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Chronic Neck Pain

Revisiting Risk-stratified Whiplash-exposed Patients 12 to 14 Years After Injury

By |May 14, 2021|Chronic Low Back Pain, Chronic Neck Pain, Chronic Spinal Pain, Whiplash|

Revisiting Risk-stratified Whiplash-exposed Patients 12 to 14 Years After Injury

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SOURCE:   Clinical Journal of Pain 2020 (Dec)

   OPEN ACCESS   

Martin K Rasmussen 1 2, Alice Kongsted 3 4, Tina Carstensen 5 6, Troels S Jensen 1 6, Helge Kasch 6 7

1   Danish Pain Research Centre Aarhus University Hospital.

2   Center for Translational Neuromedicine, Copenhagen University, Copenhagen, Denmark.

3   Department of Sports Science and Clinical Biomechanics, University of Southern Denmark.


Objective:   The objective of this study was to evaluate the long-term predictive value of the Danish Whiplash Group Risk Assessment Score (DWGRAS) with 7 risk strata.

Design:   E-questionnaire-based follow-up study (n=927) combining 2 cohorts of whiplash-injured patients, 1 observational (n=187) and 1 interventional randomized controlled trial (n=740).

Methods:   Nine hundred twenty-seven previously healthy persons exposed to acute whiplash injury during motor vehicle collision were sent letter by postal service asking the addressee if they would respond to an E-questionnaire. Outcome measures were: whiplash-related disability, pain, use of medication/nonmedical treatment, work capacity.

Results:   The response rate was 37%. Fifty-five percent reported whiplash-related disability. Fourteen percent reported daily symptoms. A strong relationship was found between risk strata and impact of event and between risk strata and disabling symptoms.

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Neck Pain Patterns and Subgrouping

By |December 6, 2020|Chronic Neck Pain|

Neck Pain Patterns and Subgrouping Based on Weekly SMS-derived Trajectories

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SOURCE:   BMC Musculoskelet Disord 2020 (Oct 14)

P. Irgens, A. Kongsted, B. L. Myhrvold, K. Waagan, K. B. Engebretsen, B. Natvig, N. K. Vøllestad, and H. S. Robinson

Department of Interdisciplinary Health Sciences,
Institute of Health and Society,
University of Oslo, P.O. Box 1089,
Blindern, 0317, Oslo, Norway.


 

Background: Neck and low back pain represent dynamic conditions that change over time, often with an initial improvement after the onset of a new episode, followed by flare-ups or variations in intensity. Pain trajectories were previously defined based on longitudinal studies of temporal patterns and pain intensity of individuals with low back pain. In this study, we aimed to 1) investigate if the defined patterns and subgroups for low back pain were applicable to neck pain patients in chiropractic practice, 2) explore the robustness of the defined patterns, and 3) investigate if patients within the various patterns differ concerning characteristics and clinical findings.

Methods: Prospective cohort study including 1208 neck pain patients from chiropractic practice. Patients responded to weekly SMS-questions about pain intensity and frequency over 43 weeks. We categorized individual responses into four main patterns based on number of days with pain and variations in pain intensity, and subdivided each into four subgroups based on pain intensity, resulting in 16 trajectory subgroups. We compared baseline characteristics and clinical findings between patterns and between Persistent fluctuating and Episodic subgroups.

Results: All but two patients could be classified into one of the 16 subgroups, with 94% in the Persistent fluctuating or Episodic patterns.

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Predictors of Visit Frequency for Patients

By |May 20, 2020|Chronic Low Back Pain, Chronic Neck Pain|

Predictors of Visit Frequency for Patients Using Ongoing Chiropractic Care for Chronic Low Back and Chronic Neck Pain; Analysis of Observational Data

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SOURCE:   BMC Musculoskeletal Disorders 2020 (May 13); 21 (1): 298

Patricia M. Herman, PhD, Sarah E. Edgington, PhD, Eric L. Hurwitz, DC, PhD, & Ian D. Coulter, PhD

RAND Corporation,
Santa Monica, CA, USA.


 

Background:   Chronic spinal pain is prevalent, expensive and long-lasting. Several provider-based nonpharmacologic therapies have now been recommended for chronic low-back pain (CLBP) and chronic neck pain (CNP). However, healthcare and coverage policies provide little guidance or evidence regarding the long-term use of this care. To provide one glimpse into the long-term use of nonpharmacologic provider-based care, this study examines the predictors of visit frequency in a large sample of patients with CLBP and CNP using ongoing chiropractic care.

Methods:   Observational data were collected from a large national sample of chiropractic patients in the US with non-specific CLBP and CNP. Visit frequency was defined as average number of chiropractic visits per month over the 3-month study period. Potential baseline predictor variables were entered into two sets of multi-level models according to a defined causal theory-in this case, Anderson’s Behavioral Model of Health Services Use.

Results:   Our sample included 852 patients with CLBP and 705 with CNP. Visit frequency varied significantly by chiropractor/clinic, so our models controlled for this clustering. Patients with either condition used an average of 2.3 visits per month. In the final models visit frequency increased (0.44 visits per month, p = .008)

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The Global Spine Care Initiative

By |August 10, 2019|Chronic Neck Pain, Low Back Pain|

The Global Spine Care Initiative: Applying Evidence-based Guidelines on the Non-invasive Management of Back and Neck Pain to Low- and Middle-income Communities

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SOURCE:   European Spine Journal 2018 (Sep); 27 (Suppl 6): 851–860

Roger Chou, Pierre Côté, Kristi Randhawa, Paola Torres, Hainan Yu, Margareta Nordin, Eric L. Hurwitz, Scott Haldeman, Christine Cedraschi

Department of Medical Informatics and Clinical Epidemiology,
Oregon Health and Science University,
Portland, OR, USA.


PURPOSE:   The purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain.

METHODS:   We synthesized two evidence-based clinical practice guidelines for the management of low back and neck pain. Our recommendations considered benefits, harms, quality of evidence, and costs, with attention to feasibility in medically underserved areas and low- and middle-income countries.

RESULTS:   Clinicians should provide education and reassurance, advise patients to remain active, and provide information about self-care options. For acute low back and neck pain without serious pathology, primary conservative treatment options are exercise, manual therapy, superficial heat, and nonsteroidal anti-inflammatory drugs (NSAIDs).

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The Course of Serum Inflammatory Biomarkers

By |May 10, 2019|Chronic Neck Pain, Whiplash|

The Course of Serum Inflammatory Biomarkers Following Whiplash Injury and their Relationship to Sensory and Muscle Measures: A Longitudinal Cohort Study

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SOURCE:   PLoS One. 2013 (Oct 17); 8 (10): e77903

Michele Sterling, James M. Elliott, and Peter J. Cabot

Centre of National Research on Disability and Rehabilitation Medicine (CONROD),
The University of Queensland, Brisbane,
Queensland, Australia.


Tissue damage or pathological alterations are not detectable in the majority of people with whiplash associated disorders (WAD). Widespread hyperalgisa, morphological muscle changes and psychological distress are common features of WAD. However little is known about the presence of inflammation and its association with symptom persistence or the clinical presentation of WAD. This study aimed to prospectively investigate changes in serum inflammatory biomarker levels from the acute (<3 weeks) to chronic (>3 months) stages of whiplash injury.

It also aimed to determine relationships between biomarker levels and hyperalgesia, fatty muscle infiltrates of the cervical extensors identified on MRI and psychological factors. 40 volunteers with acute WAD and 18 healthy controls participated. Participants with WAD were classified at 3 months as recovered/mild disability or having moderate/severe disability using the Neck Disability Index. At baseline both WAD groups showed elevated serum levels of C-reactive protein (CRP) but by 3 months levels remained elevated only in the moderate/severe group.

The recovered/mild disability WAD group had higher levels of TNF-α at both time points than both the moderate/severe WAD group and healthy controls. There were no differences found in serum IL-1β. Moderate relationships were found between hyperalgesia and CRP at both time points and between hyperalgesia and IL-1β 3 months post injury. There was a moderate negative correlation between TNF-α and amount of fatty muscle infiltrate and pain intensity at 3 months.

Only a weak relationship was found between CRP and pain catastrophising and no relationship between biomarker levels and posttraumatic stress symptoms. The results of the study indicate that inflammatory biomarkers may play a role in outcomes following whiplash injury as well as being associated with hyperalgesia and fatty muscle infiltrate in the cervical extensors.


From the FULL TEXT Article:

Introduction

Whiplash associated disorders (WAD) are a common and costly health problem for western society. Many (up to 50%) of those injured transition to chronicity [1] and current management approaches for both acute and chronic WAD are only modestly effective. [2, 3] Further understanding of processes underlying ongoing pain and disability following whiplash injury may facilitate new directions for management of this condition and improve health outcomes.

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Exposure to a Motor Vehicle Collision and the Risk

By |May 1, 2019|Chronic Neck Pain, Whiplash|

Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-analysis

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SOURCE:   PM R. 2019 (Apr 25) [Epub]

Paul S. Nolet, DC, MS, MPH, Peter C. Emary, DC, MSc, Vicki L. Kristman, PhD, Kent Murnaghan, MA MISt,
Maurice P. Zeegers, PhD, Michael D. Freeman, MedDr, PhD

Care and Public Health Research Institute,
Maastricht University,
Maastricht, Netherlands.


OBJECTIVE:   To summarize the literature that has examined the association between a motor vehicle collision (MVC) related neck injury and future neck pain (NP) in comparison with the population that has not been exposed to neck injury from an MVC.

LITERATURE SURVEY:   Neck injury resulting from a MVC is associated with a high rate of chronicity. Prognosis studies indicate 50% of injured continue to experience NP a year after the collision. This is difficult to interpret due to the high prevalence of NP in the general population.

METHODOLOGY:   We performed a systematic review of the literature using five electronic databases, searching for risk studies on exposure to a MVC and future NP published from 1998 to 2018. The outcome of interest was future NP. Eligible risk studies were critically appraised using the modified Quality in Prognosis Studies (QUIPS) instrument. The results were summarized using best-evidence synthesis principles, a random effects meta-analysis, meta-regression and testing for publication bias was performed with the pooled data.

SYNTHESIS:   Eight articles were identified of which seven were of lower risk of bias. Six studies reported a positive association between a neck injury in an MVC and future NP compared to those without a neck injury in a MVC. Pooled analysis of the six studies indicated an unadjusted relative risk of future NP in the MVC exposed population with neck injury of 2.3 (95% CI [1.8, 3.1]), which equates to a 57% attributable risk under the exposed. In two studies where exposed subjects were either not injured or injury status was unknown, there was no increased risk of future NP.

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