Sustained effects of comprehensive inpatient rehabilitative treatment and sleeping neck support in patients with chronic cervicobrachialgia
From: Int J Rehabil Res. 2008 Dec;31(4):342-6
Clinical experience shows that the intensity of cervical syndrome patients’ complaints is affected by the nighttime sleeping posture, as any long-lasting inappropriate posture of the spine can irritate the capsular ligaments of the motor segments. These patients’ complaints revolve mostly around pain sensations that appear primarily during the night and in the morning, and frequently cause sleep disturbances. It is difficult to alleviate such symptoms by physical therapy and postural exercises. Therefore, the night-time sleeping position must be changed to achieve physiological positioning of the spine. In addition to adequate mattresses, sleeping neck supports (special neck pillows) can optimize the sleeping position.
The aim of this study was to determine whether inpatient rehabilitative treatment along with sleeping neck supports has long-term benefits in patients suffering from chronic cervicobrachialgia (neck and arm pain).
The participants were randomly assigned to one of two groups. Only patients in one group (group 2) were given a neck support pillow to use during sleep. Participants were instructed by the physiotherapists in the use of these pillows, were given written instructions, and the information was reviewed during the first days of therapy. Reliable support to the low posterior neck throughout sleep is considered essential. Only the Curavario (Pala Medic Company, Pleisweiler, Germany) pillow provided by this company was used. The size of this pillow is 50 x 32 x 15 cm, and it consists of polyurethane pads of different hardness. To be responsive to individual requirements, one side of the pillow is softer than the other.
Sleep disturbances caused by pain were significantly decreased in the group given the sleeping neck support compared with the control group. Up to 12 months after the end of inpatient therapy, use of the special pillow prevented an increase in sleep disturbances caused by pain (after 3 months and 12 months respectively)
In this study, inpatient physical therapy combined with a sleeping neck support had a significantly better long-term outcome than physical therapy alone. Interestingly, an increase in complaints after treatment as significantly prevented for up to 6 months with the use of a sleeping neck support pillow.
The interaction of physiotherapists and the sleeping neck support pillow, however, was clinically important and statistically significant.
Cochrane reviews have systematically assessed therapeutic trials. A 1996 report included 24 randomized clinical trials and concluded that, there is little information available from clinical trials to support many of the treatments for mechanical neck pain. In general, conservative interventions have not been studied in neough detail to assess efficacy adequately.
In the past decade, there has been a proliferation of neck support pillows that are recommended for patients with neck pain. The results of the earlier studies were, however, inconclusive owing to the small sample sizes; they showed no clinically important differences in objective outcomes over a 2-week period. From a patient’s perspective, however, neck support is an important part of a comprehensive physiotherapy programme.
In a prospective cohort study of neck supports, 47% of patients with C6–C7 level tenderness were found to have improved at first follow-up; further improvement was seen on second follow-up in 63% of those with fibromyalgia and 84% of those without fibromyalgia.
In another randomized crossover study of patients with chronic neck pain, three types of pillows were compared. A water filled pillow was compared with the patients’ regular pillow or a neck roll pillow; the water pillow was associated with greater pain relief and improved quality of sleep.
Systematic meta-analytic reports dealing with the treatment of chronic neck pain have found either lacking, limited, or conflicting evidence for the effectiveness of passive physical therapies, active training, or multimodal rehabilitation.
Ylinen et al. reported a randomized controlled study in which a 2-week multimodal rehabilitation programme followed by 12-month, home-based neck muscle strength and endurance training led to a clinically significant decrease in neck pain and disability in women with chronic neck pain. Moreover, the improved subjective outcomes were associated with a significant increase in neck strength and range of motion as well as improved pressure pain threshold.
The results of this study are supported by a recently published randomized trial, which showed that the interaction of exercise and pillow was statistically significant and clinically meaningful for patients with chronic neck pain.
This study results indicate that individuals with cervicobrachialgia and its typical complaints (pain radiation and sleep disturbances caused by pain) should receive comprehensive physiotherapy and an individually selected sleeping neck support pillow.
