Background. Back pain is a common problem and a major cause of disability and health care utilization. Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain. Data Sources. Records without language restriction from various databases up to February 2010. Data Extraction. The efficacy outcomes of interest were pain intensity and disability. Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature. Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.

The aim of this systematic review was to assess evidence from randomized controlled trials (RCTs) on the effectiveness and safety of acupuncture and electroacupuncture in patients with chronic neck pain. We searched nine databases including Chinese, Japanese and Korean databases through 30 July 2016. The participants were adults with chronic neck pain and were treated with acupuncture or electroacupuncture. Eligible trials were those with intervention groups receiving acupuncture and electroacupuncture with or without active control, and control groups receiving other conventional treatments such as physical therapy or medication. Outcomes included pain intensity, disability, quality of life (QoL) and adverse effects. For statistical pooling, the standardized mean difference (SMD) and its 95% confidence interval (CI) were calculated using a fixed-effects model. Sixteen RCTs were selected. The comparison of the sole acupuncture group and the active control group did not come out with a significant difference in pain (SMD 0.24, 95% CI [Formula: see text]0.27-0.75), disability (SMD 0.51, 95% CI [Formula: see text]0.01-1.02), or QoL (SMD [Formula: see text]0.37, 95% CI [Formula: see text]1.09-0.35), showing a similar effectiveness of acupuncture with active control. When acupuncture was added into the control group, the acupuncture add-on group showed significantly higher relief of pain in studies with unclear allocation concealment (SMD [Formula: see text]1.78, 95% CI [Formula: see text]2.08-[Formula: see text]1.48), but did not show significant relief of pain in studies with good allocation concealment (SMD [Formula: see text]0.07, 95% CI [Formula: see text]0.26-0.12). Significant relief of pain was observed when the sole electroacupuncture group was compared to the control group or electroacupuncture was added onto the active control group, but a lot of the results were evaluated to have low level of evidence, making it difficult to draw clear conclusions. In the result reporting adverse effects, no serious outcome of adverse event was confirmed. Acupuncture and conventional medicine for chronic neck pain have similar effectiveness on pain and disability when compared solely between the two of them. When acupuncture was added onto conventional treatment it relieved pain better, and electroacupuncture relieved pain even more. It is difficult to draw conclusion because the included studies have a high risk of bias and imprecision. Therefore better designed large-scale studies are needed in the future.

UNLABELLED:Chronic neck pain is a common medical complaint partly mediated by psychosocial distress and having a high socioeconomic impact. There is preliminary evidence that stress reduction by meditation might be beneficial in chronic pain syndromes. We aimed to evaluate the effectiveness of an 8-week meditation program (jyoti meditation) in patients with chronic neck pain by means of a randomized clinical trial. Eighty-nine patients (aged 49.7 ± 10.5 years, 73 female) with chronic neck pain who scored>40 mm on a 100-mm visual analog scale and had concomitant increased perceived stress were randomized to an 8-week meditation program (jyoti meditation) with weekly 90-minute classes (n = 45) or to a home-based exercise program (n = 44) with a wait list offer for meditation. Both groups were instructed to practice at home. Outcomes were assessed at baseline and after 8 weeks. Primary outcome measure was change of mean pain at rest (visual analog scale score) from baseline to week 8. Secondary outcomes included pain at motion, functional disability, pain-related bothersomeness, perceived stress, quality of life, and psychological outcomes. Patients had neck pain for a mean of 11 years. Eighteen patients in the meditation group and 16 patients in the exercise group were lost to follow-up. Meditation training significantly reduced pain when compared to the exercise group after 8 weeks(reduction of 45.5 ± 23.3 mm to 21.6 ± 17.2 mm in the meditation group, and 43.8 ± 22.0 mm to 37.7 ± 21.5 mm in the exercise group; mean difference: 13.2 mm [95% confidence interval: 2.1, 24.4; P = .02]). Pain-related bothersomeness decreased more in the meditation group (group difference 11.0 mm [95% confidence interval: 1.0, 21.0; P = .03]). No significant treatment effects were found for pain at motion, psychological scores, and quality of life, although the meditation group showed nonsignificant greater improvements compared to the exercise group. In conclusion, meditation may support chronic pain patients in pain reduction and pain coping. Further well-designed studies including more active control comparisons and longer-term follow-up are warranted.

PERSPECTIVE:This article presents the results of a randomized controlled trial on the clinical effects of an 8-week meditation program or self-care exercise in patients with chronic neck pain. Meditation reduced pain at rest but not disability and might be a useful treatment option for pain management of chronic neck pain.

BACKGROUND:Various studies have shown the efficacy of conventional isometric, Pilates and yoga exercises. However, data on the effects and comparison of these specific exercises on the cervical muscle morphology are insufficient or lacking.

OBJECTIVE:To investigate the effects of different exercise treatments on neck muscles in patients with chronic neck pain.

DESIGN:A randomized study.

METHODS:Fifty-six patients with chronic neck pain were randomized into 3 groups as follows: Pilates group (n = 20), yoga group (n = 18) and isometric group (n = 18). Demographics and background information were recorded. The thickness and cross-sectional area of neck muscles were evaluated by ultrasound imaging. Cervical motions were measured with a goniometer. Pain severity was evaluated withthe McGill Pain Scale, disability with the Neck Disability Index, quality of life with the Nottingham Health Profile, and emotional status with the Beck Depression Inventory. In addition to a conventional physio-therapy programme, 15 sessions of physical therapy, including hot pack, ultrasound, andtranscutaneous electrical nerve stimulation (TENS), were provided to all patients. All groups performed the exercises for 6 weeks. The aforementioned assessments were performed before and 6 weeks after the treatment.

RESULTS:Although pain, disability, depression and quality of life improved similarly within all groups (all p < 0.05), muscle thickness values as regards the semispinalis capitis were increased only in the Pilates group (p = 0.022).

STUDY LIMITATIONS:The lack of complex (progressive resistive) exercise treatment protocols, short treatment duration and partial supervision.

CONCLUSION:All 3 types of exercise had favourable effects on pain and functional scores, but no differences were found among the groups, except for the Pilates group, in which the semispinalis capitis muscle increased in thickness.

BACKGROUND:Various studies have shown the efficacy of conventional isometric, Pilates and yoga exercises. However, data on the effects and comparison of these specific exercises on the cervical muscle morphology are insufficient or lacking.

OBJECTIVE:To investigate the effects of different exercise treatments on neck muscles in patients with chronic neck pain.

DESIGN:A randomized study.

METHODS:Fifty-six patients with chronic neck pain were randomized into 3 groups as follows: Pilates group (n = 20), yoga group (n = 18) and isometric group (n = 18). Demographics and background information were recorded. The thickness and cross-sectional area of neck muscles were evaluated by ultrasound imaging. Cervical motions were measured with a goniometer. Pain severity was evaluated withthe McGill Pain Scale, disability with the Neck Disability Index, quality of life with the Nottingham Health Profile, and emotional status with the Beck Depression Inventory. In addition to a conventional physio-therapy programme, 15 sessions of physical therapy, including hot pack, ultrasound, andtranscutaneous electrical nerve stimulation (TENS), were provided to all patients. All groups performed the exercises for 6 weeks. The aforementioned assessments were performed before and 6 weeks after the treatment.

RESULTS:Although pain, disability, depression and quality of life improved similarly within all groups (all p < 0.05), muscle thickness values as regards the semispinalis capitis were increased only in the Pilates group (p = 0.022).

STUDY LIMITATIONS:The lack of complex (progressive resistive) exercise treatment protocols, short treatment duration and partial supervision.

CONCLUSION:All 3 types of exercise had favourable effects on pain and functional scores, but no differences were found among the groups, except for the Pilates group, in which the semispinalis capitis muscle increased in thickness.

To determine if ultrasound (US) is effective in reducing pain and mobility limitation in the treatment of traumatic cervical sprain, we performed an experimental study. The sample comprised 54 diagnosed subjects with a mean age of 36.54 y (standard deviation = 12.245), assigned by simple random selection to an experimental group with ultrasound treatment and a control group with placebo ultrasound. Treatment consisted of 10 sessions of an ultrasound treatment protocol, followed by 15 sessions of a protocol identical for both groups without ultrasound. The variables assessed were pain and joint mobility. There was no significant difference (p>0.05) between groups in the first 10 sessions of treatment. However, there was a statistically significant difference (p<0.05) between groups on the pain variable, 20 days after completion of the US. High-active ultrasound treatment is more effective than placebo in reducing pain.

UNLABELLED:Introduction/objectives: Although inflammation in disc hernia (DH) has been recognized and it is a well-known process mediated by loss of the cellular redox balance, only a few studies about the impact of chronic oxidative stress on this neurological disorder have been made. Ozone therapy has been widely used with clinical efficacy in DH. This work aimed at characterizing the systemic redox status of patients with low back pain and neck pain as well as studying if ozone oxidative post-conditioning modified the pathological oxidative stress and protected against oxidative protein damage and if there is any relationship between oxidative changes and pain in both DH.

METHODS:Redox status of 33 patients with diagnosis of DH by computerized axial tomography, nuclear magnetic resonance, and clinical evaluations was studied. Ozone was administered by paravertebral way. After ozone treatment, plasmatic levels of antioxidant/pro-oxidant markers, pain, and life quality disability parameters were evaluated.

RESULTS:One hundred percent of patients showed a severe oxidative stress. Major changes in superoxide dismutase activity, total hydroperoxides, advanced oxidation protein products, fructolysine content, and malondialdehyde were observed. After ozone oxidative post-conditioning, there was a re-establishment of patients' cellular redox balance as well as a decrease in pain in both DH. A relationship between indicators of oxidative protein damage and pain was demonstrated.

CONCLUSIONS:Ozone therapy protected against oxidation of proteins and reduced the pain. Relationship between markers of oxidative protein damage, disability parameters, and pain suggests the role of oxidative stress in the pathological processes involved in DH.

OBJECTIVES:: Chronic neck pain is a significant public health problem with only very few evidence-based treatment options. There is growing evidence for the effectiveness of yoga for relieving musculoskeletal disorders. The aim of this study was to evaluate the effect of Iyengar yoga compared with exercise on chronic nonspecific neck pain. METHODS:: Patients were randomly assigned to either yoga or exercise. The yoga group attended a 9-week yoga course and the exercise group received a self-care manual on home-based exercises for neck pain relief. The main outcome measure was the present neck pain intensity (100 mm visual analog scale). Secondary outcome measures included functional disability (Neck Disability Index), pain at motion (visual analog scale), health-related quality of life (Short Form-36 questionnaire), cervical range of motion, proprioceptive acuity, and pressure pain threshold. RESULTS:: Fifty-one patients (mean age 47.8 y ; 82.4% female) were randomized to yoga (n=25) and exercise (n=26) intervention. After the study period, patients in the yoga group reported significantly less neck pain intensity compared with the exercise group [mean difference: -13.9 mm (95% CI, -26.4 to -1.4), P=0.03]. The yoga group reported less disability and better mental quality of life. Range of motion and proprioceptive acuity were improved and the pressure pain threshold was elevated in the yoga group. DISCUSSION:: Yoga was more effective in relieving chronic nonspecific neck pain than a home-based exercise program. Yoga reduced neck pain intensity and disability and improved health-related quality of life. Moreover, yoga seems to influence the functional status of neck muscles, as indicated by improvement of physiological measures of neck pain.

Back pain brings about one of the heaviest burden of disease. Despite much research, this condition remains poorly understood and effective treatments are frustratingly elusive. Thus, researchers in the field need to consider new hypotheses. Vitamin C (ascorbic acid) is an essential co-factor for collagen crosslinks, a key determinant of ligament, tendon and bone quality. Recent studies have reported high frequency of hypovitaminosis C in the general population. We hypothesized that lack of vitamin C contributes to poor collagen properties and back pain. We conducted this study to examine the associations between serum concentration of vitamin C and the prevalence of spinal pain and related functional limitations in the adult general population.This study used nationwide cross-sectional data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2003-2004. Data were available for 4,742 individuals aged≥20 years.Suboptimal serum vitamin C concentrations were associated with the prevalence of neck pain (adjusted odds ratio (aOR): 1.5; 95% confidence interval (CI): 1.2-2.0), low back pain (aOR: 1.3; 95% CI: 1.0-1.6), and low back pain with pain below knee (aOR: 1.3; 95% CI: 1.0-1.9) in the past three months, self-reported diagnosis of arthritis/rheumatism (aOR: 1.4; 95% CI: 1.2-1.7), and related functional limitations' score (adjusted difference of means (aB): 0.03; 95% CI: 0.00-0.05).The prevalence of hypovitaminosis C in the general population is high. Our study shows associations betweenvitamin C and spinal pain that warrant further investigation to determine the possible importance of vitamin C in the treatment of back pain patients.

BACKGROUND: Shoulder biomechanics and spine alignment have been found to be related to occasional and/or chronic neck-shoulder pain. Pilates is a physical training approach that focuses on posture, flexibility, segmental alignment and core control, through posture and movement exercises. The objectives of this study were to determine the effect of a Pilates training program on arm-trunk posture, strength, flexibility and biomechanical patterns during a functional shoulder flexion task. METHODS: Nineteen subjects (9 controls, 10 experimental) were assessed twice, 12 weeks apart, during which the experimental group was submitted to a Pilates training program (two 1-h sessions per week). The assessment consisted of trials of seated posture, abdominal strength, shoulder range of motion, and maximal shoulder flexion, during which neck, shoulder and trunk kinematics and the activity of 16 muscles were recorded. FINDINGS: After training, subjects showed smaller static thoracic kyphosis during quiet sitting and greater abdominal strength. The experimental group also showed reduced posterior and mediolateral scapular displacements, upper thoracic extension and lumbar lateral flexion, as well as higher activity of the ipsilateral cervical erector spinae, contralateral rhomboid muscles and lower activity of the ipsilateral lumbar erector spinae during the shoulder flexion task. INTERPRETATION: The Pilates training program was effective in improving abdominal strength and upper spine posture as well as in stabilizing core posture as shoulder flexion movements were performed. Since deficits in these functional aspects have previously been associated with symptoms in the neck-shoulder region, our results support the use of Pilates in the prevention of neck-shoulder disorders.

BACKGROUND AND PURPOSE:Neck pain is a common musculoskeletal condition that affects a large portion of the population. It is not known if qigong affects neck pain. The purpose of this review is to systematically review the effects of qigong in subjects with neck pain.

METHODS:A systematic review of literature indexed in the following databases: PubMed, Medline, CINAHL, Physiotherapy Evidence Database, and SportsDiscus, was conducted and methodologically graded using the Physiotherapy Evidence Database Scale (PEDro).

RESULTS:Five studies satisfied criteria and were included in this review. The majority of included studies found that qigong had a significant effect on neck pain or disability (95% CI). Qigong was not generally more effective than exercise therapy groups.

CONCLUSION:The findings of this systematic review indicate that qigong might have a beneficial effect in some individuals with neck pain, although not necessarily more effective than therapeutic exercise.

OBJECTIVE:To evaluate the short-term and long-term effects on treatment of neck pain caused by cervical spondylosis with the combination of acupuncture and moxibustion with seed-size moxa cone.

METHODS:One hundred and forty-five patients of neck pain were randomly divided into an acupuncture-moxibustion group (49 cases), an acupuncture group (48 cases) and a moxibustion group (48 cases). Acupoints of Bailao (Extra), Dazhui (GV 14), Jianzhongshu (SI15) and Zhongzhu (TE 3) were adopted for all the 3 groups. Acupuncture was applied at all the acupoints with 20 min needling retention for the acupuncture group. Moxibustion with seed-size moxa cone was used with 5 cones on each point for the moxibustion group. And both acupuncture and moxibustion with seed-size moxa cone were adopted for the acupuncture-moxibustion group. The treatment was applied once every 3 days, and 10 treatments should be finished within 4 weeks. Follow-up should be carried out for 3 months. The short-term and long-term effects were evaluated with the scores of Northwick Park Pain Questionnaire (NPQ) and McGill Pain Questionnaire (MPQ) as the indices of therapeutic effect.

RESULTS:The NPQ score and MPQ score of all the 3 groups after the treating course and the 3-month follow-up were both decreased when compared with those before the treatment (all P<0. 05). The scores of NPQ and MPQ the acupuncture-moxibustion group were lower than that of the other two groups. And the difference had obvious significance (P<0. 05). High efficiency of pain relieving for cervical spondylosis could be found in all the 3 groups, which showed that short-term and long-term effects were good for all the 3 groups. And the highest curative effect could be found in acupuncture-moxibustion group.

CONCLUSION:Combination of acupuncture and moxibustion with seed-size moxa cone has reached a superior effect in short-term and long-term for neck pain caused by cervical spondylosis.

OBJECTIVE:To evaluate the short-term and long-term effects on treatment of neck pain caused by cervical spondylosis with the combination of acupuncture and moxibustion with seed-size moxa cone.

METHODS:One hundred and forty-five patients of neck pain were randomly divided into an acupuncture-moxibustion group (49 cases), an acupuncture group (48 cases) and a moxibustion group (48 cases). Acupoints of Bailao (Extra), Dazhui (GV 14), Jianzhongshu (SI15) and Zhongzhu (TE 3) were adopted for all the 3 groups. Acupuncture was applied at all the acupoints with 20 min needling retention for the acupuncture group. Moxibustion with seed-size moxa cone was used with 5 cones on each point for the moxibustion group. And both acupuncture and moxibustion with seed-size moxa cone were adopted for the acupuncture-moxibustion group. The treatment was applied once every 3 days, and 10 treatments should be finished within 4 weeks. Follow-up should be carried out for 3 months. The short-term and long-term effects were evaluated with the scores of Northwick Park Pain Questionnaire (NPQ) and McGill Pain Questionnaire (MPQ) as the indices of therapeutic effect.

RESULTS:The NPQ score and MPQ score of all the 3 groups after the treating course and the 3-month follow-up were both decreased when compared with those before the treatment (all P<0. 05). The scores of NPQ and MPQ the acupuncture-moxibustion group were lower than that of the other two groups. And the difference had obvious significance (P<0. 05). High efficiency of pain relieving for cervical spondylosis could be found in all the 3 groups, which showed that short-term and long-term effects were good for all the 3 groups. And the highest curative effect could be found in acupuncture-moxibustion group.

CONCLUSION:Combination of acupuncture and moxibustion with seed-size moxa cone has reached a superior effect in short-term and long-term for neck pain caused by cervical spondylosis.