Similarities in stress physiology among patients with chronic pain and headache disorders: evidence for a common pathophysiological mechanism?
From: The Journal of Headache and Pain. 2008 Apr 14 [Epub ahead of print]
One common feature of chronic musculoskeletal pain and headaches are that they are both influenced by stress. Among these, tension headache, fibromyalgia and chronic neck and shoulder pain appear to have several similarities, both with regard to pathophysiology, clinical features and demographics. The main hypothesis of the present study was that patients with chronic pain (tension headache, fibromyalgia and shoulder neck pain) had stress-induced features distinguishing them from migraine patients and healthy controls. We measured pain, blood pressure, heart rate (HR) and skin blood flow (BF) during (1 h) and after (30 min) controlled low-grade cognitive stressor in 22 migraine patients, 18 tension headache patients, 23 fibromyalgia patients, 29 shoulder neck pain patients and 44 healthy controls. fibromyalgia patients had a lower early HR response to stress than migraine patients, but no differences were found among fibromyalgia, tension headaches, shoulder and neck pain patients. Finger skin BF decreased more in fibromyalgia patients compared to migraine patients, both during and after the test. When comparing chronic pain patients (chronic tension headaches, fibromyalgia and shoulder neck pain) with those with episodic pain (episodic tension headache and migraine patients) or little or no pain (healthy controls), different adaptation profiles were found during the test for systolic and diastolic blood pressure, HR and skin BF in the chronic group. In conclusion, these results suggest that tension headache, fibromyalgia and shoulder neck pain patients may share common pathophysiological mechanisms regarding the physiological responses to and recovery from low-grade cognitive stress, differentiating them from episodic pain conditions such as migraine.
Prevalence of complaints of arm, neck and shoulder among computer office workers and psychometric evaluation of a risk factor questionnaire
From: BMC Musculoskeletal Disorders 2007, 8:68
Complaints of Arm Neck and Shoulder represent a wide range of complaints, which can differ in severity from mild, periodic symptoms to severe, chronic and debilitating conditions. They are thought to be associated with both physical and psychosocial risk factors. The measurement and identification of the various risk factors for these complaints is an important step towards recognizing (a) high risk subgroups that are relevant in profiling complaints of arm neck and shoulder and (b) also for developing targeted and effective intervention plans for treatment. The purpose of the present study was to investigate the prevalence of complaints of arm neck and shoulder in a Dutch population of computer workers and to develop a questionnaire aimed at measuring workplace physical and psychosocial risk factors for the presence of these complaints.
To examine potential workplace risk factors for the presence of complaints of arm neck and shoulder, the Maastricht Upper Extremity Questionnaire (MUEQ), a structured questionnaire, was developed and tested among 264 computer office workers of a branch office of the national social security institution in the Netherlands. The MUEQ holds 95 items covering demographic characteristics, in addition to seven main domains assessing potential risk factors with regard to (1) work station, (2) posture during work, (3) quality of break time, (4) job demands, (5) job control, and (6) social support. The MUEQ further contained some additional questions about the quality of the work environment and the presence of complaints in the neck, shoulder, upper and lower arm, elbow, hand and wrist. The prevalence rates of complaints of arm neck and shoulder in the past year were computed. Further, we investigated the psychometric properties of the MUEQ (i.e. factor structure and reliability).
Neck and shoulder complaints are more frequently reported among Dutch computer workers than arm, elbow and hand complaints. The results further indicate that the MUEQ has satisfactory reliability and internal consistency when used to document complaints of arm neck and shoulder among computer workers in the Netherlands.
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From: NIOSH Publication No. 97-141 Musculoskeletal Disorders and Workplace Factors
Definition of Posture for Neck and Neck/Shoulder Pain
We included those articles that mentioned neck posture or head postures, adverse or extreme head or neck postures, or static postures of the head and/or neck.
Studies Reporting on Posture as a Work Factor for Neck and Shoulder Pain
We included 31 studies of the association between extreme or static posture and neck and neck/shoulder pain, including TNS. Studies usually focused on the different prevalences of neck symptoms and/or physical findings in workers in occupations or tasks requiring some combination of forceful, repetitive movements, and extreme or static postures of the upper extremity, and compared them to workers in occupations without those requirements.
Twenty-seven studies that considered extreme or static posture found a statistically significant positive association between posture and neck or neck/shoulder pain; three had non-significant findings, 13 studies had estimations of risk. Eleven studies did not report their results in terms of ORs or PRRs; of these, all but one found a significant relationship.
Studies Meeting the Four Evaluation Criteria
Of the 31 studies evaluating neck postures and neck pain, the four investigations mentioned above [Ohlsson et al. 1995; Jonsson et al. 1988; Kilbom and Persson 1987; Kilbom et al. 1986] fulfilled the four evaluation criteria. Three of these studies [Jonsson et al. 1988; Kilbom et al. 1986; Kilbom and Persson 1987], dealt with the same cohort; female electronics workers followed for 3 successive years. These studies found significant association between posture variables and neck pain; however, none used methods that reported ORs.
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Effectiveness of an educational and physical programme in reducing headache, neck and shoulder pain: a workplace controlled trial.
From: Cephalalgia. 2008 Mar 3
This study was an 8-month controlled trial to evaluate the effectiveness of a workplace educational and physical programme in reducing headache and neck and shoulder pain.
Central registry office employees (n = 192; study group) and 192 peripheral registry office and central tax office employees (controls) in the city of Turin, Italy were given diaries for the daily recording of pain episodes. After 2 months, the study group only began the educational and physical programme.
The primary end-point was the change in frequency of headache and neck and shoulder pain expressed as the number of days per month with pain, and as the proportion of subjects with a >/= 50% reduction of frequency (responder rate). The number of days of analgesic drug consumption was also recorded. Diaries completed for the whole 8 months were available for 169 subjects in the study group and 175 controls.
The baseline frequency of headache (days per month) was 5.87 and 6.30 in the study group and in controls; frequency of neck and shoulder pain was 7.12 and 7.79, respectively. Mean treatment effects [days per month, 95% confidence interval (CI)] on comparing the last 2 months vs. baseline were: headache frequency -2.45 (-3.48, -1.43); frequency of neck pain -2.62 (-4.09, -1.16); responder rates (odds ratio, 95% CI) 5.51 (2.75, 11) for headache, 3.10 (1.65, 5.81) for neck and shoulder pain, and 3.08 (1.06, 8.90) for days with analgesic drug consumption.
The study suggests that an educational and physical programme reduces headache and neck and shoulder pain in a working community.
