Introduction Neck pain has a high lifetime prevalence and represents a significant health issue. Reduced active cervical range of motion (ACROM) has been found in neck pain patients. Inertial sensor technology can provide objective measurements to assess the impaired ACROM. Purpose Primarily, this study investigated the inter- and intra-rater reliability of the Moover® three-dimensional (3D) inertial motion sensor (Sensor Medica, Rome, Italy) in Greek patients with non-specific chronic neck pain. Secondly, the intra-rater reliability of the Neck Disability Index (NDI) was also assessed. Methods Fifty patients (18 males and 32 females) suffering from non-specific chronic neck pain participated in this study. Two physiotherapists measured separately each participant\'s ACROM in three planes, within a 48-hour period. The participants\' position and the sequence and direction of the three cervical movements (cervical rotation, lateral flexion, and flexion-extension) were standardized. Results The inter-rater reliability intraclass correlation coefficient (ICC) values were good to excellent ranging from 0.77 to 0.95 for the first measurement and 0.85 to 0.95 for the second (p < 0.001). The intra-rater reliability ICC values were moderate to excellent ranging from 0.74 to 0.92 for the first rater and good to excellent ranging from 0.83 to 0.94 for the secondrater (p < 0.001). Intra-rater reliability of the overall NDI was indicated as good, and ICC was 0.80 (95%CI: 0.65-0.89; p < 0.001). ICC values for all sections were significant and ranged from 0.40 to 0.88. Conclusion This study showed the reliability of the Moover 3D inertial sensor for ACROM measurement in Greek patients with chronic neck pain. The NDI scale also showed good intra-rater reliability in the same sample. Both intra- and inter-rater reliability of the Moover 3D were proven to be acceptable over a 48-hour period. The specific sensor might have a potential application in a clinical setting.

UNASSIGNED: Compare procedural characteristics and clinical efficacy of cervical medial branch radiofrequency neurotomy (CMBRFN) using a multi-tined cannula (MTC) versus a conventional cannula (CC) to treat chronic neck pain.
UNASSIGNED: Prospective, double-blinded randomized controlled trial.
UNASSIGNED: Patients who responded to dual medial branch blocks with ≥75% pain relief were randomized to receive RFN with either the MTC or the CC. Primary outcomes: procedural pain, procedure duration, fluoroscopy time and radiation dose. Secondary outcomes: proportion of patients reporting ≥50% numerical rating scale reduction and ≥30% neck disability index reduction at 3, 6 and 12 months.
UNASSIGNED: Forty-two patients underwent treatment. There was no difference in procedural pain between the MTC and CC groups (NRS 4.7 ± 2.0 vs. 4.2 ± 1.8, p = 0.465), but three patients, all in the CC group, could not complete the procedure due to pain. CMBRFN in the MTC group was significantly faster than in the CC group (35.5 ± 7.3 min vs. 58.2 ± 14.8 min, p < 0.001), with less fluoroscopy time (167.6 ± 76.4 s vs. 260.8 ± 123.5 s, p = 0.004). Radiation dose was 8.95 ± 7.9 mGy in the MTC group and 11.53 ± 10.3 mGy in the CC group (p = 0.36). Rates of ≥50% NRS reduction were not significantly different between the two groups at 3 months, but at 6 and 12 months, they were significantly higher in the CC group. At 3, 6 and 12 months, rates of ≥30% NDI reduction were significantly higher in the CC group.
UNASSIGNED: The MTC offers technical advantages compared to the CC for both the operator and the patient. However, CMBRFN with the multi-tined cannula seems less effective to treat neck pain than with the conventional cannula.

UNASSIGNED: Spinal cord stimulation (SCS) is a growing interventional treatment modality in patients experiencing intractable pain refractory to conservative treatments. Many patients with chronic low back and leg pain that persists after surgery have found pain relief, and more evidence is suggesting that chronic upper limb and neck pain may respond just as well to this therapy. However, the placement of foreign body, for instance SCS leads, in the epidural space can become the source for deep intra-spinal infection.
UNASSIGNED: We present a 49-year-old robust male who underwent a temporary cervical SCS trial and was diagnosed with epidural abscess on the day 9 when the leads were pulled. The trial phase was complicated by immediate and prolonged post procedure pain. The diagnosis of epidural abscess was made soon after clinical presentation with no neurological deficits or escalation in pain but new onset fever. He made a complete recovery after extensive laminectomy and antibiotic treatment.
UNASSIGNED: The decision to extend the SCS trial length poses a question of risk versus benefit in regards to potential infectious complications versus pain relief. Continuing antibiotic therapy during a SCS trial phase is a possible strategy but of uncertain benefit.
UNASSIGNED: Anesthesiology, Pain Management.

UNASSIGNED: To compile all the scientific evidence available to date to evaluate the effect of virtual reality based therapy (VRBT) on reducing pain intensity, kinesiophobia, and associated disability, and on increasing the hr-QoL in patients with chronic neck pain (CNP) or chronic low back pain (CLBP).
UNASSIGNED: Studies published in PubMed Medline, SCOPUS, Web of Science, CINAHL Complete, and Physiotherapy Evidence Database (PEDro) up to June 2023 were searched. All searches followed the PICOS Framework. Two authors independently screened the studies found in the searches. Any differences of opinion regarding the selection of studies were settled by a third author.
UNASSIGNED: Twenty-five RCTs, published between 2013 and 2022, providing data from 1261 patients (20 RCTs) with CLBP and 261 patients (five RCTs) with CNP, were included. In reducing pain intensity for patients with CLBP, meta-analyses showed that VRBT is effective in reducing pain just to the end of the intervention, and this effect could be maintained 1 and 6 months after the therapy.
UNASSIGNED: VRBT was found to be better than therapeutic exercise (TE), sham, and no intervention (NI), showing a major effect when VRBT was used as a complementary therapy to conventional physiotherapy (CPT). Further, VRBT showed an immediate effect and immersive VRBT was the most adequate VRBT modality in reducing pain in CNP patients. No differences were found between non-immersive VRBT and immersive VRBT in reducing pain, kinesiophobia, disability, and hr-QoL in patients with CLBP.

Radiofrequency ablation (RFA), a minimally invasive procedure for pain reduction, is increasingly used for managing chronic neck pain and headaches. This article offers a concise overview of cervical spine RFA. In the context of RFA, heat is applied to specific nerve tissues to interrupt pain signals. Wallarian degeneration occurs as a result of the thermal injury to the nerve. The heat generated by the RFA procedure can damage the nerve fibers, initiating the degenerative process. Wallarian degeneration is a process that occurs in a nerve axon due to the thermal injury, leading to the breakdown and eventual degradation of the axon and its myelin sheath. However, nerves have regeneration capacity, especially the peripheral nerves, which are often the target of RFA for pain management. After Wallarian degeneration takes place, the nerve sheath, or the connective tissue surrounding the nerve, can serve as a scaffold for the growth of new nerve fibers. Over time, these new fibers can regenerate and re-establish connections, potentially restoring nerve function. Three common types are traditional thermal, water-cooled, and pulsed radio frequency ablation. Given the regenerative potential of nerves, these procedures are typically effective for 1 to 2 years, with some variability. Despite a 112% increase in Medicare claims for RFA from 2009 to 2018, it\'s recommended for patients who respond positively to diagnostic medial branch blocks, with recent guidelines suggesting a single block may be sufficient. Although generally effective, the procedure carries risks, including nerve and tissue injury. Notably, the procedure\'s increased utilization notably surpasses the most commonly reported prevalence rates of conditions it aims to treat. Moreover, diagnostic blocks performed before cervical RFA also have their risks, such as inadvertent vascular injections leading to seizures or paralysis. In summary, the risks and benefits of cervical RFA must be considered with regards to the patient\'s comorbidities and specific pain issues. The skill and experience of the practitioner plays a significant role in minimizing these risks. Detailed discussions with healthcare providers about the risks, benefits, and alternatives can help in making an informed decision about the procedure.

The purpose of the present cross-sectional study was to examine the relationship between heart rate variability (HRV) and the range of cervical motion, disability, pain intensity, pain catastrophizing, and quality of life in patients with chronic, non-specific neck pain. Thirty-five patients, aged 20-48 years, with chronic non-specific neck pain, completed validated questionnaires regarding neck pain intensity, pain-associated disability, catastrophic thoughts, and quality of life. The range of cervical motion was assessed using a digital goniometer. HRV indices were recorded in three positions (supine, sitting, and standing) through a smartphone application. Several significant correlations were observed between HRV indices and neck pain disability, the helplessness factor of catastrophizing, neck rotation, and quality of life. These correlations were only observed in the standing position. Pain catastrophizing was positively correlated with disability and pain intensity during active neck movement (Pearson r = 0.544, p < 0.01; Pearson r = 0.605, p < 0.01, respectively). Quality of life was negatively correlated with pain intensity during active movement (Pearson r = -0.347, p < 0.05). HRV indices were correlated with the psychological and physical domains of neck pain. These cardiac indices have been related to neck pain variables in some previous studies. Further research is needed to confirm this relationship in different daily conditions.

BACKGROUND: It can be challenging to perform activities of daily living in patients with chronic neck pain. As the severity of the pain increases, the quality of the movements decreases. Not only the neck, but also the shoulder, elbow, grip strength and psychomotor skills are affected by these pains.
OBJECTIVE: In this study, it was aimed to investigate the effect of neck pain on grip strength and psychomotor skills in adults diagnosed with chronic neck pain.
METHODS: A cross-sectional study was conducted to examine the effect of pain on grip strength and psychomotor skills in patients with chronic neck pain. This study was planned to be carried out between October 2019 and May 2020 at the Private Yaşam Medical Center in Adana, with the official permission of the institution manager, but this period was carried out between October 2019 and November 2020 due to the fact that sufficient number of patients could not be reached due to the COVID-19 global epidemic. A total of 80 individuals, including 40 control and 40 patients, were included in the study. Forty adult patients who applied to the clinic with a diagnosis of chronic neck pain and 40 healthy adults without a diagnosis of chronic neck pain were included in the study. Conducted with 80 adults between the age of 19 and 74 years old. Individuals were divided into Group 1-control group (n = 40) and Group 2-patient group (n&#x02009;=&#x02009;40). Information such as age, height, body weight and occupation of the groups were noted. Visual analogue scale and Neck Disability Index were applied to both the groups; hand grip strength with a Jamar hydraulic hand dynamometer, finger lateral grip strength with a pinchmeter and psychomotor skills with the Purdue Pegboard test were evaluated.
RESULTS: In the study, hand grip strength (p < .05), finger lateral grip strength (p < .05), psychomotor skills (p < .01) showed a statistically significant decrease in the patient group compared to the control group.
CONCLUSIONS: It is thought that in addition to the routine treatments for neck pain in the treatment plan of patients with chronic neck pain, exercises to improve the functionality and psychomotor skills in daily living activities can be included in the direction of increasing the grip strength and will guide future studies.

OBJECTIVE: Chronic neck pain, a prevalent health concern characterized by frequent recurrence, requires exploration of treatment modalities that provide sustained relief. This systematic review and meta-analysis aimed to evaluate the durable effects of acupuncture on chronic neck pain.
METHODS: We conducted a literature search up to March 2024 in six databases, including PubMed, Embase, and the Cochrane Library, encompassing both English and Chinese language publications. The main focus of evaluation included pain severity, functional disability, and quality of life, assessed at least 3 months post-acupuncture treatment. The risk of bias assessment was conducted using the Cochrane Risk of Bias 2.0 tool, and meta-analyses were performed where applicable.
RESULTS: Eighteen randomized controlled trials were included in the analysis. Acupuncture as an adjunct therapy could provide sustained pain relief at three (SMD: - 0.79; 95% CI - 1.13 to - 0.46; p < 0.01) and six (MD: - 18.13; 95% CI - 30.18 to - 6.07; p < 0.01) months post-treatment. Compared to sham acupuncture, acupuncture did not show a statistically significant difference in pain alleviation (MD: - 0.12; 95% CI - 0.06 to 0.36; p = 0.63). However, it significantly improved functional outcomes as evidenced by Northwick Park Neck Pain Questionnaire scores 3 months post-treatment (MD: - 6.06; 95% CI - 8.20 to - 3.92; p < 0.01). Although nine studies reported an 8.5%-13.8% probability of adverse events, these were mild and transitory adverse events.
CONCLUSIONS: Acupuncture as an adjunct therapy may provide post-treatment pain relief lasting at least 3 months for patients with chronic neck pain, although it is not superior to sham acupuncture, shows sustained efficacy in improving functional impairment for over 3 months, with a good safety profile.

UNASSIGNED: Cervicogenic headache is characterized by chronic posterior neck pain radiating to one side of the head, resulting from cervical spine bone or soft tissue diseases. Cervical ganglioneuroma (GN), a rare benign neuroblastic tumor, especially in the cervical spine, may cause cervicogenic headache-like symptoms.
UNASSIGNED: We report a case of GN which was surgically removed successfully to relieve the symptom.
UNASSIGNED: A 68-year-old male presented with right posterior neck pain with referred pain to the ipsilateral occipital area in May 2020. Despite administration of medications, physical therapy, and spine interventions, the symptoms intermittently recurred over one year. In July 2021, the patient complained of painful limitation of neck motion, especially on right-sided bending; no motor or sensory deficits, except for subjective numbness of the finger tips, were detected. Plain radiography of the cervical spine showed moderate degenerative changes in the mid-cervical spine. Cervical MRI revealed a cystic mass (1.5 cm × 0.5 cm × 1 cm-in size) around the right C2 dorsal root ganglion adjacent to the C1-C2 facet joint. His symptoms significantly improved after complete tumor excision.
UNASSIGNED: GN of the upper cervical spine should be considered when persistent cervicogenic headache is refractory to conservative management. In such a case, advanced imaging studies such as MRI should be performed for early diagnosis and appropriate treatment.

This study aimed to evaluate the inter-examiner reliability of shear wave elastography (SWE) for measuring cervical multifidus (CM) muscle stiffness in asymptomatic controls and patients with chronic neck pain. A longitudinal observational study was conducted to assess the diagnostic accuracy of a procedure. SWE images, following a detailed procedure previously tested, were acquired by two examiners (one novice and one experienced) to calculate the shear wave speed (SWS) and Young\'s modulus. The painful side was examined for the experimental cases while the side examined in the control group was selected randomly. Data analyses calculated the intra-class correlation coefficients (ICCs), absolute errors between examiners, standard errors of measurement, and minimal detectable changes. A total of 125 participants were analyzed (n = 54 controls and n = 71 cases). The Young\'s modulus and SWS measurements obtained by both examiners were comparable within the asymptomatic group (both, p > 0.05) and the chronic neck pain group (both, p > 0.05). Nonetheless, a notable distinction was observed in the absolute error between examiners for shear wave speed measurements among patients with neck pain, where a significant difference was registered (p = 0.045), pointing to a sensitivity in measurement consistency affected by the presence of chronic neck pain. ICCs demonstrated moderate-to-good reliability across both groups, with ICC values for asymptomatic individuals reported as >0.8. Among the chronic neck pain patients, ICC values were slightly lower (>0.780). The study revealed moderate-to-good consistency, highlighting the practicality and generalizability of SWE.