To evaluate immediate effects of two different modes of acupuncture on motion-related pain and cervical spine mobility in chronic neck pain patients compared to a sham procedure. Thirty-six patients with chronic neck pain and limited cervical spine mobility participated in a prospective, randomized, double-blind, sham-controlled crossover trial. Every patient was treated once with needle acupuncture at distant points, dry needling (DN) of local myofascial trigger points and sham laser acupuncture (Sham). Outcome measures were motion-related pain intensity (visual analogue scale, 0-100 mm) and range of motion (ROM). In addition, patients scored changes of general complaints using an 11-point verbal rating scale. Patients were assessed immediately before and after each treatment by an independent (blinded) investigator. Multivariate analysis was used to assess the effects of true acupuncture and needle site independently. For motion-related pain, use of acupuncture at non-local points reduced pain scores by about a third (11.2 mm; 95% CI 5.7, 16.7; P = 0.00006) compared to DN and sham. DN led to an estimated reduction in pain of 1.0 mm (95% CI -4.5, 6.5; P = 0.7). Use of DN slightly improved ROM by 1.7 degrees (95% CI 0.2, 3.2; P = 0.032) with use of non-local points improving ROM by an additional 1.9 degrees (95% CI 0.3, 3.4; P = 0.016). For patient assessment of change, non-local acupuncture was significantly superior both to Sham (1.7 points; 95% CI 1.0, 2.5; P = 0.0001) and DN (1.5 points; 95% CI 0.4, 2.6; P = 0.008) but there was no difference between DN and Sham (0.1 point; 95% CI -1.0, 1.2; P = 0.8). Acupuncture is superior to Sham in improving motion-related pain and ROM following a single session of treatment in chronic neck pain patients. Acupuncture at distant points improves ROM more than DN; DN was ineffective for motion-related pain.
Given the high prevalence of recurrent and chronic pain as well as the broadness of severity, an important issue on further research is identification of factors which influence the chronification process. For this purpose improved measures of graded classification of pain status are needed.
Following vertebral fractures, IVP on CT scans is more common than presumed and increases with age. There exists a significant inverse correlation between the BMD and the frequency of IVP.
In several prospective studies it has been demonstrated that psychological factors are better predictors of low back pain than biographical or medical factors. The most elaborate model for the development of chronic low back pain is the model of fear avoidance. The essential feature of this model is that exaggerated negative orientations towards pain ("pain catastrophizing") lead to fear of movements and the belief that movements will lead to more pain. The result is the perpetuation of avoidance behavior. This leads to inactivity, reduced mobility, increased disability, and increased anger, demoralization, anxiety, and depression. From fear avoidance models several principles for the therapeutic management of pain can be derived. Therapists have to be aware of the powerful effects of anticipating processes which can give rise to fear of pain, amplifying the intensity of pain, and consequently result in avoidance behavior. On the other hand, reduction of uncertainty via adequate information about the non-serious nature of back pain disorders may lead to an adequate confrontative pain behavior, less emotional arousal and more useful coping mechanisms. In particular, the uncritical use of widespread back schools has to be looked upon carefully for pronouncing avoidance learning. For chronic pain, therapy must include mechanisms from the treatment of phobias in which pain behavior is looked upon as the result of a phobic process.
Compared with standard treatment, a functional restoration program for CLBP significantly improves some aspects of health-related quality of life. It results in a decrease of pain and pain-related disability even in patients with a long history of CLBP.
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