Inter-Rater Reliability of Neck Reflex Points in Women with Chronic Neck Pain

Abstract

Background: Neck reflex points (NRP) are tender soft tissue areas of the cervical region that display reflectory changes in response to chronic inflammations of correlated regions in the visceral cranium. Six bilateral areas, NRP C0, C1, C2, C3, C4 and C7, are detectable by palpating the lateral neck. We investigated the inter-rater reliability of NRP to assess their potential clinical relevance. Methods: 32 consecutive patients with chronic neck pain were examined for NRP tenderness by an experienced physician and an inexperienced medical student in a blinded design. A detailed description of the palpation technique is included in this section. Absence of pain was defined as pain index (PI) = 0, slight tenderness = 1, and marked pain = 2. Findings were evaluated either by pair-wise Cohen's kappa (ĸ) or by percentage of agreement (PA). Results: Examiners identified 40% and 41% of positive NRP, respectively (PI > 0, physician: 155, student: 157) with a slight preference for the left side (1.2:1). The number of patients identified with >6 positive NRP by the examiners was similar (13 vs. 12 patients). ĸ values ranged from 0.52 to 0.95. The overall kappa was ĸ = 0.80 for the left and ĸ = 0.74 for the right side. PA varied from 78.1% to 96.9% with strongest agreement at NRP C0, NRP C2, and NRP C7. Inter-rater agreement was independent of patients' age, gender, body mass index and examiner's experience. Conclusion: The high reproducibility suggests the clinical relevance of NRP in women.

Whole Systems Research Methods in Health Care: A Scoping Review

“…In addition to the approaches used in a few reviewed exemplars, whole systems researchers may refer to a growing methodological literature in this area. 26,125,136…”

Improvement in post-orthodontic chronic musculoskeletal pain after local anesthetic injections in the trigeminal area: a case series

“…19 Previous research has indicated a significant reduction in the sensitivity of the trapezius region in patients with chronic neck pain, trapezius tension, and chronic pharyngeal irritation after receiving bilateral submucosal injections of 0.5 mL of 1% procaine in the pharyngeal region. 31 We identified several case reports on the therapeutic effects of LA injections in patients with chronic pain, in addition to their anesthetic effects. [13][14][15]17,32 Nociceptive processes cause a reflex response that is largely mediated by sympathetic nerves and involves changes in blood flow, increased skin turgor and muscle tone, hyperalgesia in localized areas of the skin, and organ dysregulation at corresponding dermatome levels.…”

Treatment of Localized Vulvar Pain with Neural Therapy: A Case Series and Literature Review

“…The objective is the generation of a directed stimulus (through the needle) and the selective extinction of other stimuli (through the LA), thus affecting the nervous system and tissue perfusion [15] and allowing the interruption of positive feedback loops (vicious circles) of pain and other pathological processes [12, 13, 15]. The treatment modalities in NT are local therapy (injection in trigger points and in areas of tension or pain on palpation) [16]; segmental therapy (injection in reflex areas of HEAD, sympathetic ganglia, nerve roots, or peripheral nerves) [12, 13]; and interference field therapy (injection into areas of chronic alteration of a structure of the organism that can cause or maintain a symptomatic alteration in another area of the organism) [10, 12, 13].…”