SENSORY RE-TRAINING IN PATIENTS WITH CHRONIC NECK PAIN

Study Overview
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Brief Summary
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It is known that tactile acuity and proprioceptive sense decrease in patients with chronic neck pain. However, sensory re-training in patients with chronic neck pain has not been given sufficient importance. The effects of proprioceptive and tactile acuity training on pain intensity in patients with chronic neck pain will be compared in this study. Eligible participants will be divided into three groups as follows: Proprioceptive Training Group (PTG), Tactile Acuity Training Group (TAG), and Control Group (CG). The randomization will be performed using the block randomization method to obtain an equal number of participants in the groups. Each participant will be evaluated two times at a 4-week interval. Participants will be evaluated regarding subjective pain intensity by using a Numerical Rating Scale, temporal summation, and conditioned pain modulation using an algometer (JTECH Medical-Algometer Commander, USA). Neck proprioception exercises will be applied to the patients in the PTG at 3 days a week for 4 weeks. Tactile acuity training will be applied to the patients in the TAG 3 days a week for 4 weeks. Between the two assessments, the Control Group will not receive any treatment.

Official Title
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Comparison of the Effects of Proprioception and Tactile Accuracy Training on Proprioception, Range of Motion, Pain and Disability in Patients With Chronic Neck Pain

Conditions
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Neck Pain, Cervical Pain, Neck Muscle Issue, Neck Pain, Posterior, Cervical Pain, Posterior

Intervention / Treatment
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* Other: Proprioceptive Training Exercise
* Other: Tactile Acuity Training
* Other: Control Group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: to be aged between 20-60 years old Pain limited to the posterior of the cervical region. Pain that lasts longer than 3 months Pain severity of 3 or higher on the Visual Analog Scale Exclusion Criteria: Malignant tumor in any part of the body (no screening will be performed for the presence of tumor and patients diagnosed with tumors before the study will not be included). Vertebral fractures Fibromyalgia chronic fatigue syndrome History of surgery in the neck or shoulder area Radicular pain Neurological deficit of disc pathologies Spinal stenosis Spondylolisthesis Pronounced cervical kyphosis Significant scoliosis involving the cervical region

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Proprioceptive Training Group<br>oculomotor exercises will be applied to the participants three times a week for four weeks. oculomotor exercises: head relocation gaze stability eye follow saccadic eye movement head and eye coordination | Other: Proprioceptive Training Exercise<br>* oculomotor exercises will be applied to the participants three times a week for four weeks. oculomotor exercises: head relocation gaze stability eye follow saccadic eye movement head and eye coordination<br>|
| Experimental: Tactile Acuity Training<br>Participants will be requested to lie face down. Five points will be marked in the painful areas on the right and left sides of the neck. The distance between the points will equal the two-point discrimination value. A photograph of the neck will be taken. The patient will not see his/her own neck during the application but see the photograph of his/her neck. The points will be touched lightly with two different stimuli (a pen with a 2 mm diameter and a mushroom probe with an 11 mm diameter). Participants will be asked about the location and type of the stimuli. The interstimulus interval will be 15 seconds. If more than 90% of correct answers are obtained, the distance between the points will be reduced by 10%. The training will be performed in three separate blocks, a total of 72 stimuli (block duration = 6 minutes, rest time between blocks = 3 minutes, number of stimuli applied in each block = 24 stimuli). The treatment time will be 24 minutes. | Other: Tactile Acuity Training<br>* Participants will be requested to lie face down. Five points will be marked in the painful areas on the right and left sides of the neck. The distance between the points will equal the two-point discrimination value. A photograph of the neck will be taken. The patient will not see his/her own neck during the application but see the photograph of his/her neck. The points will be touched lightly with two different stimuli (a pen with a 2 mm diameter and a mushroom probe with an 11 mm diameter). Participants will be asked about the location and type of the stimuli. The interstimulus interval will be 15 seconds. If more than 90% of correct answers are obtained, the distance between the points will be reduced by 10%. The training will be performed in three separate blocks, a total of 72 stimuli (block duration = 6 minutes, rest time between blocks = 3 minutes, number of stimuli applied in each block = 24 stimuli). The treatment time will be 24 minutes.<br>|
| Sham Comparator: Control Group<br>The participants will be evaluated two times at 4-week intervals. No intervention will be applied during the time frame. | Other: Control Group<br>* The participants will be evaluated two times at 4-week intervals. No intervention will be applied during the time frame.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain intensity | It will be evaluated using a Numerical Rating Scale (0 indicate no pain, 10 indicate most vulnerable pain) | Change form baseline at 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pressure pain threshold | It will be evaluated in the middle of the upper trapezius muscle and the dominant side of the tibialis anterior muscle. It will be evaluated two times at 30-second intervals. The average of value will be recorded. | Change form baseline at 4 weeks | 
| temporal summation | It will be evaluated in the middle of the upper trapezius muscle. 10 subsequent stimuli with a 1-second application at the level of pressure pain threshold and 1-second rest. Pain intensity at 1, 5 and 10th stimuli will be asked based on the Numerical Rating Scale. | Change form baseline at 4 weeks | 
| conditioned pain modulation | The sphygmomanometer will be applied on the arm which is the contralateral side of the upper trapezius. It will be inflated at a rate of 20 mm/Hg and held at this value for 30 seconds. Then, the patient's pain intensity will be questioned according to the numerical pain scale. | Change form baseline at 4 weeks | 
| neck disability | A neck disability questionnaire (NDI) will be used | Change form baseline at 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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oculomotor exercises, neck pain, cervical pain, sensory re-training