The effect of neural mobilisation on cervico-brachial pain: design of a randomised controlled trial

BMC Musculoskeletal Disorders

Witness Mudzi¹  Aimee Stewart¹  Cato A Basson² 

[1] Physiotherapy Department, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Park Town, 2193 Johannesburg, South Africa;Private practice, 407 Stonewall Avenue, Faerie Glen 0043, PO Box 74745, Lynnwood Ridge 0040, South Africa

关键词: Catastrophising;    Neuropathic pain;    Neural mobilisation;    Cervico-brachial pain;    Neck pain;   

Others  :  1090910
DOI  :  10.1186/1471-2474-15-419

 received in 2013-11-16, accepted in 2014-11-21,  发布年份 2014

【 摘 要 】

Background

Neck pain is a common musculoskeletal complaint and is often associated with shoulder or arm pain. There is a paucity of information on effective treatment for neck and arm pain, such as radiculopathy or cervico-brachial pain. Guidelines recommend neck mobilisation/ manipulation, exercises and advice as the treatment for neck pain, and neck and arm pain. There are a few studies that have used neural mobilisation as the treatment for cervico-brachial pain. Although results seem promising the studies have small sample sizes that make it difficult to draw definite conclusions.

Methods

A randomised controlled trial will be used to establish the effect of neural mobilisation on the pain, function and quality of life of patients with cervico-brachial pain. Patients will be recruited in four physiotherapy private practices and randomly assigned to usual care or usual care plus neural mobilisation.

Discussion

In clinical practice neural mobilisations is commonly used for cervico-brachial pain. Although study outcomes seem promising, most studies have small participant numbers. Targeting the neural structures as part of the management plan for a subgroup of patients with nerve mechano-sensitivity seems feasible. Patients with neuropathic pain and psychosocial risk factors such as catastrophising, respond poorly to treatment. Although a recent study found these patients less likely to respond to neural mobilisation, the current study will be able to assess whether neural mobilisation has any added benefit compared to usual care. The study will contribute to the knowledge base of treatment of patients with cervico-brachial pain. The findings of the study will be published in an appropriate journal.

Trial registration

Trial registration Number: PACTR201303000500157.

【 授权许可】

   
2014 Basson et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Picavet HS, Schouten JS: Musculoskeletal pain in the Netherlands: prevalence, consequences and risk factor groups, the DMC(3)-study. Pain 2003, 102:167-178.
• [2]Binder A: The diagnosis and treatment of nonspecific neck pain and whiplash. Eura Medicophysical 2007, 43:79-89.
• [3]Lindgren L: Preface: neck pain and the decade of the bone and joint 2000–2010. Spine 2008, 33:S1-S2.
• [4]Fejer R, Kyvik KO, Hartsvigsen J: The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J 2006, 15(6):834-848.
• [5]Hoy D, March L, Woolf A, Blyth F, Brooks P, Smith E, Vos T, Barendregt J, Blore J, Murray C, Burstein R, Buchbinder R: The global burden of neck pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014, 73(7):1309-15.
• [6]Salt E, Wright C, Kelly S, Dean A: A systematic literature review on the effectiveness of non-invasive therapy for cervicobrachial pain. Man Ther 2011, 16(1):53-65.
• [7]Daffner SDHA, Hanscom BS, Brislin BT, Vacarro AR, Albert TJ: Impact of neck and arm pain on overall health status. Spine 2003, 28(17):2030-2035.
• [8]Hall TM, Elvey RL: Nerve trunk pain: physical diagnosis and treatment. Man Ther 1999, 4(2):63-73.
• [9]Jull G, Sterling M, Falla D, Treleaven J, O’Leary S: Differential diagnosis of cervicobrachial pain. London: Churchill Livingston; 2008.
• [10]Allison GT, Nagy BM, Hall T: A randomized clinical trial of manual therapy for cervico-brachial pain syndrome – a pilot study. Man Ther 2002, 7(2):95-102.
• [11]Nee RJ, Vincenzino B, Jull GA, Cleland JA, Coopieters MW: Neural tissue management provides immediate clinically relevant benefits without harmful effects for patients with nerve related neck and arm pain: a randomised trial. J Physiother 2012, 58(1):23-31.
• [12]Young IA, Michener LA, Cleland JA, Aguilera AJ, Snyder AR: Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther 2009, 89(7):632-642.
• [13]Merskey H, Bogduk N: “Part III: Pain Terms, a current list with definitions and notes on usage”. In Classification of Chronic Pain. 1994 edition. Seattle: IASP Press; 2011:209-214.
• [14]Dworkin RH, Jensen MP, Gammaitoni AR, Olaleye DO, Galer BS: Symptom profiles differ in patients with Neuropathic Versus Non-neuropathic pain. J Pain 2007, 8(2):118-126.
• [15]Cowell IM, Philips DR: Effectiveness of manipulative physiotherapy for the treatment of neurogenic cervicobrachial pain syndrome: a single case study - experimental design. Man Ther 2002, 7(1):31-38.
• [16]Smith BH, Torrance N, Bennett MI, Lee AJ: Health and quality of life associated with chronic pain of predominantly neuropathic origin in the community. Clin J Pain 2007, 23(2):143-149.
• [17]Sterling M, Pedler A: A neuropathic pain component is common in acute whiplash and associated with a more complex clinical presentation. Man Ther 2009, 14:173-179.
• [18]Karels CH, Bierma-Zeinstra SM, Verhagen AP, Koes BW, Burdorf A: Sickness absence in patients with arm, neck and shoulder complaints presenting in physical therapy practice: 6 months follow-up. Man Ther 2010, 15(5):476-481.
• [19]Pool JJM, Ostelo RWJG, Knol D, Bouter LM, De Vet HCW: Are psychological factors prognostic indicators of outcome in patients with sub-acute neck pain? Man Ther 2010, 15:111-116.
• [20]Verhagen AP, Karels CH, Schellingerhout JM, Willemsen SP, Koes BW, Bierma-Zeinstra SM: Pain severity and catastrophising modify treatment success in neck pain patients in primary care. Man Ther 2010, 15(3):267-272.
• [21]Walton DM, Pretty J, MacDermid JC, Teassel RW: Risk factors for persistent problems following whiplash injury: results of a systematic review and meta-analysis. J Orthop Sports Phys Ther 2009, 39(5):334-350.
• [22]Karels CH, Bierma-Zeinstra SM, Burdorf A, Verhagen AP, Nauta AP, Koes BW: Social and psychological factors influenced the course of arm, neck and shoulder complaints. J Clin Epidemiol 2007, 60(8):839-848.
• [23]Sullivan MJL, Bishop SR, Pivik J: The pain catastrophizing scale: development and validation. psychological assessment. Psychol Assess 1995, 7(4):524-532.
• [24]Thompson DP, Urmston M, Oldhamb JA, Woby SR: The association between cognitive factors, pain and disability in patients with idiopathic chronic neck pain. Disabil Rehabil 2010, Early on line:1-10.
• [25]Schellingerhout JM, Verhagen AP, Heymans MW, Pool JJM, Vonk F, Koes BW, de Vet HCW: Which subgroups of patients with non-specific neck pain are more likely to benefit from spinal manipulation therapy, physiotherapy, or usual care? Pain 2008, 139(3):670-680.
• [26]Webb R, Brammah T, Lunt M, Urwin M, Allison T, Symmons D: Prevalence and predictors of intense, chronic, and disabling neck and back pain in the UK general population. Spine 2003, 28(11):1195-1202.
• [27]Childs JD, Cleland JA, Elliott JM, Teyhen DS, Wainner RS, Whitman JM, Sopky BJ, Godges JJ, Flynn TW: Neck pain: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopedic section of the American physical therapy association. J Orthop Sports Phys Ther 2008, 38(9):A1-A34.
• [28]Miller J, Gross A, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL: Manual therapy and exercise for neck pain: a systematic review. Man Ther 2010, 15:334-354.
• [29]Shacklock M: Clinical Neurodynamics: A New System of Musculoskeletal Treatment. Edinburgh: Elsevier/Butterworth; 2005.
• [30]Coppieters MW, Alshami AM: Longitudinal excursion and strain in the median nerve during novel nerve gliding exercises for carpal tunnel syndrome. J Orthop Res 2007, 25(7):972-980.
• [31]Schmid AB, Elliott JM, Strudwick MW, Little M, Coppieters MW: Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome–an MRI study to reveal therapeutic mechanisms. J Orthop Res 2012, 30(8):1343-1350.
• [32]Bialosky JE, Bishop MD, Price DD, Robinson ME, Vincent KR, George SZ: A randomized sham-controlled trial of a neurodynamic technique in the treatment of carpal tunnel syndrome. J Orthop Sports Phys Ther 2009, 39(10):709-723.
• [33]Butler DS: The Sensitive Nervous System. 1st edition. Adelaide: Noigroup Publications; 2000.
• [34]Costello M: Treatment of a patient with cervical radiculopathy using thoracic spine thrust manipulation, soft tissue mobilization and exercise. J Manual Manipul Ther 2009, 16(3):129-135.
• [35]Cleland JA, Childs JD, Palmer JA, Eberhart S: Slump stretching in the management of non-radicular low back pain. Man Ther 2007, 11:279-286.
• [36]Baysal O, Altay Z, Ozcan C, Ertem K, Yologlu S, Kayhan A: Comparison of three conservative treatment protocols in carpal tunnel syndrome. Int J Clin Pract 2006, 60(7):820-828.
• [37]Vincenzino B, Collins D, Wright A: The initial effects of cervical spine manipulative physiotherapy treatment on pain and dysfunction of lateral epicondylalgia. Pain 1996, 68:69-74.
• [38]Coppieters MW, Stappaerts KH, Wouters LL, Jansens K: Abberant protective force generation during neural provocation testing and the effect of treatment in patients with neurogenic cervicobrachial pain. J Manipul Physiol Ther 2003, 26:99-106.
• [39]Ellis RF, Hing WA: Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy. J Man Manip Ther 2008, 16(1):8-22.
• [40]Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lanteri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E: Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005, 114(1–2):29-36.
• [41]Nee RJ, Jull GA, Vicenzino B, Coppieters MW: The validity of upper-limb neurodynamic tests for detecting peripheral neuropathic pain. J Orthop Sports Phys Ther 2012, 42(5):413-424.
• [42]Bolton JE, Wilkinson RC: Responsiveness of pain scales: a comparison of three pain intensity measures in chiropractic patients. J Manipul Physiol Ther 1998, 21:1-7.
• [43]Bijur PE, Latimer CT, Gallagher EJ: Validation of a verbal numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med 2003, 10:390-392.
• [44]Holdgate A, Asha S, Craig J, Thompson J: Comparison of a verbal numeric rating scale with the visual analogue scale for the measurement of acute pain. Emerg Med (Fremantle) 2003, 15(5–6):441-446.
• [45]Westaway MDSP, Binkley M: The patient-specific functional scale: validation of its use in persons with neck dysfunction. J Orthop Sports Phys Ther 1998, 27(5):331-338.
• [46]Stratford PW, Gill C, Westaway MD, Binkley M: Assesing disability and change in individual patients: a report of a patient specific measure. Physiother Can 1995, 47(4):258-263.
• [47]Cleland JAFJ, Whitman JM: The reliability and construct validity of the neck disability index and patient specific functional scale in patients with cervical radiculopath. Spine 2006, 31(5):598-602.
• [48]Horn KK, Jennings S, Richardson G, Van Vliet D, Hefford C, Abbot JH: The patient-specific functional scale: psychometrics, clinimetrics, and application as a clinical outcome measure. J Orthop Sports Phys Ther 2012, 42(1):30-42.
• [49]Coons SJ, Rao S, Keininger DL, Hays RD: A comparative review of generic quality-of-life instruments. Pharmacoeconomics 2000, 17(1):13-35.
• [50]Peolsson A, Ludvigsson ML, Wibault J, Dedering A, Peterson G: Function in patients with cervical radiculopathy or chronicwhiplash-associated disorders comparedwith healthy volunteers. J Manipulative Physiol Ther 2014, 37(4):211-218.
• [51]Kamper SJ, Maher CG, Mackay G: Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manipul Ther 2009, 17(3):163-170.
• [52]Hitchkock SA, Meyer HP, Gwyther E: Neuropathic pain in AIDS patients prior to antiretroviral therapy. South Afr Med J 2008, 98(11):889-892.
• [53]Chetty S, Baalbergen E, Bhigjee AI, Kamerman P, Ouma J, Raath R, Raff M, Salduker S, South African Expert P: Clinical practice guidelines for management of neuropathic pain: expert panel recommendations for South Africa. S Afr Med J 2012, 102(5):312-325.
• [54]Osman A, Barrio FX, Gutierrez PM, Kopper PA, Merrifield T, Grittmann L: The pain catastrophizing scale: further psychometric evaluation with adult samples. J Behav Med 2000, 23(4):351-365.
• [55]Coppieters MW, Hough AD, Dilley A: Different nerve-gliding exercises induce different magnitudes of median nerve longitudinal excursion: an In vivo study using dynamic ultrasound imaging. Orthop Sports Phys Ther 2009, 39(3):164-171.
• [56]Coppieters M, Stappaerts K, Jansens K, Jull G: Reliability of detecting ‘onset of pain’ and ‘submaximal pain’ during neural provocation testing of the upper quadrant. Physiother Res Int 2002, 7(3):146-156.
• [57]Sterling M, Treleaven J, Jull G: Responses to a clinical test of mechanical provocation of nerve tissue in whiplash associated disorder. Man Ther 2002, 7(2):89-94.
• [58]Petty NJ, Moore AP (Eds): Neuromusculoskeletal Examination and Assessment. Edinburgh: Churchill Livingstone; 1998.
• [59]Dumville JC, Hahn S, Miles JNV, Torgenson DJ: The use of unequal randomisation ratios in clinical trials: a review. Contemp Clin Trials 2006, 27:1-12.
• [60]Shen D, Lu S: Randomization in Clinical Trial Studies. In Conference Proceedings: SAS Conference. Bonita Springs, Florida: LexJansen; 2006:Paper PO06. wwwlexjansencom/pharmasug
• [61]Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Br Med J 2009, 339(8 august):332-336.
• [62]Schulz KF, Grimes DA: Generation of allocation sequences in randomised trials: chance, not choice. Lancet 2002, 359(February 9):515-519.
• [63]TRACsa: Clinical guidelines for best practice management of acute and chronic whiplash-associated disorders. In Trauma and Injury Recovery. Adelaide, Australia; 2008.
• [64]Gross A, Miller J, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Bronfort G, Hoving JL: Manipulation or mobilisation for neck pain: a cochrane review. Man Ther 2010, 15(4):315-333.
• [65]Hengeveldt E, Banks K, English K: Maitland’s Vertebral Manipulation. 2005.
• [66]Falla D, O’Leary S, Fagan A, Jull G: Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting. Man Ther 2007, 17:139-143.
• [67]Gross AR, Haines T, Goldsmith CH, Santaguida L, McLaughlin LM, Peloso P, Burnie S, Hoving J, Cervical Overview G: Knowledge to action: a challenge for neck pain treatment. J Orthop Sports Phys Ther 2009, 39(5):351-363.
• [68]Nee RJ, Vicenzino B, Jull GA, Cleland JA, Coppieters MW: A novel protocol to develop a prediction model that identifies patients with nerve-related neck and arm pain who benefit from the early introduction of neural tissue management. Contemp Clin Trials 2011, 32(5):760-770.