This is Chapter 4 from RC’s best-selling book:

“Basic Principles of Chiropractic Neuroscience”

The common causes of pain and paresthesia are:

(1) obvious direct trauma or injury;

(2) reflex origins in musculoskeletal lesions, which deep pressure often exaggerates, such as trigger areas;

(3) peripheral nerve injury (eg, causalgia), which results in an intense burning superficial pain;

(4) the presence of nerve inflammations and degeneration of the peripheral or CNS, which frequently cause other changes indicative of such lesions;

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Background   Neck pain is a common complaint in patients presenting for chiropractic treatment. The few studies on predictors for improvement in patients while undergoing treatment identify duration of symptoms, neck stiffness and number of previous episodes as the strong predictor variables. The purpose of this study is to continue the research for predictors of a positive outcome in neck pain patients undergoing chiropractic treatment.

Methods   Acute (< 4 weeks) (n = 274) and chronic (> 3 months) (n = 255) neck pain patients with no chiropractic or manual therapy in the prior 3 months were included. Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQ) at baseline prior to treatment. At 1 week, 1 month and 3 months after start of treatment the NRS and BQ were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was provided by the clinician. Improvement at each of the follow up points was categorized using the PGIC. Multivariate regression analyses were done to determine significant independent predictors of improvement.

Results   Baseline mean neck pain and total disability scores were significantly (p < 0.001and p < 0.008 respectively) higher in acute patients. Both groups reported significant improvement at all data collection time points, but was significantly larger for acute patients. The PGIC score at 1 week (OR = 3.35, 95% CI = 1.13-9.92) and the baseline to 1 month BQ total change score (OR = 1.07, 95% CI = 1.03-1.11) were identified as independent predictors of improvement at 3 months for acute patients. Chronic patients who reported improvement on the PGIC at 1 month were more likely to be improved at 3 months (OR = 6.04, 95% CI = 2.76-13.69). The presence of cervical radiculopathy or dizziness was not predictive of a negative outcome in these patients.

CONCLUSIONS:   The most consistent predictor of clinically relevant improvement at both 1 and 3 months after the start of chiropractic treatment for both acute and chronic patients is if they report improvement early in the course of treatment. The co-existence of either radiculopathy or dizziness however do not imply poorer prognosis in these patients.

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Chronic Neck Pain and Chiropractic Page

Introduction

Cervical radiculopathy (CR) is an impingement or inflammatory irritation of the cervical spine nerve root(s), resulting in pain (or numbness) radiating along nerves of the upper extremity; [1,2] the C6 and C7 levels are most often affected. [1,3] Limited research is available on the incidence and prevalence of CR; however, the incidence rate (in Rochester, Minnesota) has been reported at 83.2 cases per 100,000 people per year (107.3/100,000 for males vs. 63.5/100,000 for females), with peak incidence in those aged 50–54 years. [1] A history of physical exertion or major trauma precedes the onset of symptoms in less than 15% of cases. The most common causes are cervical spondylosis and intervertebral disc herniation, [1,3] accounting for approximately 70% and 20% of cases, respectively. [1] In the former, posterior vertebral body osteophytes and/or facet joint/ligamentum flavum hypertrophy encroach upon the intervertebral foramen; posterolateral herniation of disc material results in foraminal encroachment in the latter. In either case, cervical nerve root pain and dysfunction can occur. [4]

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Radiculopathy and Chiropractic Page

Cervical radiculopathy (CR), while less common than conditions with neck pain alone, can be a significant cause of neck pain and disability; thus the determination of adequate treatment options for patients is essential. Currently, inadequate scientific literature restricts specific conservative management recommendations for CR. Despite a paucity of evidence for high-velocity low-amplitude (HVLA) spinal manipulation in the treatment for CR, this strategy has been frequently labeled as contraindicated. Scientific support for appropriate outcome measures for CR is equally deficient. While more scientific data is needed to draw firm conclusions, the present review suggests that spinal manipulation may be cautiously considered as a therapeutic option for patients suffering from CR. With respect to outcome measures, the Neck Disability Index appears well-suited for spinal manipulative treatment of CR.

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Radiculopathy and Chiropractic Page