Table 21Chronic neck pain: physical modalities

Author, Year, Followupa Pain Duration, Study QualityInterventionPopulationFunction and Pain OutcomesOther Outcomes

Altan, 2005145

3 months

Pain duration: 4.5 years

Fair

A. GaAs low-level laser treatment (n=26): over the 3 trigger points bilaterally and 1 point in the taut bands in trapezius muscle bilaterally for 2 min over each point once a day for 2 weeks. Laser wavelength of 904 nm.

B. Sham laser treatment (n=27)

A vs. B

Age: 43 vs. 43 years

Female: 87% vs. 48%

Baseline pain (0-10 VAS): 6.9 vs. 6.2

Baseline pain (5-point scale, 0-5): 2.4 vs. 2.2

A vs. B

3 months:

Pain (VAS): 3.2 vs. 3.8, difference −0.6 (95% CI −1.0 to −0.3)

Pain (5 point scale): 1.1 vs. 1.2, difference −0.1 (95% CI −0.2 to 0.05)

NR

Chiu, 2011146

1.5 months

Pain duration: NR

Poor

A. Cervical Traction (intermittent) (n=39): ranging from 10-20% of patient body weight, holding time 10-25 seconds; resting time 20-50% of holding time; twice/week for 6 weeks; sessions lasting 20 minutes.

B. Infrared Irradiation Control (n=40): via infrared lamp positioned so that patients reported minimal warmth over the back of their neck; twice/week for 6 weeks; sessions lasting: 20 minutes.

A vs. B

Age: 50.9 vs. 46.8 years

Female: 65.2% vs. 76.5%

Baseline NPQ (0-100%): 46.1 vs. 38.5

Baseline NPS (0-10): 5.8 vs. 5.2

A vs. B

1.5 months

NPQ Disabilityb: 31.4 vs. 29.6; p>0.05, 95% CI 29.7 to 37.5, power=0.15

NPS Pain Severityb: 3.5 vs. 2.8; p>0.05, 95% CI 3.3 to 4.5, power=0.17

NR

Chow, 2006147

1 month

Pain duration: 15 years

Good

A. Low-level laser therapy (n=45): 2x/week for 7 consecutive weeks, maximum half hour per treatment. Up to 50 tender points in the neck were treated for 30 seconds per point. Laser wavelength of 830 nm.

B. Sham laser (n=45)

A vs. B

Age: 57 vs. 55 years

Female: 64% vs. 67%

Baseline NPQ (0-100%):

Baseline NPAD (0-100):

Baseline pain (0-10 VAS): 5.9 vs. 4.0

MPQ VAS (1-5):

A vs. B

1 month

NPQ: −3.5 vs. −0.6, difference −3.0 (95% CI −5.0 to −0.9)

NPAD: −15.2 vs. −3.1, difference −12.1 (95% CI −19.3 to −4.8)

Proportion with improved pain >3 points (%): 40% vs. 7%, RR 6.0 (95% CI 1.9 to 19.0)

Pain VAS: −2.7 vs. 0.3, difference 3.0 (95% CI −3.8 to −2.1)

MPQ VAS: −2.1 vs. 0.1, difference −2.2 (95% CI −3.5 to −0.9)

A vs. B

1 month

SF36 PCS (0-100): 3.2 vs. −1.3, difference 4.5 (95% CI 0.7 to 8.2)

SF 36 MCS (0-100): 2.4 vs. 5.4, difference −2.9 (95% CI −7.2 to 1.3)

MPQ sensory (0-33): −3.4 vs. −1.9, difference −1.5 (95% CI −4.5 to 1.5)

MPQ affective (0-12): −1.3 vs. −0.7, difference −0.6 (95% CI −2.3 to 1.1)

Gur, 2004148

2.5 months

Pain duration: 43 months

Fair

A. Active Ga-As low-level laser therapy (n=30): daily for 2 weeks, 3 minutes each myofascial tender point. Laser wavelength of 904 nm.

B. Sham laser (n=30)

A vs. B

Age: 32 vs. 31 years

Female: 82% (total pop only)

Employed: 12% vs. 17%

Baseline NPAD (0-100): 65.4 vs. 68.5

Baseline pain at rest (0-10 VAS): 7.4 vs. 6.9

Baseline pain at movement (0-10 VAS): 7.4 vs. 7.2

A vs. B

2.5 months

NPAD: 41.1 vs. 63.3, difference −22.2 (95% CI −36.7 to −7.6)

VAS pain at rest: 4.2 vs. 6.3, difference −2.1 (95% CI −3.8 to −0.4)

VAS pain at movement: 5.3 vs. 7.3, difference −2.0 (95% CI −3.3 to −0.7)

A vs. B

2.5 months

BDI (0-63): 14.72 vs. 21.38, difference −6.66 (95% CI −13.24 to −0.08)

NHP (0-100): 56.41 vs. 72.48, difference −16.1 (95% CI −30.9 to −1.3),

Trock, 1994149

1 month

Pain duration: 7.5 years

Poor

A. Pulsed electromagnetic fields (n=42): extremely low frequency (<2 A, 120 V) applied with stepwise energy characteristics as follows: 5 Hz, 0-15 gauss for 10 minutes; 10 Hz, 15-25 gauss for 10 minutes; and 12 Hz, 15-25 gauss for 10 minutes. Maximum number of pulses/burst was 20.

B. Sham (n=39)

Treatments were given for 30 minute periods, 3-5 times per week for 18 treatments.

A vs. B

Age: 61 vs. 67 years

Female: 71% vs. 67%

Weight (lb): 161 vs. 162

Duration of symptoms: 7 vs. 8 years

Baseline ADL difficulty (0-24) 11.9 vs. 11.5

Baseline pain (0-10 VAS): 7.2 vs. 6.2

A vs. B

1 month:

ADL difficulty: 3.8 vs. 2.1, difference 1.6 (95% CI −1.5 to 4.8)

Pain: 2.6 vs. 1.5, difference 1.1 (95% CI −0.3 to 2.6)

A vs. B

1 month:

Patients’ assessment of improvement (0-100): 41.2 vs. 40.0, difference 1.2 (95% CI −15.2 to 17.6)

ADL = activity of daily living; BDI = Beck Depression Inventory; CI = confidence interval; Ga-As = Gallium Arsenide; MPQ = McGill Pain Questionnaire; NHP = Nottingham Health Profile; NPAD = Neck Pain and Disability Scale; NPQ = Northwick Park Questionnaire; NPS = numeric pain scale; NR = not reported; RR = risk ratio; SF-36 MCS = Short-Form 36 Questionnaire Mental Coomponent Score; SF-36 PCS = Short-Form 36 Questionnaire Physical Component Score; VAS = visual analog scale

a

Unless otherwise noted, followup time is calculated from the end of the treatment period

b

Results of two-way repeated measures analysis of variance (ANOVA).

From: Results

Cover of Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update
Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update [Internet].
Comparative Effectiveness Review, No. 227.
Skelly AC, Chou R, Dettori JR, et al.

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