The Effect of Auditory and Motor Cognitive Distractions on the Neural Provocation Test in Subjects With Neck Pain

Study Overview
=================
Brief Summary
-----------------
The main objective of this research is to evaluate the influence of different distraction stimuli on neural mechano-sensitivity tests.

Official Title
-----------------
The Effect of Auditory and Motor Cognitive Distractions on the Neural Provocation Test in Subjects With Neck Pain: A Randomized Controlled Trial

Conditions
-----------------
Chronic Pain

Intervention / Treatment
-----------------
* Behavioral: median nerve mobilization
* Behavioral: Neural stress provocation with cognitive auditory distraction
* Behavioral: Providing neural stress with a motor distraction
* Behavioral: Neural stress provocation with auditory and motor cognitive distraction.


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Men and women aged between 18 and 65 years Medical diagnosis of non specific chronic neck pain with more than 6 months of evolution of neck pain Exclusion Criteria: Patients with rheumatic diseases, cervical hernia, cervical whiplash syndrome, neck surgeries o a history of arthrodesis Systemic diseases Vision, hearing or vestibular problems Severe trauma or a traffic accident that had an impact on the cervical area.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Neural Stress Provoked by the Median Nerve<br> | Behavioral: median nerve mobilization<br>* The patient is placed in a supine position and his cervical spine with 25º of lateral flexion on the opposite side of the member in which we perform the test. First a passive scapular depression is performed, 90º of shoulder abduction combining external shoulder rotation. Next, a supination of the forearm is performed with wrist extension and finger extension. Finally, the elbow is extended to the limit of resistance or when the investigator observes the elevation of the shoulder girdle.<br>|
| Experimental: Neural stress provocation with cognitive auditory distraction<br> | Behavioral: Neural stress provocation with cognitive auditory distraction<br>* Neural provocation of the median nerve is performed but an auditory distraction is added with a metronome with a constant time of 50 beats per minute.<br>|
| Experimental: Providing neural stress with a motor distraction<br> | Behavioral: Providing neural stress with a motor distraction<br>* The neural provocation of the median nerve is performed and we add a motor distraction that consists of the patient intermittently squeezing a ball with the opposite hand.<br>|
| Experimental: Neural stress provocation with both distractions<br> | Behavioral: Neural stress provocation with auditory and motor cognitive distraction.<br>* The neural provocation of the median nerve is performed, we add auditory distraction with the metronome with a constant time of 50 BPM and a motor distraction consisting of squeezing a ball to the rhythm that sounds the metronome.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mechanosensitivity based on range of motion | The inclinometer, an instrument characterized by the constant use of gravity as a reference point to evaluate mobility, is used to evaluate the range of nerve movement. | Change in pressure pain threshold immediately at the end of the intervention | 
| Pain intensity | It is the subjective feeling of self-reported pain ranging from 0-100 points. | Change in pain intensity immediately at the end of the intervention |