Pain and Quality of Life in the Treatment of Cervical Dystonia

Abstract

Cervical dystonia (CD) is a chronic movement disorder characterised by abnormal postures of the neck. Although muscle contractions represent the most visible disease feature, associated symptoms such as pain are frequent and relevant contributors to disability. At the same time, pain constitutes one of the most important factors in terms of poor quality of life (QoL) and is one of the more affected QoL domains in CD patients. However, the mechanism underlying the pain associated with CD remains unclear. There are no therapeutic controlled trials that have evaluated pain or QoL as primary outcomes, but the available data suggest that therapeutic interventions that improve dystonia also alleviate pain and have a beneficial effect on QoL. The management of CD should incorporate problems such as pain, depression and anxiety in order to achieve a significant decrease in the burden of disease.

Quality of life in cervical dystonia after treatment with botulinum toxin A: a 24-week prospective study

“…The causes of CD may or may not be identifiable 1. CD can be an immensely painful, distressing, and hopeless experience for sufferers with contingent mental disorder.…”

“…CD can be an immensely painful, distressing, and hopeless experience for sufferers with contingent mental disorder. The common types of CD are lateral flexion or tilt of the neck (laterocollis), posterior extension of the neck (retrocollis), forward flexion of the neck (anterocollis), and horizontal turning of the neck (torticollis) 1,2. CD is found in one in every 250,000 people in Rochester, Minnesota, USA, and 5.7 in 100,000 in a European study 1.…”

“…The common types of CD are lateral flexion or tilt of the neck (laterocollis), posterior extension of the neck (retrocollis), forward flexion of the neck (anterocollis), and horizontal turning of the neck (torticollis) 1,2. CD is found in one in every 250,000 people in Rochester, Minnesota, USA, and 5.7 in 100,000 in a European study 1. The worldwide estimate of CD incidents is 0.80 per 100,000 person-years and is most commonly found among Caucasian women 3.…”

“…The etiology of CD may be unidentifiable (primary CD) or secondary to other neurological diseases (secondary CD) such as post encephalitis syndrome, post stroke dystonia, and other neurodegenerative diseases that cause an organic damage to the basal ganglia 1,2. Functional magnetic resonance imaging of CD patients shows an increased activation of putamen, thalamus, and caudate nucleus 3,4.…”

Effects of EMG Biofeedback on Pain and Quality of Life in Cervical Dystonia

“…Such reduced activation may be brought about by attentional factors [35]. During EMG biofeedback the patient becomes aware of overactivation and he/she is in a better position to manipulate muscle tension through attention [36]. This could operate at a voluntary or an involuntary level.…”