A study published in 2015 in Manual Therapy evaluated the effectiveness of neck and aerobic
training along with pain education vs. pain education alone on neck pain,
muscle activity, and postural sway in patients with chronic neck pain. The study was a single blind randomized
controlled trial with a parallel group design.
Fifteen patients completed the study at a pain clinic. 8 patients were in the control group and 7
patients were in the intervention group.
Effect on neck pain,
function, and Global Perceived Effect (GPE) was measured before and after the
intervention on both groups using the Cranio-Cervical Flexion Test and three
postural control tests. Surface
electromyography was recorded from neck flexor and extensor muscles during the
tests.
Both the intervention group and the control group received
four 1.5 hour sessions of pain education.
The intervention group also received eight supervised .5 hour training
sessions with instruction in progressive neck, shoulder and balance exercises,
as well as aerobic training. The
patients were instructed to perform the exercises twice a day and the aerobic
training every other day.
The intention-to-treat analysis revealed that both groups
experienced a reduction in pain as measured by the Numeric Rating Scale for
Pain, but the intervention group experienced a greater reduction as well as
increased GPE. The reduction in pain for
the intervention group was larger than two points, which is considered
clinically relevant. This study provided
evidence that both pain education and specific training exercises reduce neck
pain more than pain education alone.
Were the researchers able to do any follow to up to see long term effects?
ReplyDeleteI'm really digging Erin seeking out knowledge on manual therapy. She should come by HP sometime - Sam is getting the full course of learning all kinds of manual therapy for the cervico-thoracic spine and upper extremity, and he's doing wonderfully so far.
ReplyDeleteAs for long term effects, Meghan - long term effects in chronic pain (especially for the neck) with interventions alone is generally poor to fair when it comes to physical interventions; there are some reasons to why this might be, and why OT is so important for this:
There has been quite a trend towards using aerobic activity for chronic pain since it had been consistently correlated to treating Fibromyalgia pain, and generally exercise tends to be a strong choice for treating uncomplicated neck pain due to its ability to mobilize vertebral joints effectively. Even with the resurgence of dry needling/myofascial pain modalities since the early 2000's and a better understanding of the role of joint mobilization/manipulation in cervical spinal pain, outcomes in chronic pain still remain poor. This is entirely because chronic pain, at its root, is a cognitive-behavioral, volitional, and neuroplastic condition that is often without nociception or appreciable tissue damage. The present trend towards treating chronic pain in the pain management community is cognitive-behavioral (which I actually don't agree with - I firmly believe its better treated with a volition/motivation enhancement approach; I'll save why for another time, but think MOHO) in the context of daily life. There has NEVER been a more appropriate realm in the context for pain for OT to address.
If any of the students wish to address chronic pain, then I cannot urge them enough to start taking stock in their psych skills as soon as possible. Chronic pain outcomes in the long term are dependent upon creating changes in patient volition and challenging "pain behaviors" and secondary gain behaviors that pervade their daily activities - many of these habits, routines, and pain rituals, patients are not aware of. If you can grant your patient the ability to identify their own problem behaviors, and then to enhance their own motivation to change said behaviors, then you are infinitely more likely to maintain the efficacy of your physical/manual modality outcomes. The evidence seems to support this quite a lot!
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ReplyDeleteNice, thanks Dan! Just another great example of how you can't really separate out mental health/psychosocial from physical disabilities (in my humble opinion).
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