Evaluation of Nociceptive Processing in the Cervical Region
Condition: Pain, Neck
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      The main objective of this research is to asses the effectivity of action observation
      therapy, left/right discrimination and therapeutic exercise in the nociceptive processing of
      the cervical region.
    

Detailed description: 
      Neck pain is the fourth cause of loss of years due to disability, behind back pain,
      depression and joint pain. Studies show that about half of the population will experience at
      least one episode of the clinically important neck during their life. The vast majority of
      studies indicate a prevalence of neck pain that varies between 15% and 50%, including a
      systematic review with a ratio of 37.2%, the investigators can ensure that neck pain is a
      common pathology among the population. Among the variables associated with neck pain, besides
      rheumatology, include genetic, psychopathological variables (such as depression, anxiety,
      coping skills, somatization), sleep disorders, smoking and a sedentary lifestyle, among
      others. All those variables alter the nervous system in a proprioceptive level, so that deep
      and superficial flexor, as well as the rest of the muscles, they do not receive correct
      information that prevents them from processing properly the obtained information. Therefore,
      alterations also occur at central nervous system levels as in the processing of pain and its
      control by inhibitory descending systems.

      The most used treatment for neck pain is exercise. In a recent Cochrane review conducted by
      Gross A. et al., It has been proven, despite the shortage of high-quality studies, that the
      use of exercise routines based on strength and resistance training causes a reduction in
      pain.

      Motor imagery (MI) or graduated motor imagery (GMI) is defined as "the mental and dynamic
      process of action, without real movement execution" and the action observation (AO) consists
      in observing an action carried out by another person. These treatments are based on the
      ability of the nervous system to assimilate the images seen and process them until they reach
      the motor cortex, and thanks to the mirror neurons, the painful pattern decreases until it
      disappears. Thus, visualising a painful situation provokes and evokes in the brain, a painful
      experience, even when this is not actually happening.

      Therefore, the interruption of this neural network of cortical proprioceptive representations
      and integration of motor processes, also known as "body schema", is particularly relevant for
      movement and manual therapies. One way to measure the current state of the body scheme is
      through laterality tasks or "left / right judgement task" (LRJT), which have proven to be an
      effective and reliable tool and can also be used as a treatment.

      All of the above facilitates the possibility of using these tools as treatments focused on
      the cortical area with GMI. However, the effectiveness of MI is controversial. Some studies
      have been carried out in pathological patients, in a pilot study they confirmed the changes
      produced in the neck region, both by an increase in the range of movement and an increase in
      the pain threshold to pressure, focused on the population with chronic neck pain. It is
      difficult to find studies in healthy patients, although in recent years some publications on
      motor imagery can be found finding changes in the descending inhibitory systems of pain and
      its processing. Many variables such as the duration of the sessions, the time per exercise or
      the type of tasks to be performed, together with the lack of studies on the neck region and
      the comparison between different tasks and their respective affectation of the descending
      pain inhibitory systems, have led us to carry out this study.
    

Intervention name(s): Right Left Judgement; Action Observation; Exercise
Intervention type(s): Device; Other; Behavioral
Intervention description(s): It is an application by Noigroup (Neuro Orthopedic Institute), adapted to different devices.; Videos of cervical movements.; Evidence based exercises for the neck.
Other intervention name(s): Recognise® by Noigroup
Allocation: Randomized
Intervention model: Sequential Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Neck; Graded motor imagery; Exercise; Action Observation; Right/Left judgment tasks