVE: This study is aimed to assess the efficacy of traditional acupuncture for chronic neck pain in patients by comparing the differences in symptoms, dysfunctions and quality of life.
METHODS: The study used a two-arm, single-blinded, randomised controlled design. The patients were randomised to the study group and control group, who respectively received traditional acupuncture and placebo treatment. The Northwick Park Neck Pain Questionnaire (NPQ), visual analogue scale (VAS), Short Form (36) Health Survey (SF-36) and doctor's judgement were applied for measuring effectiveness. The patients' effectiveness outcome was assessed, respectively, before the intervention, immediately after the intervention, at the end of the first month of follow-up and at the end of the third month of follow-up. The statistical analysis was done on Statistical Package for Social Sciences (SPSS) v13, which included comparison of demographic and clinical homogeneity, the repeated measures approach based on the general linear model (GLM) for effectiveness assessment and the sum rank test for doctors' subjective efficacy judgement.
RESULTS: Totally, 190 patients were recruited and 178 patients (88 in the study group and 90 in the control group) completed the intervention and follow-up assessment. The scores of NPQ, VAS and SF-36 were improved after the intervention and during follow-up (P<0.01 vs. before the intervention). The patients in the study group had better effectiveness outcome in NPQ, VAS and in the VT, SF and MH domains of SF-36 (P<0.05).
CONCLUSION: Traditional acupuncture can relieve pain intensity and improve the quality of daily life with a relative long-term clinical efficacy in patients with chronic neck pain.
PURPOSE: To determine the immediate effects of the central posteroanterior (PA) mobilization technique on both pain and active cervical range of motion in patients with mechanical neck pain presenting with central or bilateral symptoms. METHODS: A randomized controlled trial was conducted in 60 patients who were randomly allocated into either 'central PA' or 'random' mobilization group. Two physical therapists and one assessor participated. Outcome measures included neck pain at rest, pain on the most painful movement, and active cervical range of motion taken before and immediately 5 min after the mobilization treatment. RESULTS: Significant reductions in pain at rest and on the most painful movement were noted within-group comparisons (p < 0.001). However, the 'central PA' mobilization group obtained a significantly greater reduction in pain on the most painful movement than the 'random' mobilization group (p < 0.05). Both mobilization techniques had no effects on the active cervical range of motion. However, the differences in the means of pain reduction between both mobilization techniques were modest (<10 mm). CONCLUSION: The clinical recommendation regarding the selection of the central PA mobilization technique for treating patients with central or bilateral mechanical neck pain is therefore arguably.
OBJECTIVE: To determine the immediate effects on both pain and active range of motion (ROM) of the unilateral posteroanterior (PA) mobilization technique on the painful side in mechanical neck pain patients presenting with unilateral symptoms. DESIGN: Triple-blind, randomized controlled trial. SETTING: Outpatient physical therapy, institutional clinic. PARTICIPANTS: Patients (N=60), 2 physical therapists, and 1 assessor involved in this study. INTERVENTIONS: The patients were randomly allocated into either preferred or random mobilization group by using an opaque concealed envelope. The first therapist performed the screening, assessing, prescribing the spinal level(s), and the grade of mobilization. The second therapist performed the mobilization treatment according to their allocated group stated in an envelope. The assessor who was blind to the group allocation conducted the measurements of pain and active cervical ROM. MAIN OUTCOME MEASURES: Pain intensity, active cervical ROM, and global perceived effect were measured at baseline and 5 minutes posttreatment. RESULTS: After mobilization, there were no apparent differences in pain and active cervical ROM between groups. However, within-group changes showed significant decreases in neck pain at rest and pain on most painful movement (P<0.001) with a significant increase in active cervical ROM after mobilization on most painful movement (P=0.002). CONCLUSIONS: The results of this study did not provide support for the preference of the unilateral PA mobilization on the painful side to the random mobilization.
Objective: To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy. Design: Randomised controlled trial. Setting: Neurology outpatient clinics in three Dutch hospitals. Participants: 205 patients with symptoms and signs of cervical radiculopathy of less than one month's duration Interventions Treatment with a semi-hard collar and taking rest for three to six weeks; 12 twice weekly sessions of physiotherapy and home exercises for six weeks; or continuation of daily activities as much as possible without specific treatment (control group). Main outcome measures: Time course of changes in pain scores for arm and neck pain on a 100 mm visual analogue scale and in the neck disability index during the first six weeks. Results: In the wait and see group, arm pain diminished by 3 mm/week on the visual analogue scale (β=-3.1 mm, 95% confidence interval -4.0 to -2.2 mm) and by 19 mm in total over six weeks. Patients who were treated with cervical collar or physiotherapy achieved additional pain reduction (collar: β=-1.9 mm, -3.3 to -0.5 mm; physiotherapy: β=-1.9, -3.3 to -0.8), resulting in an extra pain reduction compared with the control group of 12 mm after six weeks. In the wait and see group, neck pain did not decrease significantly in the first six weeks (β=-0.9 mm, -2.0 to 0.3). Treatment with the collar resulted in a weekly reduction on the visual analogue scale of 2.8 mm (-4.2 to -1.3), amounting to 17 mm in six weeks, whereas physiotherapy gave a weekly reduction of 2.4 mm (-3.9 to -0.8) resulting in a decrease of 14 mm after six weeks. Compared with a wait and see policy, the neck disability index showed a significant change with the use of the collar and rest (β=-0.9 mm, -1.6 to -0.1) and a non-significant effect with physiotherapy and home exercises. Conclusion: A semi-hard cervical collar and rest for three to six weeks or physiotherapy accompanied by home exercises for six weeks reduced neck and arm pain substantially compared with a wait and see policy in the early phase of cervical radiculopathy. Trial registration: Clinical trials NCT00129714.
Objective: To observe the clinical effect of acupuncture in treating cervical spondylosis with different syndrome types. Methods: One hundred and seventeen patients were randomized into the treated group (59 cases), treated with normal acupuncture, and the control group (58 cases), treated with sham acupuncture, operated once every other day, 9 times in total (in 18 days) as one therapeutic course, and a succeeding 3-month follow-up study was carried out after terminating the therapy. The efficacy of treatment was evaluated with the Northwick Park Neck Pain Questionnaire (NPQ) and Visual Analogue Scale (VAS), and the scores gained in patients with different syndrome types were analyzed with a general linear model. Results: The NPQ and VAS scores showed a linear decreasing tendency in both groups at the time of ending treatment and the 1st month of follow-up, but showed a secondary curve increasing tendency in the 3rd month of follow-up. Multivariate analysis showed the difference was of statistical significance (P<0.05). However, the analysis through lead-in of syndrome type as an individual influencing factor showed that syndrome type exerts a significant influence on VAS score (P<0.05), but has insignificant influence on the NPQ score (P>0.05). Conclusion: Acupuncture shows good immediate effect in treating cervical spondylosis, but its long-term effect is not satisfactory. The difference in syndrome type may have some impact on the effects of acupuncture in alleviating pain, but exerts no evident influence on the comprehensive effect.
Chronic neck pain is a major public health problem with very few evidence-based complementary treatment options. This study aimed to test the efficacy of 12 weeks of a partner-delivered home-based cupping massage, compared to the same period of progressive muscle relaxation in patients with chronic non-specific neck pain. Patients were randomly assigned to self-directed cupping massage or progressive muscle relaxation. They were trained and asked to undertake the assigned treatment twice weekly for 12 weeks. Primary outcome measure was the current neck pain intensity (0-100 mm visual analog scale; VAS) after 12 weeks. Secondary outcome measures included pain on motion, affective pain perception, functional disability, psychological distress, wellbeing, health-related quality of life, pressure pain thresholds and adverse events. Sixty one patients (54.1±12.7 years; 73.8%female) were randomized to cupping massage (n = 30) or progressive muscle relaxation (n = 31). After treatment, both groups showed significantly less pain compared to baseline however without significant group differences. Significant effects in favor of cupping massage were only found for wellbeing and pressure pain thresholds. In conclusion, cupping massage is no more effective than progressive muscle relaxation in reducing chronic non-specific neck pain. Both therapies can be easily used at home and can reduce pain to a minimal clinically relevant extent. Cupping massage may however be better than PMR in improving well-being and decreasing pressure pain sensitivity but more studies with larger samples and longer follow-up periods are needed to confirm these results.
