Chronic Neck Pain – Chiropractic Resource Organization

Limited Prognostic Value of Pain Duration in Non-specific Neck Pain Patients Seeking Chiropractic Care

By Frank M. Painter|May 21, 2022|Chronic Neck Pain|

Limited Prognostic Value of Pain Duration in Non-specific Neck Pain Patients Seeking Chiropractic Care

SOURCE: European Journal of Pain 2022 (Apr 21) [EPUB]

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David Guillén, Alexandros Guekos, Nadia Graf, Barry Kim Humphreys, Cynthia Peterson, Petra Schweinhardt

Faculty of Medicine,
University of Zurich,
Zurich, Switzerland.

Background: Pain chronicity is considered an important prognostic factor for outcome. Here, it was investigated whether pain duration influences outcome when only chronic patients (pain >3 months) are considered. Secondary aims were to determine, in patients of any pain duration, how much variance in outcome is explained by pain duration and whether pain duration truly predicts outcomes, that is out-of-sample prediction in independent data.

Methods: Secondary analysis of a cohort study of neck pain patients. Patients were assessed before start of treatment and at 1-week, 1-, 3-, 6- and 12-month follow-up. Outcomes were patient global impression of change (PGIC) and percent change in patients’ perceived pain intensity, rated on a numerical rating scale (NRS). Regression analyses (linear and logistic) and supervised machine learning were used to test the influence of pain duration on PGIC and percent NRS change at 1-week, 1-, 3-, 6- and 12-month follow-up within sample and out-of-sample. Separate analyses were performed for the full sample (n = 720) and for chronic patients (n = 238) only.

Results: No relationship between pain duration and outcome was found for chronic patients only. For the full sample, statistical relationships between pain duration and outcomes were observed at all tested follow-up time points. However, the amount of variance in outcome explained by pain duration was low and no out-of-sample prediction was possible.

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Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

By Frank M. Painter|May 8, 2022|Acute Neck Pain, Chiropractic Care, Chronic Neck Pain|

Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

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SOURCE: J Clinical Medicine 2021 (Oct 28); 10 (21): 5011

Aleksander Chaibi, Knut Stavem and Michael Bjørn Russell

Head and Neck Research Group,
Division for Research and Innovation,
Akershus University Hospital,
1478 Oslo, Norway

Background: Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs)

Method: To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. Data extraction was done in duplicate and formulated in tables. Quality and evidence were assessed using the Cochrane Back and

Results: Six studies were included. The overall pooled effect size for neck pain was very large –1.37 (95% CI, –2.41, –0.34), favouring treatments with SMT compared with controls. A single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment, ((–2.8 (46%) (95% CI, –2.1, –3.4) vs. –1.7 (30%) (95% CI, –1.1, –2.3), respectively; p = 0.02)). Minor transient AEs reported included increased pain and headache, while no serious AEs were reported.

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Prevalence and Characteristics of Chronic Spinal Pain Patients with Different Hopes (Treatment Goals) for Ongoing Chiropractic Care

By Frank M. Painter|January 14, 2022|Chronic Low Back Pain, Chronic Neck Pain, Spinal Pain Management|

Prevalence and Characteristics of Chronic Spinal Pain Patients with Different Hopes (Treatment Goals) for Ongoing Chiropractic Care

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SOURCE: J Alternative and Complementary Medicine 2019 (Oct 1); 25 (10): 1015–1025

Patricia M. Herman, ND, PhD, Sarah E. Edgington, MA, Gery W. Ryan, PhD, and Ian D. Coulter, PhD

RAND Corporation,
Santa Monica, CA.

Objectives: The treatment goals of patients successfully using ongoing provider-based care for chronic spinal pain

Design: Multinomial logistical hierarchical linear models were used to examine the characteristics of patients with

Settings/Location: Observational data from a large national sample of patients from 125 chiropractic clinics clustered in 6 U.S. regions.

Subjects: Patients with nonwork-injury-related nonspecific chronic low-back pain (CLBP) and chronic neck pain (CNP).

Interventions: All were receiving ongoing chiropractic care.

Outcome measures: Primary outcomes were patient endorsement of one of four goals for their treatment. Explanatory variables included pain characteristics, pain beliefs, goals for mobility/flexibility, demographics, and other psychological variables.

Results: Across our sample of 1614 patients (885 with CLBP and 729 with CNP) just under one-third endorsed a treatment goal of having their pain go away permanently (cure). The rest had goals of preventing their pain from coming back (22% CLBP, 16% CNP); preventing their pain from getting worse (14% CLBP, 12% CNP); or temporarily relieving their pain (31% CLBP, 41% CNP). In univariate analysis across these goals, patients differed significantly on almost all variables. In the multinomial logistic models, a goal of cure was associated with shorter pain duration and more belief in a medical cure; a goal of preventing pain from coming back was associated with lower pain levels; and those with goals of preventing their pain from getting worse or temporarily relieving pain were similar, including in having their pain longer.

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Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

By Frank M. Painter|January 10, 2022|Chronic Neck Pain, Cost-Effectiveness of Chiropractic, Low Back Pain, Spinal Pain Management|

Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

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SOURCE: Frontiers in Pain Ressearch 2021 (Oct 25); 2: 765921

Carlos Gevers-Montoro, Benjamin Provencher, Martin Descarreaux, Arantxa Ortega de Mues and Mathieu Piche

Department of Anatomy,
Université du Québec à Trois-Rivières,
Trois-Rivières, QC, Canada

Spine pain is a highly prevalent condition affecting over 11% of the world’s population. It is the single leading cause of activity limitation and ranks fourth in years lost to disability globally, representing a significant personal, social, and economic burden. For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable. One of the conservative management options available is spinal manipulative

The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness (as it compares to other interventions in more pragmatic settings) and efficacy (as it compares to inactive controls under highly controlled conditions) of SMT for the management of neck pain and low back pain. Additionally, a perspective on the current recommendations on SMT for spine pain and the needs for future research will be

In summary, SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy. Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain. Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain. Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT.

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

By Frank M. Painter|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)

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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 Frank M. Painter|December 6, 2020|Chronic Neck Pain|

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

The Chiro.Org Blog

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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