title: Pulsed high frequency (27MHz) electromagnetic therapy for persistent neck pain. A double blind, placebo-controlled study of 20 patients. Treatment of cervical spondylosis. Electroacupuncture versus physiotherapy. Diode Laser in Cervical Myofascial Pain: A Double‐Blind Study versus Placebo Risk of recurrence of occupational back pain over three year follow up. Treatment of acute cervical pain — A comparative group study Active or passive physiotherapy for occupational cervicobrachial disorders? A comparison of two treatment methods with a 1-year follow-up. A controlled study of acupuncture in neck pain. The role of the psychologist in multidisciplinary treatments for chronic neck and shoulder pain: a controlled cost-effectiveness study. The effect of pain reduction on perceived tension and EMG-recorded trapezius muscle activity in workers with shoulder and neck pain. Manipulation of the cervical spine--a pilot study. Manipulation for Chronic Neck Pain: A Double‐Blind Controlled Study Does group gymnastics at the workplace help in neck pain? A controlled study. Working Disability Due to Occupational Back Pain: Three-year Follow-up of 2,300 Compensated Workers in Quebec Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study. Seasonal variation in neck and shoulder symptoms.
abstract: In the majority of patients with neck pain , symptoms will resolve spontaneously or quite quickly in response to therapy . However , some patients ' symptoms persist for a long period , irrespective of therapy . In this study , 20 patients with persistent ( greater than 8 weeks ) neck pain were enrolled in a double blind , placebo-controlled trial of low energy , pulsed electromagnetic therapy (PEMT)--a treatment previously shown to be effective in soft tissue injuries . For the first 3-week period , group A ( 10 patients ) received active PEMT units while group B ( 10 patients ) received facsimile placebo units . After 3 weeks , both pain ( visual analogue scale ( P less than .023 ) and range of movement ( P less than .002 ) had improved in the group on active treatment compared to the controls . After the second 3 weeks , during which both groups used active units , there were significant improvements in observed scores for pain and range of movement in both groups . PEMT , in the form described , can be used at home easily in the treatment of patients with neck pain . It is frequently successful and without side effects A prospect i ve , controlled clinical trial was undertaken to assess the relative efficacies of physiotherapy and electroacupuncture in the treatment of cervical spondylosis . The results suggested that , while both methods were effective , electroacupuncture produced an earlier symptomatic improvement with increased neck movement , especially in patients with mild degenerative changes of the cervical spine We present a double-blind trial in which a pulsed infrared beam was compared with a placebo in the treatment of myofascial pain in the cervical region . The patients were su bmi tted to 12 sessions on alternate days to a total energy dose of 5 J each . At each session , the four most painful muscular trigger points and five bilateral homometameric acupuncture points were irradiated . Those in the placebo group su bmi tted to the same number of sessions following an identical procedure , the only difference being that the laser apparatus was nonoperational . Pain was monitored using the Italian version of the McGill pain question naire and the Scott-Huskisson visual analogue scale . The results show a pain attenuation in the treated group and a statistically significant difference between the two groups of patients , both at the end of therapy and at the 3-month follow-up examination A r and om sample including 2342 cases representative of all occupational back injuries in Quebec ( 1981 ) was followed up prospect ively over three years to assess the recurrence rate of back problems ( lumbar , thoracic , and cervical ) . Each medical and accident report was review ed to obtain the site of symptoms and occupation . Age , sex , industrial sector , and number of episodes of absence from work were abstract ed from the computerised Quebec Compensation Board files . The recurrence rate was 20.0 % at one year follow up and 36.3 % at three years . A multivariate analysis using a Poisson regression , was performed to model the risk of recurrence over time . Men had a higher chance of recurrence ( risk ratio = 1.85 , 95 % CI = 1.50 - 2.27 ) but among recurrent cases , the average total number of episodes was comparable between men and women . Age showed a protective effect on the probability of recurrence ( 10 years : RR = 0.93 , 95 % CI = 0.88 - 0.98 ) due to the lower recurrence rate in the 45 - 64 year old group ( 31.8 % ) . Cervical and lumbar symptoms had identical recurrence profiles whereas thoracic symptoms had a significantly lower recurrence rate . Drivers had the highest recurrence rate ( 42.1 % ) and nurses had the highest average number of recurrences ( 2.03 ) among recurrent cases . Both occupations had statistically significant excesses after controlling for the other variables Thirty patients with acute cervical pain were r and omized into 3 groups and treated with neck collar , transcutaneous nerve stimulation , or manual therapy . The improvement was rapid in all groups , but the restoration of the cervical mobility was significantly more rapid in the transcutaneous nerve stimulation group . Some of the patients with manual therapy treatment had remarkably quick symptom reduction , although this was not significantly better than the collar alone . It is concluded that transcutaneous nerve stimulation is a valuable pain reducer and gives a more rapid restoration of cervical mobility in acute cervical pain In this study 169 female office employees were interviewed and examined to determine the occurrence and severity of neck and shoulder symptoms . Forty-seven of those with symptoms who fulfilled the criteria taken as indicating need for treatment were enrolled in a controlled clinical trial and divided into two groups . One group participated in dynamic muscle training of neck and shoulder muscles ( active physiotherapy ) . The other patients were treated by means of surface heat , massage , and stretching ( passive physiotherapy ) .  Pain in the neck and shoulder regions disappeared significantly more often just after active treatment as compared to passive treatment . Symptoms returned within three months in both groups . However , after 12 months , the incidence of headache was significantly less in the group that had received active physiotherapy . Maximal isometric muscle strength in relation to cervical lateral flexion and extension and grip strength and endurance force of shoulder muscles improved significantly after active physiotherapy , but only maximal isometric extension force increased significantly after passive physiotherapy .  Numbers of tender points in neck and shoulder muscles decreased significantly after both types of physiotherapy . Pressure threshold levels increased but not significantly in both groups during treatment Twenty-five out- patients with chronic neck pain participated in a prospect i ve , r and omized trial of acupuncture versus placebo transcutaneous nerve stimulation . A single-blind , non-cross-over design incorporated several outcome measures in an attempt to determine any particular facet of pain that responded to acupuncture .  No significant difference between the two treatments was found either post-treatment or at follow-up . Whilst the small population studied limits the conclusions that may be drawn , these findings suggest that acupuncture may have no greater effect than that of a powerful placebo This study was design ed to determine a cost-effective use of psychologist re sources in multimodal cognitive-behavioural treatments ( MMCBT ) for chronic neck/shoulder pain . A r and omised controlled trial was conducted with 66 patients divided in two groups . The first group ( A ) was treated following the approach of MMCBT with the clinical psychologist only functioning as a " coach " to the other health professionals . In this group , the psychologist had on average 5 hours of input per patients . The second group ( B ) was treated with the same inpatient MMCBT but with the behavioural component administered by the clinical psychologist directly to the patients . In this second group the psychologist had on average 17 hours of input per patient in the entire intervention . The outcome variables included physical , emotional and social factors , and sick-leave . Both groups showed significant improvements over time . The improvements were evident only in sub-groups , specifically in women . The only significant difference between the groups was in " perceived helplessness " favouring the " psychologist contact " setting . It is concluded that in terms of input of clinical psychology , the treatment setting with the " coaching " technique proved to be the most cost-effective use of the psychologist in the two treatment setting s investigated The study was initiated to evaluate the effect of pain-reducing therapies on factors previously associated with work-related shoulder and neck pain , namely increased muscle activity in the upper trapezius and perceived general tension . Thirty-three women in three groups were assessed before and after an intervention period and by question naire 6 months later . The purpose of this study was primarily to investigate associations between upper trapezius muscle activity , perceived general tension and pain , and secondly , to compare effects of individually based physiotherapy and group exercise for workers with shoulder and neck myalgia . All three groups reported a significant alleviation of pain and perceived general tension , while the electromyographically ( EMG ) recorded upper trapezius muscle activity level remained unchanged or increased . Improvements were similar in all three treatment groups , but individual-based therapies were rated more beneficial on subjective measures . Significant correlation was found between pain and perceived general tension ( r = 0.66 , p < 0.01 ) , while there was no correlation between pain or perceived general tension and recorded muscle activity A r and omized controlled trial of manipulation of the cervial spine was carried out on 52 patients in general practice , and the results were assessed symptomatically and goniometrically for three weeks . Manipulation produced a significant immediate improvement in symptoms in those with pain or stiffness in the neck , and pain/paraesthesia in the shoulder , and a nearly significant improvement in those with pain/paraesthesia in the arm/h and . Manipulation also produced a significant increase in measured rotation that was maintained for three weeks and an immediate improvement in lateral flexion that was not maintained . This is to our knowledge the first published formal trial of such manipulation and should increase interest in this form of treatment by the medical profession Twenty-one patients with symptomatic cervical spondylosis or nonspecific neck pain were given an amnesic dose of diazepam before manipulation of the cervical spine . Eighteen patients served as controls  and also received diazepam but no manipulation . Results were obtained in a r and omized , double-blind fashion . Statements of outcome by patients and mean visual analog scales for pain and activity showed no significant differences between manipulation and control groups , though both tests favored manipulation . Control subjects subsequently treated by manipulation showed no consistent favorable response . Question naires dealing with personality , life events , social and medical histories , etc . , provided no correlations with outcome , nor did radiographic findings . Diffuse local tenderness correlated with high pain scores after treatment . The authors conclude that the value of a single manipulation of the cervical spine has not been established and that further exploration of indications is needed . The use of intravenous diazepam should be considered because it allows a double-blind experimental design The effects of group  gymnastics  on  neck pain were studied among 44 women in a printing company . A r and omized cross-over design was used with two groups matched according to the work task , frequency of symptoms , and age . The treatment consisted of gymnastics for 45 min once a week for 10 weeks . Neck pain was rated by  visual analogue scale  and pressure pain sensitivity of the neck muscles was measured with an algometer . The results showed no clear effects of the group gymnastics program . An equal and significant reduction in pain ratings was seen in both groups after the first intervention in the spring . Recurrence of symptoms was seen in both groups in September , and no significant reduction in pain occurred during the second intervention in the autumn . The results suggest a seasonal variation in neck symptoms which has to be considered when planning or evaluating intervention studies A cohort of3,342 cases constituting a r and om sample of all occupational back injuries compensated in Quebec ( Canada ) during 1981 was observed prospect ively for 3 years to study associations between cumulative duration of absence from work  and sex , age , site of symptoms ( cervical , thoracic , and lumbar ) , and occupation . Of the cohort members , 287 ( 9.7 % ) cumulated 6 months of absence or more . A logistic regression model showed age and site of symptoms to be the two most important risk factors associated with absences of 6 months or more . No association was found with sex or occupation . The results showed discrepancies between measures of frequency distribution of back injuries and duration of absence from work , an important finding in terms of identifying health priorities Head repositioning accuracy ( HRA ) after full range active motion was evaluated in 60 cervicalgic patients . The mean angular error was 7.7 degrees + /- 3.3 ( mean + /- SD ) and 82 % were outside a threshold value of 4.5 degrees . After r and omization 30 patients followed a rehabilitation program based on eye-head coupling ( RG ) and 30 served as a control group ( CG ) . At 10 week follow-up , a greater gain in HRA was observed in the RG ( 2 degrees + /- 2.7 , mean + /- SD ) than in the CG ( 0 + /- 2.6 , mean + /- SD ) ( p = 0.005 ) . Clinical parameters ( pain , drug intake , range of motion , and self assessed functional improvement ) were also more improved in the RG than in the CG . These data emphasize the role of a neck proprioception alteration in chronic neck pain and suggest that a rehabilitation program based on eye-head coupling should be included in most medical management of cervicalgic patients The objective of the investigation was to study the course of neck and shoulder symptoms and the predictors for these symptoms among women in light sedentary work .  Postal surveys were conducted among 351 tellers ( age 20 - 50 years ) of a bank company in September , December , March , and May. The response rates were 74 - 90 % . The outcome was the frequency of the symptoms during the previous three months . In the analysis , univariate explorations and r and om-effects logistic binomial regression for distinguishable responses were used . A change in the frequency of neck and shoulder symptoms was seen in 40.5 % of the subjects during the follow-up period from autumn to spring . The frequency of the symptoms decreased from autumn and winter towards spring . The stability of the frequency of the symptoms was positively associated with age . Seasonal variation in symptoms should be considered when preventive programs against neck and shoulder disorders are planned and evaluated
target: Bearing in mind the limited number of studies and the low method ological quality , there are some indications that the localization ( radiation to the arms/neurologic signs ) and radiologic findings ( degenerative changes in the discs and joints ) are not associated with a worse prognosis .
  A higher severity of pain and a history of previous attacks however , seems to be associated with a worse prognosis
background: Neck pain occurs frequently in western societies .
  In the majority of cases , no specific cause can be identified .
  In order to gain insight into the clinical course and prognostic factors of non-specific neck pain , a systematic review was conducted .