Local and Widespread Pressure Pain Hyperalgesia Is Not Side Specific in Females with Unilateral Neck Pain that Can Be Reproduced during Passive Neck Rotation

Abstract

Current evidence for widespread hyperalgesia in non-specific neck pain (NSNP) is unclear. It is currently recommended to group NSNP patients according to pain-provoking movements. The aim of this study was to investigate local and widespread pain sensitivity in females with unilateral NSNP that is reproducible during passive neck rotation compared with matched controls, and to compare the side specific effect of pain location on pressure pain sensitivity among females with unilateral NSNP. Thirty-six females with unilateral NSNP evoked during passive ipsilateral (n = 20) or contralateral (n = 16) rotation toward the painful side were compared with 20 controls. Participants reported their pain intensity at rest and during passive neck rotation and completed the Neck Disability Index. Pressure pain thresholds (PPTs) were assessed bilaterally over the anterior scalene; the sternocleidomastoid; the levator scapulae; lateral to the spinous process of C6; the median, ulnar, and radial nerves; and the tibialis anterior. The ANOVA revealed lower PPTs in females with unilateral NSNP compared with the controls (all at p < 0.001), but no differences were found between the sides, nor was there any Group × side interaction. Among females with NSNP, those with higher pain intensity during ipsilateral rotation toward the painful side showed lower PPTs over the anterior scalene, median nerve, ulnar nerve, and tibialis anterior (all, p < 0.05) than females with higher pain intensity during contralateral rotation toward the painful side. These findings demonstrated bilateral local and widespread pressure pain hyperalgesia in females with unilateral NSNP that was reproducible during passive neck rotation compared with controls. There was no side specific effect of pain location on PPTs among females with unilateral NSNP.

Effects of Virtual Reality versus Exercise on Pain, Functional, Somatosensory and Psychosocial Outcomes in Patients with Non-specific Chronic Neck Pain: A Randomized Clinical Trial

“…Moreover, alterations of pain processing have been investigated in patients with neck pain, showing local and distant mechanical hyperalgesia [18]. Regarding nociceptive processing alterations, other researchers have found that some subgroups of patients with chronic neck pain present generalized and bilateral hyperalgesia in addition to local hyperalgesia in the cervical region, as well as functional alterations such as decreased range of cervical movement [19][20][21]. Even in some subgroups, we have found that generalized pain is associated with psychosocial factors such as anxiety [20].…”

“…VR treatment is based on three basic elements: simulation, interaction and immersion. Thanks to these treatments, the patient is able to interact intuitively by perceiving visual, auditory, tactile or kinesthetic stimuli in a virtual world [21]. Therefore, VR treatment offers increased feedback, turning the technique into a powerful pain-distracting mechanism.…”

Immediate and Short-Term Effects of Upper Cervical High-Velocity, Low-Amplitude Manipulation on Standing Postural Control and Cervical Mobility in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

“…Due to this lack of consensus, it is difficult to compare the results due to the differences in the tests and variables measured in each study. In addition, a recent study emphasizes that the differences in the factors used to subclassify NSNP patients problematizes further comparison among studies; therefore, pain, mobility, and the association between them should be considered fundamentally for subclassifications [ 37 ].…”

“…Future studies could investigate the effect of upper cervical HVLA manipulation, whether associated or not with other clinically relevant interventions, trying to subclassify subjects with nonspecific neck pain [ 37 ], and assess postural standing stability and upper cervical movement under different conditions of origin, intensity and duration of pain. In addition, future studies should try to clarify the clinical relevance of postural analysis in subjects with nonspecific neck pain.…”

“…Patients were recruited consecutively in a private clinic (21 men and 23 women). They were between 18 and 60 years old, had CNSNP (over 12 weeks or more) higher than 2 in an 11-point Numeric Pain Rating Scale (NPRS) [ 37 ], with positive CFRT in one side (below 32–33 degrees) [ 38 , 39 ], and without any contraindication to cervical manipulation. Exclusion criteria were (a) vascular, neurological, or rheumatic pathology, or congenital malformations in the head or cervical spine; (b) alterations that affect the balance or postural control (e.g., dizziness, vertebrobasilar insufficiency, or Klein test positive); (c) traumatic antecedents on head or spine (e.g., fractures, sprains, whiplash); (e) pain in regions other than the neck or head during the assessments; (f) drug treatment (e.g., muscle relaxant, analgesic, anti-inflammatory).…”