Acute effects of single and multiple level thoracic manipulations on chronic mechanical neck pain: a randomized controlled trial

Background: Thoracic spine manipulation has become a popular alternative to local cervical manipulative therapy for mechanical neck pain. This study investigated the acute effects of single-level and multiple-level thoracic manipulations on chronic mechanical neck pain (CMNP). Methods: Forty-eight patients with CMNP were randomly allocated to single-level thoracic manipulation (STM) at T6–T7 or multiple-level thoracic manipulation (MTM), or to a control group (prone lying). Cervical range of motion (CROM), visual analog scale (VAS), and the Thai version of the Neck Disability Index (NDI-TH) scores were measured at baseline, and at 24-hour and at 1-week follow-up. Results: At 24-hour and 1-week follow-up, neck disability and pain levels were significantly (P<0.05) improved in the STM and MTM groups compared with the control group. CROM in flexion and left lateral flexion were increased significantly (P<0.05) in the STM group when compared with the control group at 1-week follow-up. The CROM in right rotation was increased significantly after MTM compared to the control group (P<0.05) at 24-hour follow-up. There were no statistically significant differences in neck disability, pain level at rest, and CROM between the STM and MTM groups. Conclusion: These results suggest that both single-level and multiple-level thoracic manipulation improve neck disability, pain levels, and CROM at 24-hour and 1-week follow-up in patients with CMNP.Rungthip Puntumetakul, Thavatchai Suvarnnato, Phurichaya Werasirirat, Sureeporn Uthaikhup, Junichiro Yamauchi, Rose Boucau

Effectiveness of physiotherapy for seniors with recurrent headaches associated with neck pain and dysfunction: a randomized controlled trial

Background Context A previous study demonstrated that in seniors, the presence of cervical musculoskeletal impairment was not specific to cervicogenic headache but was present in various recurrent headache types. Physiotherapy treatment is indicated in those seniors diagnosed with cervicogenic headache but could also be adjunct treatment for those with cervical musculoskeletal signs who are suspected of having transitional headaches. Purpose This study aimed to determine the effectiveness of a physiotherapy program for seniors with recurrent headaches associated with neck pain and cervical musculoskeletal dysfunction, irrespective of the headache classification. Study Design This is a prospective, stratified, randomized controlled trial with blinded outcome assessment. Patient Sample Sixty-five participants with recurrent headache, aged 50–75 years, were randomly assigned to either a physiotherapy (n=33) or a usual care group (n=32). Outcome Measures The primary outcome was headache frequency. Secondary outcomes were headache intensity and duration, neck pain and disability, cervical range of motion, quality of life, participant satisfaction, and medication intake. Methods Participants in the physiotherapy group received 14 treatment sessions. Participants in the usual care group continued with their usual care. Outcome measures were recorded at baseline, 11 weeks, 6 months, and 9 months. This study was funded by a government research fund of $6,850. No conflict of interest is declared. Results There was no loss to follow-up for the primary outcome measure. Compared with usual care, participants receiving physiotherapy reported significant reductions in headache frequency immediately after treatment (mean difference −1.6 days, 95% confidence interval [CI] −2.5 to −0.6), at 6-month follow-up (−1.7 days, 95% CI −2.6 to −0.8), and at 9-month follow-up (−2.4 days, 95% CI −3.2 to −1.5), and significant improvements in all secondary outcomes immediately posttreatment and at 6- and 9-month follow-ups, (

Immedicate Effects of Core Stabilization Exercise on β-Endorphin and Cortisol Levels Among Patients With Chronic Nonspecific Low Back Pain: A Randomized Crossover Design

Objective: Core stabilization exercise (CSE) is widely prescribed to treat chronic non-specific low back pain (CLBP). However, the neuro-endogenous mechanism behind the pain relieving effect by CSE is still unknown. The main objective of the study was to measure the levels of plasma beta-endorphin (PB) and plasma cortisol (PC) under CSE, placebo and control conditions in CLBP patients. Methods: Twenty-four subjects with CLBP participated in a randomized, placebo-controlled, cross-over design study. There were 3 experimental exercise conditions; control condition (positioning in crook lying and rest), placebo condition (passive cycling in crook lying using automatic cycler), and CSE on a Pilates device tested with 48 hours interval between sessions by concealed randomization. Blood sample was collected before and after the exercise conditions. PB and PC were measured through enzyme-linked immunosorbent assay and electrochemiluminescence in Cobas E411 auto analyzer. Result: PB level showed a significant difference before and after the CSE condition (P&lt;0.05), while no significant differences were noticed in control and placebo exercise conditions. Also, the trend of elevation of PB under the CSE was significantly different when compared to the placebo and control conditions (P&lt;0.01). In contrast, the PC level remains unchanged in all the three conditions. Conclusion: CSE potentially influences PB level but not PC level among CLBP patients. The mechanism of action for pain relieving effect by CSE might be possibly related to an endogenous opioid mechanism as part of its effects, and might not be involved with ‘stress induced analgesia mechanism

Is pain sensitivity altered in people with Alzheimer's disease? A systematic review and meta-analysis of experimental pain research

Background: Clinical studies suggest people with Alzheimer's disease (AD) have altered pain sensitivity. Experimental pain research is equivocal. Objective: Conduct a meta-analysis to investigate if people with AD have altered pain sensitivity compared to healthy controls (HCs). Methods: Three authors searched electronic databases from inception till November 2015 for experimental pain studies in AD vs. HCs. Outcome measures were pain threshold, tolerance, pain ratings, heart rate response to nox- ious stimuli and the Facial Action Coding System (FACS). Random effect meta-analysis calculating Hedges' g ± 95% confidence intervals (CI) was conducted. Results: Thirteen studies were identified, including 256 people with AD (74.6 (±5.6) years, 59% females with a mean mini mental state examination (MMSE) score of 19.2) and 260 HCs. Meta-analysis demonstrated no signif- icant difference in pain threshold (g = 0.025, 95% CI −0.315-0.363, p = 0.88, n AD = 135, n HCs = 157), pain tolerance (g = −0.363, 95% CI −2.035-1.309, p = 0.67, n AD = 41, n HCs = 53) or pain intensity ratings (g = 0.03, p = 0.89, n AD = 138, n HCs = 135). Heart rate response to pain was less pronounced in AD but not significant (g = −0.746, p = 0.11). People with AD (n = 90) had significantly higher FACS scores versus HCs (n = 109) (g = 0.442, p = 0.03) indicating increased pain. Meta-regression demonstrated that an increasing percentage of AD female participants moderated pain threshold (p = 0.02) whilst MMSE scores did not (p = 0.19). Conclusion: People with AD have a greater sensitivity to pain when validated observer ratings of facial expres- sions are used. Verbal response to painful stimuli, even under experimental conditions, may mean pain is not identified in people with AD. Clinically useful observer rated pain tools may be the most appropriate way to as- sess pain in AD

International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study

Background: A wide range of physical tests have been published for use in the assessment of musculoskeletal dysfunction in patients with headache. Which tests are used depends on a physiotherapist's clinical and scientific background as there is little guidance on the most clinically useful tests. Objectives: To identify which physical examination tests international experts in physiotherapy consider the most clinically useful for the assessment of patients with headache. Design/methods: Delphi survey with pre-specified procedures based on a systematic search of the literature for physical examination tests proposed for the assessment of musculoskeletal dysfunction in patients with headache. Results: Seventeen experts completed all three rounds of the survey. Fifteen tests were included in round one with eleven additional tests suggested by the experts. Finally eleven physical examination tests were considered clinically useful: manual joint palpation, the cranio-cervical flexion test, the cervical flexion-rotation test, active range of cervical movement, head forward position, trigger point palpation, muscle tests of the shoulder girdle, passive physiological intervertebral movements, reproduction and resolution of headache symptoms, screening of the thoracic spine, and combined movement tests. Conclusions: Eleven tests are suggested as a minimum standard for the physical examination of musculoskeletal dysfunctions in patients with headache

HEADACHE IN THE ELDERLY: CERVICAL MUSCULOSKELETAL, SENSORY AND PSYCHOLOGICAL FEATURES

Background: Headache is common in the elderly. Cervical degenerative changes are universal with ageing and cervicogenic headache is proposed (albeit without evidence) as a frequent cause of headache in this age group. Previous research identified a pattern of cervical musculoskeletal impairment which differentiated cervicogenic headache from other frequent headaches but this study was undertaken on younger/middle aged individuals. The value of this diagnostic pattern could be questioned for an older population with concomitant age related changes in the musculoskeletal system. The first and foremost aim of this research was to determine if cervical musculoskeletal impairment was specific to headaches classifiable as cervicogenic or was more generic to headache in elders. Participants with headache were sub-grouped on the basis of the pattern of cervical musculoskeletal impairment and the relationship between this grouping and headache classification was investigated. The presence of sensory hypersensitivity and psychological distress are features of headache that can provide information on the underlying mechanisms and provide management directives for headache. There is little knowledge of whether or not these features are influenced by a factor of age. Thus the second and third aims of this research were to investigate sensory features and psychological and quality of life features in the elderly with headache. Methods: One hundred and eighteen subjects, aged 60 to 75 years with recurrent headache and 44 controls were studied. Ninety-three reported a single headache and 25, two or more headache types. All subjects completed the Neck Disability Index (NDI), Geriatric Depression Scale-short form (GDS-S) and SF-36 questionnaires. Subjects with headache also completed a headache questionnaire and the Survey of Pain Attitudes (SOPA-35). Neck function measures included range of motion, manual examination of cervical segments, cranio-cervical flexor muscle function, joint position sense, cervical muscle strength, cross-sectional area of selected cervical extensors and posture. Sensory measures included pressure pain thresholds (PPTs) and thermal pain thresholds (TPTs). PPTs were measured over the forehead, upper neck and at a remote site (tibialis anterior). TPTs were measured over the upper neck. Results: Cluster analysis, based on the three musculoskeletal variables aligned previously with cervicogenic headache, divided headache subjects into two groups; cluster 1 (n = 57), cluster 2 (n = 50). There was significantly reduced cervical extension, axial rotation, rotation in neck flexion and lateral flexion in the headache clusters than the control group, and in the frequency of symptomatic joint dysfunction (C0-1 – C7-T1) (all p 0.05). Heat pain thresholds were significantly lower in the headache groups compared to controls (all p 0.05). There were no strong relationships between any headache variable and pain thresholds. Elders with headache scored lower on most SF-36 domains, higher on the GDS-S (p 0.05) compared to the control group. The GDS score was below the threshold value for depression. Differences in these measures were not dependent on the headache types but rather, headache frequency. Subjects with headaches ≥ 15 days/month scored lowest on SF-36 domains and highest on GDS-S questionnaire compared to those with headache < 15 days/month and controls (all p < 0.05). The mean NDI score in the subjects with headache indicated the presence of mild to moderate neck pain and disability. No strong relationships were found between well-being and headache frequency, intensity and length of headache history. The NDI score had the greatest influence on physical well-being and GDS-S score on mental well-being (p < 0.001). Conclusions: Several aspects of cervical musculoskeletal function, heat thresholds, general well being and quality of life were altered in elders with headache. Neck dysfunction was not uniquely confined to cervicogenic headache but was a generic feature of headache in the elderly. No generalized changes in pain sensitivity were present in elders with headache. Headache had a significant impact on elders’ quality of life but was not associated with depression. Neck pain was an important factor influencing function and well-being. Conservative management such as physiotherapy may be a safe and appropriate option for elders with headache, given its frequent association with cervical musculoskeletal impairment. Further research is required for a better understanding of the neck’s role in elders’ headache

Cervical musculoskeletal impairment is common in elders with headache

There is an opinion that with increasing cervical degenerative joint disease with ageing, cervicogenic headaches become more frequent. This Study aimed to determine if cervical musculoskeletal dysfunction was specific to headache classifiable as cervicogenic or was more generic to headache in elders. Subjects (n = 118), aged 60-75 years with recurrent headache and 44 controls were recruited. Neck function measures included range of motion (ROM), cervical joint dysfunction, cranio-cervical flexor muscle function, joint position sense (JPS) and cervical muscle strength. A questionnaire documented the characteristics of headaches for classification. A cluster analysis based on three musculoskeletal variables aligned previously with cervicogenic headache, divided headache subjects into two groups; cluster 1 (n = 57), cluster 2 (n = 50). Dysfunctions were greater in cluster I than in 2 for extension range and C1-2 joint dysfunction (p < 0.05). Most cervicogenic headaches were grouped in cluster 1, but musculoskeletal dysfunction was also found in headaches classifiable as migraine or tension-type headache. Neck dysfunction is not uniquely confined to cervicogenic headache in elders. Further research such as headache responsiveness to management of the neck disorder is required to better understand about the neck's causative or contributing role to elders' headache. (C) 2009 Elsevier Ltd. All rights reserved

Psychological, cognitive and quality of life features in the elderly with chronic headache

Chronic headache is common in the elderly, but there is little specific research on the impact on quality of life of headache and beliefs about pain in this age group. This study investigated the influence of headache type as well as headache frequency (>= 15 headache days/month vs