Comparison of growth factor and cytokine expression in patients with degenerated disc disease and herniated nucleus pulposus
From: Clinical Biochemistry Volume 42, Issue 15, October 2009, Pages 1504-1511
This study was conducted to investigate the expression of cytokines and growth factors in disc specimens obtained from patients with herniated nucleus pulposus and degenerated disc disease. MRI and Western blot analyses were performed to evaluate the levels of disc degeneration and the expression levels of cytokines and growth factors.
The levels of TNF-alpha and IL-8 were significantly greater in the degenerated disc disease group than in the herniated nucleus pulposus group, but no statistical differences were observed in the expression of IL-1beta, IL-6 and IL-12 between the herniated nucleus pulposus and degenerated disc disease groups. In addition, the expression of TGF beta, VEGF and NGF was significantly higher in the degenerated disc disease group than in the herniated nucleus pulposus group.
The greater levels of cytokine and growth factor expression in the degenerated disc disease group than in the herniated nucleus pulposus explain why discogenic patients usually have more severe back pain than patients with herniated discs.
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A New Muscle Pain Detection Device to Diagnose Muscles as a Source of Back and/or Neck Pain
From: Pain Med. 2009 Dec 16. [Epub ahead of print]
Trigger point identification has become the mainstay of diagnosis for the treatment of Myofascial Pain Syndrome; however, manual pressure to identify trigger points by determining low pressure pain threshold has low interrater reliability and may lack validity since it is done on inactive muscles. To elicit contractions and mimic an active muscle or movement that “causes” pain, a Muscle Pain Detection Device has been developed. A selected muscle is stimulated and painful muscles are precisely detected, allowing distinctions between primary and referred muscle pain as well as distinguishing other functional muscle pain thought to cause Myofacial Pain Syndrome. An IRB approved randomized controlled study is presented of manual pressure (20 patients) control vs Muscle Pain Detection Device (20 patients) to identify which muscle(s) was the source of pain in subjects presenting to the NYU Pain Management Center with a minimum 3 months history of back pain. Patients were unaware of their diagnostic method. Subjects were injected in 1-3 sites identified via manual pressure or Muscle Pain Detection Device by a separate, blinded physician. Prior to, and following treatment at one week and one month, the patients were administered Oswestry and visual analog scale pain questionnaires by a blinded evaluator, and their range of motion was measured by a blinded physical therapist. Results. The Muscle Pain Detection Device group reported significantly larger improvements in pain, mood and Oswestry scores compared with the control. Moreover, the Muscle Pain Detection Device group reported 82.5% pain relief at 1 month, compared with 53.2% in the control. The range of motion measurements failed to reveal any significant difference between the groups. Using the Muscle Pain Detection Device appears to be more valid and potentially more reliable than palpation to identify muscles causing regional pain that could benefit from injections.
Muscle Pain Detection Device
Optional methods for treating trigger points include self treatment usually done by manual pressure using a device like the back massager or the cane massager, often recommended for areas of neck muscle strain.
Here are some interviews and videos featuring Dr. Marcus, the inventor
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Dry needling and exercise for chronic whiplash – a randomized controlled trial.
From: BMC Musculoskelet Disord. 2009 Dec 18;10(1):160.
Persistent chronic pain following whiplash injury as a result of a motor vehicle crash is a common and costly problem. The maintenance of activity and exercises is recommended for the management of whiplash. However, trials of treatment approaches including exercise and activity for chronic whiplash have demonstrated only modest effects on pain and disability levels. One reason for these modest effects may be due to the heterogeneous nature of the whiplash condition. Many people with chronic whiplash have a complex clinical presentation with marked sensory disturbance (widespread hyperalgesia, sympathetic nervous system dysfunction) indicative of central nervous system hyperexcitability. The presence of these factors is associated with higher levels of pain and disability and poor functional recovery. The authors data also indicate that patients with these features show a poor response to an exercise based intervention approach.
Modalities such as dry-needling and acupuncture are commonly used in the treatment of musculoskeletal pain conditions. With respect to neck pain of all types and not specifically whiplash, a recent systematic review reported moderate evidence for pain relieving effects of these approaches. Furthermore, these modalities can have a modulatory effect on hyperalgesia and they are effective in alleviating symptoms of fibromyalgia, a condition that also features characteristics of central hyperexcitability. Together these findings suggest that needling techniques may be effective in the management of chronic whiplash pain, but the use of such interventions in this condition has never been investigated.
A recent Cochrane review concluded that dry-needling, added to other conventional therapies such as exercise, is more effective at relieving pain than conventional therapies alone in non-specific low back pain. This combined approach to management has never been investigated in whiplash. Therefore the primary aim of this project is to investigate the effectiveness of dry-needling, advice and exercise compared with sham dry-needling, advice and exercise in chronic whiplash. Effectiveness will be measured by reductions in pain and disability levels and improvements in patients’ impressions of overall recovery and quality of life. The secondary aim is to conduct an economic evaluation of the dry-needling, advice and exercises.
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Effect of Backpack Weight on Postural Angles in Preadolescent Children.
From: Indian Pediatr. 2009 Oct 14
Backpack use is an appropriate way for carrying loads on the spine, closely and symmetrically, while maintaining stability. Students carry their educational loads mostly in backpacks, without the workplace standards that have been developed for adults. The daily physical stresses associated with carrying backpacks cause significant forward lean of the head and trunk. It is assumed that daily intermittent abnormal postural adaptations could result in pain and disability in school going children.
The peak rate of growth occurs during puberty and the growth of the appendicular skeletal system ceases around 16 years of age for females and 18 years for males. However secondary ossification of vertebrae is not complete until the mid twenties. Therefore, the spine may be susceptible to injury for a greater length of time and therefore, proper backpack use should be emphasized during these years. When the backpack load is positioned posterior to the body, the center of gravity shifts posteriorly, over the base of the support; the area covered by the feet. This shift is accomplished by either leaning forward at the ankle or hip or inclining the head and the rigidity of postural muscles controlling these adjustments increases to support the load. Children have relatively larger heads and also have higher center of mass at about T12, compared to L5-S1 in adults.
Carrying posterior loads by young people has been linked with spinal pain, and the amount of postural change produced by load carriage has been used as a measure of the potential to cause tissue damage. Back pain in children appears to be more common than was previously thought. Studies have indicated that 10%-30% of healthy children experience back pain, especially low back pain, by their teenage years. Hence, investigating postural responses to load carrying will help us to understand the impact of school backpacks on children.
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Cognitive symptoms, cervical range of motion and pain as prognostic factors after whiplash trauma
From: Acta Neurol Scand.. [Epub ahead of print]
To evaluate pain, cervical range of motion and cognitive symptoms as predictors for poor prognosis defined as sick leave 3 years after whiplash injury. In 97 patients cervical range of motion, pain intensity and cognitive symptoms were measured immediately following whiplash trauma, at 6 months and 3 years. Patients were also asked at 3 years if they had been on sick leave the last 6 months.
Pain intensity and reduced cervical range of motion were not clinically useful as predictors of later sick leave. The best predictors were presence within 96 h after injury of the two cognitive symptoms being easily distracted and easily irritated.
Initial pain and reduced cervical range of motion may be related to minor tissue damage to the neck after whiplash which often heals while late functionality is more dependent on other factors such as cognitive dysfunction. For patients with whiplash associated disorders two simple questions should be asked; Are you currently easily irritated? and Are you currently easily distracted (e.g. is it difficult for you to follow a conversation if several people are talking in the room at the same time)? An affirmative answer to any of these questions indicates an increased risk for poor prognosis defined as sick leave 3 years later.
Evaluation of a single accelerometer based biofeedback system for real-time correction of neck posture in computer users.
From: Conf Proc IEEE Eng Med Biol Soc. 2009;1:7269-72
There is sound evidence available showing the association between computer use and the risk of developing neck pain and musculoskeletal disorders. Consistent use of computers is one of the major risk factors for neck and shoulder disorders in the workplace. One of the most recent forecasts of computer adoption estimates that there were more than a billion computers in use at the end of 2008. This report also forecasts a 12.3% compound annual growth rate between 2003 and 2015. Driven by lower prices and global demand especially in developing countries it is expected that there will be over 2 billion computer users by 2015. A study of 512 office workers found the 12 month prevalence of neck pain to be 45.5%. Reports of the lifetime prevalence of neck pain in the general population range from 67-80%. As computer adoption increases we can expect a corresponding increase in the prevalence of neck pain if appropriate countermeasures are not employed.
Over time poor neck posture results in pain, muscle aches, tension and headache and can lead to long term complications such as osteoarthritis. Physiological and biomechanical stress due to sustained postures limit important musculoskeletal stimuli that are essential for normal musculoskeletal development. Most upper extremity disorders and symptoms (neck, shoulder, elbow and wrist pain) are associated with computer use at workstations in positions of poor posture. Along with the sitting position, placement of computer monitors and keyboards and the number of hours spent working at computer workstations are important factors in the etiology of cervical disorders associated with computer use. Other workplace risk factors include the number of hours per week of computer use and the time spent in a non-neutral posture at a computer.
A detailed survey at Harvard University showed that more then half of students experienced pain and discomfort while using a computer. The three factors significantly associated with computer-related upper extremity and neck pain among the students were female gender, eight or more years of using a computer 10 or more hours a week, and using a computer for more than 20 hours per week. Most of the students in the study reported that pain in the neck and upper extremity was related to computer use and the posture assumed while using a computer. Most of them adopted a better posture by adjusting the workstation and keyboard, while some took a break when feeling uncomfortable during their work on the computer. Workplace studies, of both cross-sectional and prospective design, consistently identified a relationship between the number of hours per week of computer use and musculoskeletal pain and disorders or the upper extremity and neck.
Trapezius Myositis/Spasm, Paraspinal/Rheomboid Spasm, Cervical Radiculopathy, Thoracic Outlet Syndrome, Bicipital Tendonitis, and Rotator Cuff Tendonitis are all common upper extremity and cervical musculoskeletal disorders associated with use of computers in poor posture. Tension neck syndrome and thoracic outlet syndrome are the most common problems associated with computer use and the major cause is prolonged sitting with the neck and back in flexed positions. These conditions are commonly reported for a person sitting in front of a computer for more then 4 hours which is common in office environments.
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A randomised clinical trial of a comprehensive exercise program for chronic whiplash: trial protocol
From: BMC Musculoskelet Disord. 2009 Dec 2;10(1):149.
The most common injury following a motor vehicle accident is a whiplash injury to the neck. This injury is of particular concern as approximately 60% of people experience persistent pain and disability 6 months after the original accident. This group of people with chronic symptoms account for a disproportionately large percentage of the economic burden associated with whiplash injury. In the United States the costs associated with whiplash are estimated to be of the order of $29 billion US dollars per annum.
Currently, there is a large number of treatments available to people suffering from whiplash symptoms including acupuncture, cervical collars, traction, exercise, massage, mobilisation techniques, electro-physical agents and the local application of heat or ice.
There is growing evidence to support multimodal treatment strategies which combine exercise, manual therapy and psychological approaches. It has been shown that this type of treatment results in larger reductions in pain, greater patient satisfaction and a quicker return to work compared with conservative electro-physical treatments in individuals with acute whiplash. In addition, the likelihood of recovery is increased when treatments are individually-tailored to specifically target individual deficits and involve active rather than passive intervention strategies.
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Chiropractic care for patients with acute neck pain: results of a pragmatic practice-based feasibility study
From: J Chiropr Med. 2009 Dec;8(4):143-55.
The purpose of this study was to determine the feasibility of a chiropractic practice-based research network to investigate the treatment of acute neck pain and to report resulting findings. Participating chiropractors recruited sequentially presenting acute neck pain patients on their initial visit to the office. Patients were treated by the chiropractors using their usual methods. Data were prospectively collected by having patients complete the Neck Disability Index, Characteristic Pain Intensity score, and a patient satisfaction questionnaire. Questionnaires were completed during routine office visits at baseline and then at weeks 1, 2, 4, 8, and 26, either in the office or by mail.
Ten chiropractors supplied data on 99 patients. The number of cases contributed by each of the participating chiropractors ranged from 1 to 54, with a mean (SD) of 9.2 (10.5). Mean (SD) Neck Disability Index scores were 36 (17.9) at baseline and 9.8 (12.2) at the final evaluation; the Characteristic Pain Intensity scores were initially 55.3 (20.4) and were 24.5 (21.5) at the final evaluation. Transient minimal adverse effects were reported by chiropractors for only 7 (7.8%) patients. No serious adverse reactions were reported.
The practice-based research methodology used in this study appears to be a feasible way to investigate chiropractic care for acute neck pain, and its methodologies could be used to plan future research.
Bilateral Mechanical Pain Sensitivity Over the Trigeminal Region in Patients With Chronic Mechanical Neck Pain
From: J Pain. 2009 Nov 26
The aim of this study was to investigate bilateral pressure pain sensitivity over the trigeminal region, the cervical spine, and the tibialis anterior muscle in patients with mechanical chronic neck pain. Twenty-three patients with neck pain (56% women), aged 20 to 37 years old, and 23 matched controls (aged 20 to 38 years) were included. Pressure pain thresholds were bilaterally assessed over masseter, temporalis, and upper trapezius muscles, the C5-C6 zygapophyseal joint, and the tibialis anterior muscle in a blinded design. The results showed that pressure pain threshold levels were significantly decreased bilaterally over the masseter, temporalis, and upper trapezius muscles, and also the C5-C6 zygapophyseal joint, but not over the tibialis anterior muscle in patients with mechanical chronic neck pain when compared to controls. The magnitude of pressure pain threshold decreases was greater in the cervical region as compared to the trigeminal region. Pressure pain thresholds over the masseter muscles were negatively correlated to both duration of pain symptoms and neck pain intensity. Our findings revealed pressure pain hyperalgesia in the trigeminal region in patients with mechanical chronic neck pain, suggesting spreading of sensitization to the trigeminal region in this patient population. This article reveals the presence of bilateral pressure pain hypersensitivity in the trigeminal region in patients with idiopathic neck pain, suggesting a sensitization process of the trigemino cervical nucleus caudalis in this population. This finding has implications for development of management strategies.
