Neck Pain Clinical Trial
Official title:
Somatosensory Profiles in Patients With Non Specific Neck Arm Pain With and Without Positive Neurodynamic Tests
The aim of this study was to evaluate potential differences in somatosensory function in patients with unilateral NSNAP with and without positive ND compared to healthy controls. Furthermore, we determined whether there are any differences between groups in symptom severity, functional deficits, psychological parameters, quality of life and sleep.
Neck pain is a common musculoskeletal problem, with up to 30-50 % of adults experiencing
neck pain in any given year. Neck pain in combination with arm pain is more common than neck
pain alone and is associated with higher Ievels of self-reported disability and
psychological impairment. In most cases, no pathophysiological correlate can be found in
various investigations including magnetic resonance imaging of the cervical spine and tests
for nerve conductivity (bedside neurological examination and standard electro diagnostic
tests). In such cases, the neck-arm pain is labelled as non-specific. Although clinical
examinations that evaluate the conductivity of the nervous system are normal in non-specific
neck-arm pain (NSNAP), neurodynamic tests (ND) have been identified as positive in a
subgroup of patients. ND are clinical tools designed to elongate the nerve bed, therefore
increasing the mechanical loading of neural tissues. As such, ND provide information about
alterations of neural tissue mechanosensitivity, i.e. the presence of heightened nerve
mechanosensitivity. It is assumed that increased neural mechanosensitivity reflects gain of
function, presumably mediated by small nociceptive fibres intraneurally or within the
epineurium (nervi nervorum). However, it remains unclear whether the subgroup of patients
with NSNAP and positive ND have indeed increased gain of function of this small fibre
population compared to those patients with normal ND.
Quantitative sensory testing (QST) is a commonly used tool to determine the function of
different subsets of small (C, Ad-fibres) and large nerve fibres (Ad-fibres). Using QST, a
recent study has identified a loss of small fibre function in patients with unilateral NSNAP
and positive ND as apparent by reduced warm detection thresholds compared to the
non-affected side. However, this difference was small and potentially not clinically
rele-vant and the relatively small sample size of n=8 does not allow generalization of the
results. In the same study, patients with NSNAP were also characterized by a gain of
function, i.e. cold hypersensitivity. Similarly, widespread thermal and pressure
hypersensitivity have been documented in patients with nonspecific arm pain (with or without
neck pain). None of these studies has however investigated a potential difference between
patients with NSNAP with positive versus negative ND, leaving it unclear whether the QST
findings can indeed be attributed to a positive ND.
A recent study compared patients with NSNAP and neuropathic features using ND testing and a
self report neuropathic pain screening tool and patients with NSNAP and no neuropathic
features. Interestingly, the first group showed heightened nerve mechanosensitivity apparent
by an earlier onset of symptoms during ND testing. This raises the question whether patients
with NSNAP and positive ND have indeed a dysfunction of their nervous system that
differentiates them from patients with normal ND.
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