Comparative effectiveness of manipulation, mobilisation and the Activator instrument in treatment of non-specific neck pain: a systematic review Clinical course and prognostic factors in acute neck pain: an inception cohort study in general practice. Are non-steroidal anti-inflammatory drugs effective for the management of neck pain and associated disorders, whiplash-associated disorders, or non-specific low back pain? A systematic review of systematic reviews by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Management in non-traumatic arm, neck and shoulder complaints: differences between diagnostic groups A randomised controlled trial comparing graded exercise treatment and usual physiotherapy for patients with non-specific neck pain (the GET UP neck pain trial). Acupuncture versus Placebo for the Treatment of Chronic Mechanical Neck Pain Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Stroke, cerebral artery dissection, and cervical spine manipulation therapy Management of headache disorders: design of a randomised clinical trial screening for prognostic patient characteristics Predictors for chronic neck and low back pain in office workers: a 1-year prospective cohort study. Medial branch neurotomy in management of chronic spinal pain: systematic review of the evidence. Comparative short-term effects of two thoracic spinal manipulation techniques in subjects with chronic mechanical neck pain: a randomized controlled trial. Risk factors for neck pain in office workers: a prospective study Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: a one-year randomized controlled trial. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Identifying neuropathic pain in patients with head and neck cancer: use of the Leeds Assessment of Neuropathic Symptoms and Signs Scale. Is Behavioral Graded Activity Cost-Effective in Comparison With Manual Therapy for Patients With Subacute Neck Pain?: An Economic Evaluation Alongside a Randomized Clinical Trial Diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: a systematic review of evidence. Tension neck and evaluation of a physical training course among office workers in a bank corporation. Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain Neck motion, motor control, pain and disability: A longitudinal study of associations in neck pain patients in physiotherapy treatment. Psychological Factors and the Development of Chronic Whiplash–associated Disorder(s): A Systematic Review Social and psychological factors influenced the course of arm, neck and shoulder complaints.
Background Neck pain is a common problem and different forms of manual therapy are used in its treatment . The purpose of this systematic review was to critically appraise the literature that directly compared manipulation , mobilisation and the Activator instrument for non-specific neck pain . Methods Electronic data bases ( MEDLINE , MANTIS and CINAHL ) were search ed from their inception to October 2005 for all English language r and omised clinical trials that directly compared manipulation , mobilisation and the Activator instrument . Inclusion and exclusion criteria were applied to select the studies and these studies were then evaluated using vali date d criteria . Results Five such studies were identified . The method ological quality was mostly poor . Findings from the studies were mixed and no one therapy was shown to be more effective than the others . Conclusion Further high quality research has to be done before a recommendation can be made as to the most effective manual method for non-specific neck pain OBJECTIVE To describe the natural course of patients with acute neck pain presenting in general practice and to identify prognostic factors for recovery and sick leave . DESIGN We conducted a prospect i ve cohort study with a 1-year follow-up in general practice . Question naires were collected at baseline and after 6 , 12 , 26 , and 52 weeks . Days of sick leave were dichotomized into two groups : below and above 7 days of sick leave . Logistic regression was used to identify prognostic factors for recovery and sick leave . PATIENTS Consecutive patients with nonspecific neck pain lasting no longer than 6 weeks were invited to participate . RESULTS One hundred eighty-seven patients were included and 138 ( 74 % ) provided follow-up data . After 1 year , 76 % of the patients stated to be fully recovered or much improved , although 47 % reported to have ongoing neck pain . Almost half of the patients on sick leave at baseline returned to work within 7 days . Multivariate analysis showed that the highest association with recovery was the advice of the general practitioner ( GP ) " to wait and see " ( odds ratio [ OR ] 6.7 , 95 % confidence interval [ CI ] 1.6 - 31.8 ) . For sick leave , referral by the GP , for physical therapy or to a medical specialist , showed the highest association ( OR 2.8 , 95 % CI 1.0 - 8.4 ) . CONCLUSION Acute neck pain had a good prognosis for the majority of patients , but still a relatively high proportion of patients reported neck pain after 1-year follow-up . The advice given by the GP " to wait and see " was associated with recovery , and " referral " was associated with prolonged sick leave Abstract Purpose To evaluate the effectiveness of non-steroidal anti-inflammatory drugs ( NSAIDs ) for the management of neck pain and associated disorders ( NAD ) , whiplash-associated disorders , and non-specific low back pain ( LBP ) with or without radiculopathy . Methods We systematic ally search ed six data bases from 2000 to 2014 . R and om pairs of independent review ers critically appraised eligible systematic review s using the Scottish Intercollegiate Guidelines Network criteria . We included systematic review s with a low risk of bias in our best evidence synthesis . Results We screened 706 citations and 14 systematic review s were eligible for critical appraisal . Eight systematic review s had a low risk of bias . For recent-onset NAD , evidence suggests that intramuscular NSAIDs lead to similar outcomes as combined manipulation and soft tissue therapy . For NAD ( duration not specified ) , oral NSAIDs may be more effective than placebo . For recent-onset LBP , evidence suggests that : ( 1 ) oral NSAIDs lead to similar outcomes to placebo or a muscle relaxant ; and ( 2 ) oral NSAIDs with bed rest lead to similar outcomes as placebo with bed rest . For persistent LBP , evidence suggests that : ( 1 ) oral NSAIDs are more effective than placebo ; and ( 2 ) oral NSAIDs may be more effective than acetaminophen . For recent-onset LBP with radiculopathy , there is inconsistent evidence on the effectiveness of oral NSAIDs versus placebo . Finally , different oral NSAIDs lead to similar outcomes for neck and LBP with or without radiculopathy . Conclusions For NAD , oral NSAIDs may be more effective than placebo . Oral NSAIDs are more effective than placebo for persistent LBP , but not for recent-onset LBP . Different oral NSAIDs lead to similar outcomes for neck pain and LBP Arm , neck and /or shoulder complaints are common in western societies . In the Netherl and s , general practice guidelines are issued on shoulder pain and epicondylitis only . Little is known about actual management of the total range of diagnoses . The objectives of the study are : to determine management in patients consulting the GP with a new episode of non-traumatic arm neck and shoulder complaints up to 6 months after the first consultation . To evaluate differences in management between patients with specific diagnoses versus non-specific diagnoses and between specific diagnostic groups . In a prospect i ve cohort study in general practice . We recruited 682 eligible patients .  Data on diagnosis , management , patient- and complaint-characteristics were collected . Co-occurrence of treatment options was presented in scaled rectangles . After 6 months , additional diagnostic tests had been performed in 18 % of the patients , mainly radiographic examination ( 14 % ) . Further , 49 % had been referred for physiotherapy and 12 % to the medical specialist . Patients with specific diagnoses were more frequently referred for specialist treatment , and patients with non-specific diagnoses for physiotherapy . Corticosteroid injections ( 17 % ) were mainly applied specific diagnoses ( e.g. impingement syndrome , frozen shoulder , carpal tunnel and M. Quervain ) . Frequencies of prescribed medication ( 51 % ) did not differ between specific and non-specific diagnoses . In 19 % of the patients no referral , prescribed analgesics or injection  was applied .  Braces  ( 4 % ) were mainly prescribed in epicondylitis . Overall , management most frequently consisted of prescribed analgesics and referral for physiotherapy . Specific and non-specific diagnostic subgroups differed in the frequency corticosteroid injections were applied , and referrals to physiotherapy and to a medical specialist Evidence supports exercise-based interventions for the management of neck pain , however there is little evidence of its superiority over usual physiotherapy . This study investigated the effectiveness of a group neck and upper limb exercise programme ( GET ) compared with usual physiotherapy ( UP ) for patients with non-specific neck pain . A total of 151 adult patients were r and omised to either GET or UP . The primary measure was the Northwick Park Neck pain Question naire ( NPQ ) score at six weeks , six months and 12 months . Mixed modelling identified no difference in neck pain and function between patients receiving GET and those receiving UP at any follow-up time point . Both interventions result ed in modest significant and clinical ly important improvements on the NPQ score with a change score of around 9 % between baseline and 12 months . Both GET and UP are appropriate clinical interventions for patients with non-specific neck pain , however preferences for treatment and targeted strategies to address barriers to adherence may need to be considered in order to maximise the effectiveness of these approaches Context  Chronic neck pain  is a common , disabling condition and is difficult to treat . Because traditional therapies , such as physical therapy and nonsteroidal anti-inflammatory drugs , have limited effectiveness and can have adverse effects , many patients seek alternative therapies , such as acupuncture . Contribution This r and omized , controlled trial of acupuncture versus sham transcutaneous electrical stimulation for patients with chronic mechanical neck pain  identified no clinical ly significant benefit of acupuncture over placebo with respect to pain , function , or analgesic use . Implication s Acupuncture did not lead to clinical ly significant improvement in chronic mechanical neck pain when compared with placebo . The Editors Chronic mechanical neck pain can be caused by dysfunction of a variety of structures within the neck ( 1 - 3 ) but specifically excludes systemic problems such as rheumatoid arthritis . It is usually associated with unspecified degenerative changes ( cervical spondylosis ) that include osteoarthritis . Neck pain presents a substantial problem and may be responsible for as many days of work absenteeism as low back pain ( 4 ) . Osteoarthritis is the most common of the chronic diseases and affects most people older than 65 years of age ( 5 ) . It is degenerative and progressive in nature ( 1 - 3 , 6 ) . Because there is no cure for cervical spondylosis , treatment tends to center on symptom relief ( 7 , 8) . If the condition is symptomatic and symptoms are left untreated , this manifests as increasing episodic pain , stiffness , or both , and patients may then experience a spiral of increasing dysfunction ( 9 ) . Two systematic review s of conventional conservative physical therapy suggest that little evidence supports the efficacy of such intervention ( 8 , 10 ) . Nonsteroidal anti-inflammatory drugs , the mainstay of pharmacologic treatment , are associated with a wide spectrum of serious and well-documented adverse reactions ( 5 ) . There has been a huge increase in the use of complementary and alternative medicine in both the United States and the United Kingdom ( 11 , 12 ) . Acupuncture is the most frequently used type of complementary and alternative medicine therapy for the treatment of osteoarthritis ( 13 ) . Despite little sound evidence of efficacy ( 14 ) , approximately 1 million people seek complementary and alternative medicine treatment annually in the United States ( 15 ) . Two systematic review s of acupuncture in neck pain ( 4 , 16 ) suggest that there has been insufficient research in this area and that the published studies are of poor quality . Therefore , we conducted a rigorous evaluation to test whether western-style acupuncture performs better than placebo for treatment of chronic mechanical neck pain . We defined western acupuncture as a conventional diagnosis followed by individualized acupuncture treatment using a combination of prescriptive tender , local , and distal points . This is in contrast to a traditional Chinese approach , which would formulate an individualized diagnosis based on traditional Chinese theories of meridians and energy ( or qi ) . Methods Study Design and Patient Selection We design ed a r and omized , single-blind , placebo-controlled trial using a pragmatic treatment regimen . The study was conducted in the outpatient departments of Southampton General Hospital and Salisbury District Hospital in the United Kingdom . Between 1999 and 2001 , patients were referred by rheumatologists or family physicians or from physiotherapy waiting lists . Appropriate ethical approval was obtained from the Southampton and South West Hampshire Joint Research Ethics Committee . Patients were 18 to 80 years of age , had chronic ( > 2 months ) mechanical neck pain , and had a pain score of more than 30 mm on a visual analogue scale ( VAS ) for 5 of 7 pretreatment days ( possible score on this VAS ranges from 0 to 100 mm ) . We excluded pregnant patients ; those with a history of fracture or surgery to the neck , cervical congenital abnormality , uncontrolled low back pain , contraindication to acetaminophen , systemic illness ( for example , rheumatoid arthritis ) , or ongoing neck-related litigation or disability cl aims ; and those with current or recent manual neck treatment or steroid use ( oral or local injection ) . Sample Size Previous studies suggested a 50 % to 75 % improvement using  acupuncture  for patients with chronic pain  , compared with 30 % for placebo treatment ( 17 ) . We used these findings as the basis for our power calculation . At 5 % significance and 90 % power , 53 patients were required in each group to detect a 30 % difference in response between active and placebo treatments . Interventions Informed consent was obtained along with a full medical history , neurologic examination , cervical radiography , and laboratory investigations ( full blood count , erythrocyte sedimentation rate , and liver function tests ) . We told patients that we were comparing 2 types of intervention : 1 ) acupuncture with needles and 2 ) treatment with a machine design ed to stimulate acupuncture points through skin electrodes . The patients were informed that the treatment might or might not prove to be effective and that there was a 50 % chance that they would be assigned to a placebo but were not told what the placebo was . Blinding was not broken until 1 year after treatment . One practitioner performed all interventions . Acupuncture We used single-use , sterile , silver-h and le , prepacked needles without guide tubes . Sizes used were 13 mm 0.25 mm , 25 mm 0.25 mm , and 40 mm 0.25 mm . We based point selection on individualized western acupuncture techniques by using a list of points previously reported as being effective in neck pain ( 18 , 19 ) and by reaching a consensus according to our own clinical and teaching practice ( Appendix Table ) . The specific points for each individual were defined at each treatment session , depending on the patient 's pain distribution  and palpation of the neck and thorax to determine ah-shi points , or local tender points , for acupuncture . At least 1 distal point was used . Point location and depth of insertion were as described in traditional texts ( 19 ) . Six points on average , per side if pain was bilateral , were used on each patient , and deqi ( a term used to describe acupuncture needle sensation ) was obtained on each needle . Twenty-minute treatment sessions were given . The patient was checked every 6 or 7 minutes to ascertain whether deqi was still present , and needles were manipulated again if required . Placebo There is considerable debate about the ideal placebo for acupuncture studies ( 20 ) . To enhance the rigor of our study , we chose to use a previously well-vali date d placebo ( 17 , 21 - 23 ) that could not have a specific physiologic effect . The Noma FM-4 electroacupuncture stimulator ( Noma Ltd. , Southampton , United Kingdom ) was used . It has 4 channels , allowing pseudostimulation of up to 8 acupuncture points simultaneously , and emits visual and audio signals . Reusable electrodes ( Body Clock Health Care Ltd. , London , United Kingdom ) were fixed to the surface of the patient 's skin and were connected to the stimulator through decommissioned cables . The cables were severed inside the output plug , so that no current could reach the patient . Examination and point selection were the same as with real acupuncture for each treatment . Point location and treatment variables were changed during subsequent treatment sessions if patients felt they were not progressing . Patients were told that the machine could stimulate acupuncture points through high-frequency , low-intensity stimulation and therefore would not produce any sensation . If patients reported sensation , the therapist adjusted the unit for comfort ( although since this was a sham procedure , such adjustment made no real difference ) . Patients in both groups were instructed to use acetaminophen alone for pain relief and were not given or permitted any other form of treatment , including exercises or stretches , during the study and for 2 months after treatment ended . Patients were treated twice per week for 4 weeks . The therapist had taken an Acupuncture Association of Chartered Physiotherapists accredited course on western acupuncture techniques and had 7 years of experience practicing acupuncture . R and omization R and omization lists for Southampton General Hospital and Salisbury District Hospital were generated by using a computer program , R and omlogue , produced by Southampton University Department of Medical Statistics , Southampton , United Kingdom . Sealed envelopes containing the individual r and omization codes , numbered consecutively with sex and age strata , were then prepared ( sex strata were male and female , and age strata were 18 to 49 years and 50 to 80 years ) Patients were strictly allocated across 4 strata for either of the study hospitals according to the next available envelope number . Data Collection Before r and omization , patients were instructed to use a daily pain diary  ( on a VAS ) to record pain and  acetaminophen  use for 7 consecutive days . After a week , the pain diaries were examined , and if the inclusion criteria ( which were unknown to the patients ) were satisfied , r and omization occurred . Patients completed the various question naires before treatment and at 1 and 8 weeks after treatment . Pain continued to be recorded either weekly or daily throughout treatment and up to 8 weeks after treatment . Additional question naires and pain evaluation were also completed at 6 and 12 months after treatment . Figure 1 shows a flow chart of the trial . Figure 1 . Study flow with outcome assessment s. Outcomes The VAS score for pain 1 week after treatment , recorded daily for 7 consecutive days , was the primary outcome . Pain was recorded on a scale of 0 mm ( indicating no pain ) to 100 mm ( indicating worst pain imaginable ) . A significant outcome for acupuncture was considered to be a 30 % difference in VAS score between groups 5 weeks after r and omization ( 1 week after treatment ) , taking into account baseline pain . Secondary Abstract Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention ( WDP ) interventions in workers with neck pain , whiplash-associated disorders ( WAD ) , or upper extremity disorders . Methods We search ed electronic data bases from 1990 to 2012 . R and om pairs of independent review ers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria . Scientifically admissible studies were summarized and synthesized following best- evidence synthesis methodology . Results Of the 6,359 articles retrieved , 16 r and omized controlled trials were eligible for critical appraisal and five were admissible . We found that a return-to-work coordination program ( including workplace-based work hardening ) was superior to clinic-based work hardening for persistent rotator cuff tendinitis . Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain . Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints . Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms . Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers ’ recovery from recent work-related neck and upper extremity complaints . Conclusions At present , no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain , WAD , and upper extremity disorders . Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening . Also , adding computer-prompted breaks to ergonomic and workplace interventions benefits workers ’ recovery . The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions Abstract Stroke represents an infrequent adverse reaction associated with  cervical spine manipulation therapy .  Attempts to identify the patient at risk and the type of manipulation most likely to result in these complications of manipulation have not been successful . A retrospective review of 64 medical legal cases of stroke temporally associated with cervical spine manipulation was performed to evaluate characteristics of the treatment rendered and the presenting complaints in patients reporting these complications . These files included records from the practitioner who administered the manipulation therapy , post stroke testing and treatment records usually by a neurologist , and depositions of the patient and the practitioner of manipulation as well as expert and treating physicians . A retrospective review of the files was carried out by three ( two in 11 cases ) research ers using the same data abstract ion instrument to independently assess each case . These independent review s were followed by a consensus review in which all review ers reached agreement on file content . Ninety two percent of cases presented with a history of head and /or neck pain and 16 ( 25 % ) cases presented with sudden onset of new and unusual headache and neck pain often associated with other neurological symptoms that may represent a dissection in progress . The strokes occurred at any point during the course of treatment . Certain patients reporting onset of symptoms immediately after first treatment while in others the dissection occurred after multiple manipulations . There was no apparent dose-response relationship to these complications . These strokes were noted following any form of st and ard cervical manipulation technique including rotation , extension , lateral flexion and non-force and neutral position manipulations . The results of this study suggest that stroke , particularly vertebrobasilar dissection , should be considered a r and om and unpredictable complication of any neck movement including cervical manipulation . They may occur at any point in the course of treatment with virtually any method of cervical manipulation . The sudden onset of acute and unusual neck and /or head pain may represent a dissection in progress and be the reason a patient seeks manipulative therapy that then serves as the final insult to the vessel leading to ischemia Background Treatment of headache disorders is not always optimal . Patients are treated in multiple ways , and the lack of scientific arguments for referral and the insufficient implementation of guidelines result in unclear treatment strategies . The coexistence of headache and neck pain can lead to the referral to a musculoskeletal physiotherapist . This treatment can only be successful if an underlying cervical segmental dysfunction is present . In such cases a physical treatment can be a valuable option that should be considered . The aim of this study is to identify prognostic therapeutic patient characteristics and to increase the number of correct physiotherapy referrals . Methods / design This trial is design ed to identify patient characteristics which can influence the prognosis of the patient . Patients with recurrent headache and co-existent neck pain are recruited via a multicenter setup . After screening for eligibility , subjects are tested at baseline and r and omly allocated to one of two treatment groups . Testing includes the administering of question naires ( a  Headache Diagnosis Question naire ,  Headache Inventory List  and the Headache Impact Test ( HIT-6 ) ) and physical tests ( Thermal Stimuli , Manual Cervical Spine Examination and Pressure Algometry ) . Treatment groups are a usual care group ( UC ) administered by the General Practitioner ( GP ) and a usual care plus musculoskeletal physiotherapy treatment group ( UCMT ) . UC is based on the Dutch GP Guideline for Headache . UCMT consists of the UC plus a combination of exercises and spinal cervical mobilisations . Follow-up measurements consist of the completion of the Headache Inventory List , the HIT-6 and scoring of the global perceived effect ( GPE ) . The latter allowing the distinction between responders ( positive effect ) and non-responders ( no effect or worse ) . Logistic regression analysis will be used to identify the specific patient characteristics of the responders and the non-responders . The additional value of the musculoskeletal physiotherapy will be examined . Follow-up measurements up to 52 weeks are scheduled . Discussion This trial aims to identify prognostic patient characteristics , in order to supply a useful diagnostic tool for all health care workers , dealing with headache sufferers OBJECTIVE All occupations expose workers to varied and unique conditions . The nature of work has been recognized as influencing the health of workers . Whether predictors for chronic neck and low back pain would be occupation-specific is unknown . This study aim ed to identify predictors for chronic neck and low back pain in a cohort of office workers . METHODS A prospect i ve study was carried out among 669 healthy office workers . At baseline , risk factors were assessed using a question naire and st and ardized physical examination . A symptomatic case was defined as an individual who reported pain greater than 30 mm on a 100-mm VAS , and chronic pain was defined as experiencing ongoing neck or low back pain for greater than 3 months over the past 6 months . Two regression models were built to analyze the risk factors for developing chronic neck and low back pain . RESULTS Of the sample , 17 and 27 % of office workers who reported a new onset of neck or low back pain developed chronicity , respectively . Predictors for chronic neck pain were high body mass index , frequent neck extension during the work day , high initial pain intensity , and high psychological job dem and s. The development of chronic low back pain was associated with history of low back pain and high initial pain intensity . CONCLUSIONS The findings suggest that predictors for chronic musculoskeletal pain in a sub population may be a subset of predictors identified in a general population or occupation specific . Successful management to prevent chronic musculoskeletal pain may also need to consider the patient 's occupation Zygapophysial or facet joints have been implicated as cause of low back , mid back , upper back and neck pain with referred pain . Cervical , thoracic and lumbar facet joints are innervated by the medial branches of the dorsal rami . Zygapophysial ( facet ) joints have been implicated as the source of chronic pain in 15 % to 45 % of the patients with chronic low back pain , 54 % to 60 % of the patients with chronic neck pain and 48 % of the patients with thoracic pain . A systematic review of the evidence of effectiveness of radiofrequency denervation in the management of chronic spinal pain was undertaken . This review included r and omized clinical trials , as well as non-r and omized or observational studies in the analysis . Literature search included MEDLINE , EMBASE , systematic review s , narrative review s , cross-references to the review s and various published trials ; and peer review ed abstract s from scientific meetings during the past two years . An algorithmic approach was followed in study evaluation with a description of inclusion and exclusion criteria . A set of high-performing scales or checklists pertaining to r and omized clinical trials and observational trials derived from the Agency for Healthcare Research and Quality ( AHRQ ) was utilized ; Systems to Rate the Strength of Scientific Evidence . Qualitative analysis was conducted , using five levels of evidence for effectiveness of medial branch neurotomy . Our search strategy identified over 1,000 citations as the result of electronic and manual screening . A total of 7 r and omized trials of radiofrequency neurotomy for spinal pain were identified . However , only 4 related to medial branch neurotomy . Two of the four met the inclusion criteria . Among the multiple observational studies considered for inclusion , 4 prospect i ve evaluations were included in the systematic review . In addition , 3 retrospective evaluations were also included . Two r and omized trials comprised of 27 patients receiving active treatment . The first study consisted of cervical facet joint pain and the second consisted of lumbar facet joint pain . Both studies showed positive results . Similar to r and omized trials , prospect i ve , as well as retrospective evaluations showed positive evidence , both in short-term and long-term . The results of this systematic review of 2 well- design ed r and omized trials , 4 prospect i ve well- design ed trials without r and omization and 3 retrospective evaluations provided strong evidence that radiofrequency denervation offers short-term relief and moderate evidence of long-term pain relief of facet joint origin Spinal Manipulation ( SM ) has been purported to decrease pain and improve function in subjects with non-specific neck pain . Previous research has investigated which individuals with non-specific neck pain will be more likely to benefit from SM . It has not yet been proven whether or not the effectiveness of thoracic SM depends on the specific technique being used . This double-blind r and omized trial has compared the short-term effects of two thoracic SM maneuvers in subjects with chronic non-specific neck pain . Sixty participants were distributed r and omly into two groups . One group received the Dog technique ( n = 30 ) , with the subject in supine position , and the other group underwent the Toggle-Recoil technique ( n = 30 ) , with the participant lying prone , T4 being the targeted area in both cases . Evaluations were made of self-reported neck pain ( Visual Analogue Scale ) ; neck mobility ( Cervical Range of Motion ) ; and pressure pain threshold at the cervical and thoracic levels ( C4 and T4 spinous process ) and over the site described for location of tense b and s of the upper trapezius muscle . Measurements were taken before intervention , immediately afterward , and 20 min later . Both maneuvers improved neck mobility and mechanosensitivity and reduced pain in the short term . No major or clinical differences were found between the groups . In the between-groups comparison slightly better results were observed in the Toggle-Recoil group only for cervical extension ( p = 0.009 ) , right lateral flexion ( p = 0.004 ) and left rotation ( p < 0.05 ) Background Persisting neck pain is common in society . It has been reported that the prevalence of neck pain in office workers is much higher than in the general population . The costs to the worker , employer and society associated with work-related neck pain are known to be considerable and are escalating . The factors that place office workers at greater risk of developing neck pain are not understood . The aim of this study is to investigate the incidence and risk factors of work-related neck pain in Australian office workers . Methods / design We will conduct a prospect i ve cohort study . A cohort of office workers without neck pain will be followed over a 12 month period , after baseline measurement of potential risk factors . The categories of risk factors being evaluated are physical ( cervical spine posture , range of movement , muscle endurance and exercise frequency ) , demographic ( age , sex ) , work environment ( sitting duration , frequency of breaks ) and psychosocial ( psychological distress and psychosocial work factors ) . Cox regression analysis will be used to identify risk factors associated with work-related neck pain , and will be expressed as hazard ratios with 95 % confidence intervals . The data will also enable the incidence of neck pain in this population to be estimated . Discussion In addition to clarifying the magnitude of this occupational health problem these data could inform policy in workplaces and provide the basis for primary prevention of neck pain in office workers , targeting the identified risk factors This study investigated effects of physical exercise on  musculoskeletal pain symptoms in all regions of the body , as well as on other musculoskeletal pain in association with neck pain . A single blind r and omized controlled trial testing a one-year exercise intervention was performed among 549 office workers ;  specific neck/shoulder resistance training , all-round physical exercise , or a reference intervention . Pain symptoms were determined by question naire screening of twelve selected body regions . Case individuals were identified for each body region as those reporting pain intensities at baseline of 3 or more ( scale of 0 - 9 ) during the last three months . For neck cases specifically , the additional number of pain regions was counted . Intensity of pain decreased significantly more in the neck , low back , right elbow and right h and in cases of the two exercise groups compared with the reference group ( P<0.0001 - 0.05 ) . The additional number of pain regions in neck cases decreased in the two exercise groups only ( P<0.01 - 0.05 ) . In individuals with no or minor pain at baseline , development of pain was minor in all three groups . In conclusion , both specific resistance training and all-round physical exercise for office workers caused better effects than a reference intervention in relieving musculoskeletal pain symptoms in exposed regions of the upper body STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers The Leeds Assessment of Neuropathic Symptoms and Signs Scale ( LANSS ) is a simple bedside test in two parts-a patient-completed question naire and a brief clinical assessment . Its diagnostic capabilities have never been tested in patients with cancer pain . To determine these we conducted a prospect i ve study in out patients with head and neck cancer . All patients with pain completed the LANSS  and underwent a medical assessment with a palliative care physician , whose findings were then review ed by a pain specialist blinded to the LANSS scores . We assessed acceptability and underst and ing of the LANSS by patients and calculated the sensitivity and specificity of total LANSS scores and subscores derived from the patient-completed section . Of 130 patients approached , 125 took part . 25 ( 20 % ) of these had cancer related pain , mean score on an 11 point numerical rating scale 6.3 ( median 6.0 , range 3 - 10 ) . Average age was 60 years ( median 60 , range 27 - 84 ) ; 56 % were male .  LANSS completion time was about five minutes , and the procedure was acceptable to all patients . The pain specialist diagnosed neuropathic pain in 14/25 patients , in 13 of whom the neuropathic pain was part of a mixed pain picture . The LANSS correctly identified 11 of these cases ( sensitivity 79 % ; specificity 100 % ) . The patient-completed section alone had a sensitivity of 86 % and a specificity of 91 % . The LANSS is a simple and suitable screening test for neuropathic pain in patients with head and neck cancer related pain , although some modifications might improve it Study Design . An economic evaluation alongside a r and omized controlled trial comparing behavioral grade d activity ( BGA ) with manual therapy ( MT ) . Objective . To evaluate the cost-effectiveness of BGA in comparison with MT for patients with subacute neck pain from a societal perspective . Summary of Background Data . Neck pain is common and poses an important socioeconomic burden to society . Data on the cost-effectiveness of treatments for neck pain are scarce . Methods . A r and omized clinical trial was conducted , involving 146 patients with subacute nonspecific neck pain . The BGA program can be described as a time-contingent increase in activities from baseline toward predetermined goals . MT consists of specific spinal mobilization techniques and exercises . Clinical outcomes included recovery , pain , disability , and quality -adjusted life-years ( QALYs ) . Costs were measured from a societal perspective using cost diaries . The follow-up period was 52 weeks . Multiple imputation was used for missing cost and effect data . Uncertainty surrounding cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping . Cost-effectiveness planes and cost-effectiveness acceptability ( CEA ) curves were estimated . Results . BGA had no significant effect on recovery or QALYs gained in comparison with MT but pain and disability did improve significantly in the BGA group in comparison with the MT group . Total societal costs in the BGA group were nonsignificantly higher than in the MT group . Cost-effectiveness analyses showed that BGA is not cost-effective in comparison with MT for recovery and QALYs gained . Substantial investments are needed to reach a 0.95 probability that BGA is cost-effective in comparison with MT for pain and disability . Conclusion . On the basis of the data presented , we consider BGA not cost-effective in comparison with MT BACKGROUND Chronic refractory spinal pain poses a peculiar diagnostic challenge because of multiple putative pain sources , overlapping clinical features , and nonspecific radiologic findings . Diagnostic injection techniques are employed to isolate the source ( s ) of pain . Facet or zygapophysial joint pain is an example of spinal pain diagnosed by local anesthetic injections of the facet joint or its nerve supply . Diagnostic facet joint injections are expected to meet the cardinal features of a diagnostic test ( i.e. , accuracy , safety and reproducibility ) . Accuracy must be compared with a " gold " or criterion st and ard that can confirm presence or absence of a disease . There is , however , no available gold st and ard , such as biopsy , to measure presence or absence of pain . Hence , there is a degree of uncertainty concerning the accuracy of diagnostic facet joint injections . OBJECTIVES To evaluate accuracy , safety and reproducibility of facet or zygapophysial joint injections in diagnosing chronic spinal pain of facet joint origin . STUDY DESIGN A systematic review of the literature for clinical studies on efficacy and utility of facet joint/nerve injections in diagnosing spinal pain from facet joints . METHODS Relevant literature on diagnostic facet injections was identified through data base search es . Excluded were abstract s , review s , book chapters , case reports and studies based on single blocks or blocks without radiologic control . Prospect i ve studies with placebo control , or controlled comparative local anesthetic blocks , were given priority over retrospective studies . Each study was grade d using AHRQ and QUADAS criteria . The level of evidence was classified as conclusive , strong , moderate , limited , or inconclusive . RESULTS Available literature pointed to strong evidence for controlled comparative local anesthetic facet joint medial branch blocks in the diagnosis of neck and low back pain . There was moderate evidence in the diagnosis of pain arising from thoracic facet joints . CONCLUSION The evidence obtained from literature review suggests that controlled comparative local anesthetic blocks of facet joint nerves ( medial branch or dorsal ramus ) are reproducible , reasonably accurate , and safe . The sensitivity , specificity , false-positive rates , and predictive values of these diagnostic tests for neck and low back pain have been vali date d and reproduced in multiple studies The purpose of this study was to investigate the effects of a physical training course in a group of patients ( n = 74 ) suffering from chronic tension neck . All participants in the course were employed by a bank corporation in Helsinki , Finl and . A comparable control group ( n = 77 ) consisted of office workers with tension neck from the same bank corporation who did not attend any training course . The outcome was analysed 6 months after the course . Pain and disability in the neck and shoulder region did not vary significantly between the group which participated in the training course and the control group . The experimental group had increased the amount of physical workout  compared to the control group ( 83.7 % vs 69.0 % , P = 0.0448 ) . Also , regarding the frequency of relaxation and stretching exercises the two groups differed significantly : the experimental group had continued to perform exercises more often ( P = 0.0434 ) . The frequency of sick leave days did not significantly differ between the groups , but the office workers in the experimental group had more periods of extended sick leave ( > 10 days ) and the controls had more frequent short sick leaves . The experimental group did increase their physical workout significantly compared with the controls , but no differences were detected regarding pain and disability . In order to gain more benefit more attention should be paid to the educational part of the training courses in order to enhance the patients ' self-care abilities . Also , strategies to alleviate psychosocial problems and organized relaxation exercises could decrease muscle tension in the neck in office workers Context  Neck pain is common among primary care patients . Evidence on the effectiveness of therapies for neck pain is limited . A previous r and omized , controlled trial suggested benefits from manual therapy and physical therapy . Contribution This r and omized , controlled trial of manual therapy , physical therapy , and continued care by a doctor confirms the superiority of manual therapy and physical therapy over continued care . At 7 weeks , 68.3 % of patients in the manual therapy group reported resolved or much improved pain , compared with 50.8 % of patients in the physical therapy group and 35.9 % of patients in the continued care group . Clinical Implication s Primary care physicians should consider manual therapy when treating patients with neck pain .  The Editors Neck pain is a common problem in the general population , with point prevalences between 10 % and 15 % ( 1 - 3 ) . It is most common at approximately 50 years of age and is more common in women than in men ( 1 , 2 , 4 - 6 ) . Neck pain can be severely disabling and costly , and little is known about its clinical course ( 7 - 9 ) . Limited range of motion and a subjective feeling of stiffness may accompany neck pain , which is often precipitated or aggravated by neck movements or sustained neck postures . Headache , brachialgia , dizziness , and other signs and symptoms may also be present in combination with neck pain ( 10 , 11 ) . Although history taking and diagnostic examination can suggest a potential cause , in most cases the pathologic basis for neck pain is unclear and the pain is labeled nonspecific . Conservative treatment methods that are frequently used in general practice include analgesics , rest , or referral to a physical therapist or manual therapist ( 12 , 13 ) . Physical therapy may include passive treatment , such as massage , interferential current , or heat applications , and active treatment , such as exercise therapies . Physical therapists can specialize in passive manual ( or h and s-on ) techniques , including mobilization or manipulation ( high-velocity thrust techniques ) , also referred to as manual therapy ( 14 - 19 ) . According to the International Federation of Orthopedic Manipulative Therapies , Orthopedic manipulative ( manual ) therapy is a specialization within physical therapy and provides comprehensive conservative management for pain and other symptoms of neuro-musculo-articular dysfunction in the spine and extremities ( unpublished data ) . Today , many different manual therapy approaches are applied by various health professionals , including medical doctors , physical therapists , massage therapists , manual therapists , chiropractors , and osteopathic doctors . Review s of trials involving manual therapy or physical therapy show that most interventions in these categories are characterized by a combination of passive and active components ( 20 - 23 ) . Although a combination of manual therapy or physical therapy that includes exercises appears to be effective for neck pain , these therapies have not been studied in sufficient detail to draw firm conclusions , and the method ologic quality of most trials on neck pain is rather low ( 20 - 23 ) . Koes and colleagues ( 24 , 25 ) performed a r and omized trial on back and neck pain and found promising results for manual therapy and physical therapy in subgroup analyses of patients with neck pain . In our r and omized , controlled trial , we compared the effectiveness of manual therapy , physical therapy , and continued care by a general practitioner in patients with nonspecific neck pain . Methods Patients Patients with nonspecific neck pain whose clinical presentation did not warrant referral for further diagnostic screening were referred to one of four research centers by 42 general practitioners for study selection . We excluded patients whose history , signs , and symptoms suggested a potential nonbenign cause ( including previous surgery of the neck ) or evidence of a specific pathologic condition , such as malignancy , neurologic disease , fracture , herniated disc , or systemic rheumatic disease . Two research assistants who were experienced physical therapists and were blinded to treatment allocation performed physical examinations at baseline and follow-up . They used st and ardized inclusion and exclusion criteria and performed a short neurologic examination ( Appendix Table 1 ) and range-of-motion assessment . The eligibility criteria were age between 18 and 70 years , pain or stiffness in the neck for at least 2 weeks , neck symptoms reproducible during physical examination , willingness to adhere to treatment and measurement regimens , no physical therapy or manual therapy for neck pain during the previous 6 months , no involvement in litigation , and written informed consent . Patients with concurrent headaches , nonradicular pain in the upper extremities , and low back pain were not excluded , but neck pain had to be the main symptom for all patients . R and om Assignment and Data Collection All patient data were collected before r and omization . Patients were assigned to a treatment group on the basis of block r and omization after prestratification for symptom severity ( severity scores < 7 points or 7 points on a scale of 0 to 10 ) ; age ( < 40 years or 40 years ) ; and , mainly for practical reasons , research center ( four local centers ) . R and omized permuted blocks of six patients were generated for each stratum by using a computer-generated r and om-sequence table . A research er who was not involved in the project prepared opaque , sequentially numbered sealed envelopes that contained folded cards indicating one of the three interventions . Interventions The intervention period lasted 6 weeks . Patients were allowed to perform exercises at home and to continue medication prescribed at baseline or use over-the-counter analgesics . Other co- interventions were discouraged but were registered if they occurred . Within the boundaries of the protocol , treatment could be reassessed and adapted to the patient 's condition . The specific treatment characteristics were registered at each visit . A maximum number of visits was set for each intervention group ; however , the patients did not have to complete this maximum number if symptoms had resolved . Manual Therapy Our approach to manual therapy was eclectic and incorporated several techniques used in western Europe , North America , and Australia , including those described by Cyriax , Kaltenborn , Maitl and , and Mennel ( 15 , 16 , 19 ) . In our trial , manual therapy ( defined as the use of passive movements to help restore normal spinal function ) included h and s-on muscular mobilization techniques ( aim ed at improving soft tissue function ) , specific articular mobilization techniques ( to improve overall joint function and decrease any restrictions in movement at single or multiple segmental levels in the cervical spine ) , and coordination or stabilization techniques ( to improve postural control , coordination , and movement patterns by using the stabilizing cervical musculature ) ( 26 ) . Joint mobilization is a form of manual therapy that involves low-velocity passive movements within or at the limit of joint range of motion ( 27 ) . Manual therapists must undergo extensive training to be able to skillfully perform mobilization techniques ( 15 , 19 ) . Spinal manipulations ( low-amplitude , high-velocity thrust techniques ) were not included in this protocol . Forty-five minute treatment sessions were scheduled once per week , for a maximum of six treatments . Six experienced manual therapists acknowledged by the Netherl and s Manual Therapy Association performed the treatment . Physical Therapy The physical therapists used a combination of several treatment options , but active exercise therapies were the cornerstone of their strategy . Active exercise therapy involves participation by the patient and includes active exercises ( to improve strength or range of motion ) ,  postural exercises , stretching , relaxation exercises  , and functional exercises . Manual traction or stretching , massage , or physical therapy methods , such as interferential current or heat applications , could precede the exercise therapy . Specific manual mobilization techniques were not included in this protocol . Thirty-minute treatment sessions were scheduled twice per week for a maximum of 12 treatments . The treatment was performed by five experienced physical therapists . We prevented cross-contamination with manual therapy by choosing physical therapists who were not manual therapy specialists . Continued Care by a General Practitioner Each patient in this group received st and ardized care from his or her general practitioner , including advice on prognosis , advice on psychosocial issues , advice on self-care ( heat application , home exercises ) , advice on ergonomics ( for example , size of pillow , work position ) , and encouragement to await further recovery . The treatment protocol was similar to the practice guidelines for low back pain issued by the Dutch College of General Practitioners ( 28 ) . Patients received an educational booklet containing ergonomic advice and exercises ( 29 ) . Medication , including paracetamol or nonsteroidal anti-inflammatory drugs , was prescribed on a time-contingent basis if necessary . Ten-minute follow-up visits , scheduled every 2 weeks , were optional , and referral during the intervention period was discouraged . Outcome Measures Data were collected at the research center after 3 and 7 weeks . At 7 weeks , treatment results were expected to be maximal . The patients were repeatedly asked not to reveal any information about their treatment allocation to the research assistants . The success of blinding was evaluated at 7 weeks . Primary outcome measures focused on perceived recovery , pain , and functional disability . Patients rated perceived recovery on a 6-point ordinal transition scale , ranging from much worse to completely recovered . Success was defined a priori as completely recovered or much improved ( 30 ) . In addition , on the basis of the systematic assessment of spinal mobility , palpation , and pain reported by BACKGROUND Neck pain is associated with several alterations in neck motion and motor control , but most of the findings are based on cross-sectional studies . OBJECTIVE The aim of this study was to investigate associations between changes in neck motion and motor control , and changes in  neck pain and disability in physiotherapy patients during a course of treatment . DESIGN Prospect i ve cohort study . METHOD Subjects with non-specific neck pain ( n = 71 ) participated in this study . Neck flexibility , joint position error ( JPE ) , head steadiness , trajectory movement control and postural sway were recorded before commencement of physiotherapy ( baseline ) , at 2 weeks , and at 2 months . Numerical Rating Scale and Neck Disability Index were used to measure neck pain and disability at the day of testing . To analyze within subjects effects in neck motion and motor control , neck pain , and disability over time we used fixed effects linear regression analysis . RESULTS Changes in neck motion and motor control occurred primarily within 2 weeks . Reduction in neck pain was associated with increased cervical range of motion in flexion-/extension and increased postural sway when st and ing with eyes open . Decreased neck disability was associated with some variables for neck flexibility and trajectory movement control . Cervical range of motion in flexion-/extension was the only variable associated with changes in both neck pain and neck disability . CONCLUSIONS This study shows that few of the variables for neck motion and motor control were associated with changes neck pain and disability over a course of 2 months with physiotherapy treatment Objectives : To assess which psychological factors are important in the development of chronic whiplash symptoms . Methods : Search es were conducted across PubMed , CINAHL , Scopus , and PsychINFO up until March 2017 . Studies were included if they investigated psychological prognostic factors in association with recovery from a whiplash injury . Studies also had to be prospect i ve , cohort , follow-up or observational studies , have a 6 month follow-up and published in English . Quality assessment s were conducted by 2 independent review ers . Thirty-one articles were included investigating 34 psychological factors . Results : Poor expectations of recovery , posttraumatic stress symptoms and passive coping emerged as the most consistent prognostic factors of chronic neck pain and /or disability after a whiplash injury . Anxiety , travel anxiety , depression , personality , precollision distress , general psychological distress , and avoidance behavior were not associated with chronic whiplash problems OBJECTIVE To investigate the clinical course and prognostic factors of complaints of arm , neck , and shoulder . STUDY DESIGN AND SETTING A prospect i ve cohort study in physical therapy practice . Participating physiotherapists recruited new consulters with musculoskeletal complaints of the neck and /or upper extremities . Participants filled in question naires at baseline , 3 months , and 6 months . The main outcome measure was the persistence of complaints over 6-month follow-up . Possible predictors like social and psychological factors , physical factors , and complaint specific factors were tested in univariate and multivariate logistic regression analyses for repeated measurements . RESULTS Of the 624 participants at baseline 543 ( 87 % ) returned at least one follow-up question naire . At 6-month follow-up , 40 % had persisting pain and discomfort . Somatization , kinesiophobia , catastrophizing , and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months in the total population . In those with paid work ( 77 % ) , catastrophizing , low decision authority at work , and a long duration of complaints at baseline were significantly related to the persistence of complaints over 6 months . CONCLUSION 40 % of the participants had persisting pain and discomfort after 6 months and mainly social and psychological factors played a role in this course
Bearing in mind the limited number of studies and the low method ological quality , there are some indications that the localization ( radiation to the arms/neurologic signs ) and radiologic findings ( degenerative changes in the discs and joints ) are not associated with a worse prognosis .
A higher severity of pain and a history of previous attacks however , seems to be associated with a worse prognosis
Neck pain occurs frequently in western societies .
In the majority of cases , no specific cause can be identified .
In order to gain insight into the clinical course and prognostic factors of non-specific neck pain , a systematic review was conducted .