Neck Pain

BackgroundDifferences in cervical neuromuscular function are commonly observed between people with and without chronic neck pain. Exercise may improve cervical neuromuscular function of people with neck pain although the evidence for this has not been systematically reviewed.ObjectiveTo systematically review the existing evidence on the effect of exercises targeting the neck muscles on neuromuscular function in people with chronic non-specific neck pain.MethodsThis systematic review was conducted based on a registered protocol (CRD42021298831) with searches conducted on the following databases from inception to 21st October 2023: MEDLINE, CINAHL, Web of Science, Scopus, AMED, Google Scholar, Open Grey and Zetoc. Studies of interest were trials investigating neuromuscular adaptations to a program of exercise targeting the neck muscles (>2 weeks) in people with chronic non-specific neck pain. Two reviewers independently screened the studies and performed data extraction, risk of bias assessment, and rated the overall certainty of the evidence (GRADE).ResultsFourteen articles from 2110 citations were included. There is moderate certainty of evidence that the use of craniocervical flexion training (either in isolation or in combination with resistance training) can induce neural adaptations within the neck muscles. A meta-analysis showed a reduction in sternocleidomastoid muscle activity after neck exercise interventions compared to control interventions.ConclusionThe articles included in this systematic review confirmed that exercise can result in neuromuscular adaptations within neck muscles, as measured by electromyography. Specificity of training was seen to be relevant for the type of neuromuscular adaptations induced.

BackgroundIllness perceptions can affect the way people with musculoskeletal pain emotionally and behaviorally cope with their health condition. Understanding patients illness perceptions may help facilitate patient-centered care. The purpose of this study was to explore illness perceptions and the origin of those perceptions in people with chronic disabling non-specific neck pain seeking primary care.MethodsA qualitative study using a deductive and inductive analytical approach was conducted in 20 people with persistent (> 3 months) and disabling (i.e., Neck Disability Index ≥ 15) neck pain. Using a semi-structured format, participants were interviewed about their illness perceptions according to Leventhal's Common Sense Model. Purposive sampling and member checking were used to secure validity of study results.ResultsParticipants reported multiple symptoms, thoughts and emotions related to their neck pain, which continuously required attention and action. They felt trapped within a complex multifactorial problem. Although some participants had a broader biopsychosocial perspective to understand their symptoms, a biomedical perspective was dominant in the labelling of their condition and their way of coping (e.g., limiting load, building strength and resilience, regaining mobility, keep moving and being meaningful). Their perceptions were strongly influenced by information from clinicians. Several participants indicated that they felt uncertain, because the information they received was contradictory or did not match their own experiences.ConclusionMost participants reported that understanding their pain was important to them and influenced how they coped with pain. Addressing this 'sense making process' is a prerequisite for providing patient-centered care.

Background and Objectives: Although acupuncture is listed as a beneficial treatment for neck/shoulder stiffness, which has increased with the spread of information technology, to date, evidence of its efficacy under double-blind conditions has not been shown. This study aimed to assess whether acupuncture treatment with superficial skin piercing is superior to placebo treatment. Materials and Methods: A randomized, double-blind (practitioner-patient) placebo-controlled trial was performed at a single center with four arms (ISRCTN76896018). Four hundred patients with essential neck/shoulder stiffness were randomly assigned to penetrating needle treatment (acupuncture ritual and skin penetration), skin-touch needle treatment (acupuncture ritual and skin touch), no-touch needle treatment (acupuncture ritual alone), and no-treatment control. Each of the six acupuncturists applied a needle to each of the four acupoints in the neck/shoulder of 50 patients. Results: Each of the three treatments significantly (p = 0.01) improved neck/shoulder stiffness compared with the no-treatment control immediately and 24 h after treatment. There was a significant improvement in penetrating needle treatment over no-touch needle treatment 24 h later. However, there was no significant difference between the penetrating and skin-touch and skin-touch vs. no-touch. Conclusions: All treatments that received the ritual of acupuncture were better than the no-treatment control. Only genuine acupuncture involves the specific effects of needle insertion into the body. The acupuncture ritual had a significant impact on the subjective improvement of neck/shoulder stiffness; however, improvement with ritual alone versions of placebo acupuncture was not maintained as with superficial skin piercing. Our study provides important evidence of acupuncture efficacy and information regarding inert no-touch placebo control in acupuncture research.

IntroductionConcurrent pain in the jaw and neck is common; however, little is known about how it develops. Previous studies have focused mainly on biological factors with limited focus on psychosocial factors and patients' perspectives. To enhance understanding of concurrent jaw and neck pain, knowledge is needed about patients' perspectives on the development of symptoms and their management within health care that also includes dentistry.ObjectiveTo explore patients' perspectives on the development of concurrent jaw and neck pain in relation to navigating the health care system.MethodsSixteen individuals (11 women and 5 men, aged 19 to 56 y) with concurrent jaw and neck pain were recruited using purposive sampling. Participants were patients referred to an orofacial pain specialist in Sweden. Individual semi-structured interviews were used and analyzed using qualitative content analysis.ResultsData analysis resulted in the theme "Seeking understanding, confirmation, and simplified navigation in the health care system." The main theme consisted of 3 subthemes: (1) understanding and interpreting the body and emotions holistically, (2) seeking affirmation and legitimacy from health care, and (3) wishing for clear and easily navigable health care pathways. Patients expressed thoughts regarding their own sensemaking in respect to causes for their pain. Moreover, they requested confirmation from health care along with simplified health care navigation and a holistic approach regarding pain management.ConclusionsA mismatch exists between the patient's own sensemaking regarding the cause of their jaw and neck pain and the care they receive from their health care provider. Having pain from multiple sites that is managed in different medical systems makes it difficult to navigate within health care. A clear care pathway could reduce the risk of pain chronicity, and an increased collaboration between dentistry and medical care would be desirable.Knowledge Transfer Statement:Concurrent jaw and neck pain is common but often managed separately in dentistry and health care. This can result in a mismatch between a patient's understanding regarding concurrent jaw and neck pain and directions from their health care provider. A holistic approach and increased collaboration between dentistry and health care are needed to support patients navigating health care providers and reduce the risk of pain chronification.