Chronic neck pain and combined tension headache: a unified effective treatment approach

Abstract

A clinical case of a patient with chronic musculoskeletal neck pain (CNP) in combination with tension headache (TH) and increased anxiety is described. The combination of these conditions is common in neurological practice. The disorders mentioned are pathogenetically related and mutually reinforce each other. In this respect, a unified comprehensive approach is required for the successful treatment of patients of this category, which is demonstrated using a clinical case from our own practice. The factors for the development and chronicity of CNP, TH are shown: misconceptions about the disease, catastrophizing the pain, increased anxiety, stress, a sedentary lifestyle, prolonged time spent at the computer, long static postures. Before contacting the Clinic for Nervous Diseases of Sechenov University (СNВ), no effect of the therapy was observed, as the factors for the development and chronicity of the pain were not assessed and not corrected, pharmacotherapy (painkillers, group B vitamins) was used in combination with ineffective non-drug treatment methods (massage, physiotherapy). An educational programme for the patient about the causes of the disease and its prognosis was not implemented, and the patient was not suggested to undergo a course of therapeutic exercise or cognitive behavioural therapy (CBT), the patient was not given any recommendations on ergonomics and physical activity during the day. In the СNB, the patient was offered a comprehensive treatment approach that included educational talks, CBT, kinesiotherapy, taping and Nimesil (nimesulide) administration. CBT is a proven effective psychological method for the treatment of CNP and TH that aims to develop accurate, realistic beliefs about the disease and adaptive behaviour in a patient, as well as skills to overcome pain and increased anxiety. In the treatment of chronic NP, it is recommended to combine CBT with kinesiotherapy, a scientifically proven effective non-pharmacological treatment method. Kinesiotherapy includes therapeutic exercises, education on correct posture and recommendations on ergonomics and lifestyle. Nimesil (nimesulide), a non-steroidal anti-inflammatory drug that is widely used in Russian neurological practice and has proven efficacy and safety in the treatment of musculoskeletal pain, was chosen as pharmacotherapy. It is important to mention that nimesulide was prescribed to the patient from the first days of treatment simultaneously with the start of kinesiotherapy and CBT. Against the background of pharmacotherapy, the patient experienced rapid pain relief, which contributed to adherence to recommendations to increase physical activity, ergonomics and therapeutic exercise, as well as CBT. The complex treatment helped the patient relatively quickly and effectively. After 10 days of treatment, he reported a 50 % reduction in pain and an increase in functional activity. After 2 months, the pain had completely subsided and daily activity and quality of life increased. Six months of follow-up showed the sustainability of therapeutic results achieved.