The Effect of Physical Therapy on Pain and Quality of Life in Patients with Chronic Neck Pain: A Prospective Randomized Controlled Study

Abstract

OBJECTIVE: This study aimed to evaluate the effectiveness of physical therapy (PT) on pain, functional status, depressive symptoms, and quality of life in patients with chronic neck pain (CNP). MATERIAL AND METHODS: The study was designed as a randomized controlled trial involving outpatient clinic patients at a tertiary care hospital and included 80 patients with CNP. The patients were randomly assigned to two groups. The treatment group (TG) received ten sessions of conventional PT (hot pack, ultrasound, and Transcutaneous Electrical Nerve Stimulation) and home-based exercises. The control group (CG) was only given a home-based exercise program. Both groups were informed about correct posture and daily life activities. Patients were assessed pre-treatment, at the end of treatment (2 weeks), and 12 weeks after the treatment using the Visual Analogue Scale (VAS pain), cervical range of motion (ROM), Beck Depression Index (BDI), and short form-36 (SF-36). RESULTS: Both groups showed significant improvements in VAS pain scores, ROM, SF-36, and BDI scores post-treatment (p<0.01 for all). At the three-month follow-up, the improvements in the TG continued, while the CG showed a regression compared to the levels observed two weeks after the treatment. The degree of improvement in VAS pain and BDI scores in the TG was significantly greater than in the CG (p<0.01). CONCLUSION: In the treatment of CNP, adding PT modalities to the home exercise resulted in greater reductions in pain, disability, and depressive symptoms, as well as improvements in quality of life compared to home exercise alone. It’s appropriate to recommend PT modalities as a beneficial treatment for CNP.

Keywords

• chronic neck pain
• quality of life
• exercise
• physical therapy modalities

Kronik Boyun Ağrılı Hastalarda Fizik Tedavinin Klinik Durum ve Yaşam Kalitesi Üzerine Etkisi: Prospektif Randomize Kontrollü Bir Çalışma

Abstract

AMAÇ: Bu çalışmanın amacı, kronik boyun ağrısı (KBA) olan hastalarda fizik tedavinin (FT) ağrı, fonksiyonel durum, depresif semptomlar ve yaşam kalitesi üzerindeki etkinliğini değerlendirmektir. GEREÇ ve YÖNTEM: Çalışma, 3. basamak hastane tabanlı, randomize kontrollü olarak tasarlanmıştır. KBA olan 80 hasta iki gruba randomize edilmiştir. Tedavi grubuna (TG), on seans konvansiyonel FT (sıcak paket, ultrason ve Transkutanöz Elektriksel Sinir Stimülasyonu) ve ev egzersiz programı verilmiştir. Kontrol grubuna (KG) ise yalnızca ev egzersiz programı verilmiştir. Her iki gruba da doğru duruş, günlük yaşam eğitimi verilmiştir. Hastalar, tedavi öncesi, tedavi sonunda (2 hafta) ve tedaviden 12 hafta sonra Vizüel Analog Skoru (VAS ağrı), servikal eklem hareket açıklığı (EHA), Beck Depresyon Ölçeği (BDÖ) ve yaşam kalitesi kısa form-36 (SF-36) kullanılarak değerlendirilmiştir. BULGULAR: Her iki grup da tedavi sonrası VAS ağrı skorları, servikal EHA, SF-36 ve BDÖ skorlarında anlamlı iyileşmeler göstermiştir (tüm parametrelerde, p<0,01). Üç aylık takipte, TG’deki iyileşmeler devam ederken; KG’de tedavi sonrası ikinci haftada gözlemlenen düzeylerde gerileme izlenmiştir. TG’deki VAS ağrı ve BDÖ skorlarındaki iyileşme derecesi, KG’ye göre anlamlı derecede daha fazladır (her biri için, p<0,01). SONUÇ: Kronik boyun ağrısı tedavisinde, ev egzersiz programına FT modalitelerinin eklenmesi, yalnızca ev egzersiz programına göre ağrı, engellilik ve depresif semptomlarda daha büyük azalmalar ile yaşam kalitesinde daha fazla iyileşmeler sağlamıştır. Kronik boyun ağrısında FT modalitelerinin faydalı bir tedavi olarak önerilmesi uygun gözükmektedir.

Keywords

• kronik boyun ağrısı
• yaşam kalitesi
• egzersiz
• fizik tedavi modaliteleri

References

1. 1. Noormohammadpour P, Mansournia MA, Koohpayehzadeh J, Asgari F, Rostami M, Rafei A, et al. Prevalence of Chronic Neck Pain, Low Back Pain, and Knee Pain and Their Related Factors in Community-Dwelling Adults in Iran: A Population-based National Study Clin J Pain. 2017; 33: 181-187.
2. 2. Herman PM, Edgington SE, Hurwitz EL, Coulter ID. Predictors of visit frequency for patients using ongoing chiropractic care for chronic low back and chronic neck pain; analysis of observational data. BMC Musculoskelet Disord. 2020; 21: 298.
3. 3. Amin DI, Mohamed GI, ElMeligie MM. Effectiveness of McKenzie exercises plus stabilization exercises versus McKenzie exercises alone on disability, pain, and range of motion in patients with nonspecific chronic neck pain: A randomized clinical trial. J Back Musculoskelet Rehabil. 2024; 37: 1507-1517.
4. 4. Damgaard P, Bartels EM, Ris I, Christensen R, Juul-Kristensen B. Evidence of Physiotherapy Interventions for Patients with Chronic Neck Pain: A Systematic Review of Randomised Controlled Trials. ISRN Pain. 2013; 2013: 567175.
5. 5. Sami Alattar S, Alzahrani H. Effectiveness of adding dry needling of the upper trapezius muscle to the usual physiotherapy for managing chronic neck pain: A randomized controlled trial with a 7-week follow-up. Musculoskeletal science & practice. 2024; 74: 103155.
6. 6. Dorji K, Graham N, Macedo L, Gravesande J, Goldsmith CH, Gelley G, et al. The effect of ultrasound or phonophoresis as an adjuvant treatment for non-specific neck pain: systematic review of randomised controlled trials. Disabil Rehabil. 2022; 44: 2968-2974.
7. 7. D'Sylva J, Miller J, Gross A, Burnie SJ, Goldsmith CH, Graham N, et al. Manual therapy with or without physical medicine modalities for neck pain: a systematic review. Man Ther. 2010; 15: 415-433.
8. 8. Haklıgil GV, Oksüz S, Angın E. The effects of conventional treatment in addition to Pilates on biopsychosocial status in chronic neck pain: A randomized clinical trial. J Back Musculoskelet Rehabil. 2024; 37: 1715-1727.

9. 9. Öztürk C, Akşit R. Tedavide Sıcak ve Soğuk In: Oğuz H, Dursun E, Dursun N (Eds) Tıbbi Rehabilitasyon. İstanbul: Nobel Tıp Kitabevleri, 2015; 333-353.
10. 10. Tiidus PM. Massage and ultrasound as therapeutic modalities in exercise-induced muscle damage. Can J Appl Physiol. 1999; 24: 267-278.
11. 11. Martimbianco ALC, Porfírio GJ, Pacheco RL, Torloni MR, Riera R. Transcutaneous electrical nerve stimulation (TENS) for chronic neck pain. Cochrane Database Syst Rev. 2019; 12: CD011927.
12. 12. Sayilir S. The short-term effects of TENS plus therapeutic ultrasound combinations in chronic neck pain. Complement Ther Clin Pract. 2018; 31: 278-281.
13. 13. Kroeling P, Gross A, Graham N, Burnie SJ, Szeto G, Goldsmith CH, et al. Electrotherapy for neck pain. Cochrane Database Syst Rev. 2013; 8: CD004251.
14. 14. Swenson RS. Therapeutic modalities in the management of nonspecific neck pain. Phys Med Rehabil Clin N Am. 2003; 14: 605-627.
15. 15. Koçyigit H, Aydemir Ö, Fişek G, Ölmez N, Memiş A. Kısa form-36’nın Türkçe versiyonunun güvenilirliği ve geçerliliği. İlaç ve Tedavi. 1999; 12: 102-106.
16. 16. Hisli N. A study on the validity of Beck depression inventory. Psikoloji Dergisi 1988; 22: 118-126.
17. 17. Yilmaz M, Tarakci D, Tarakci E. Comparison of high-intensity laser therapy and combination of ultrasound treatment and transcutaneous nerve stimulation on cervical pain associated with cervical disc herniation: A randomized trial. Complement Ther Med. 2020; 49: 102295.
18. 18. Venosa M, Romanini E, Padua R, Cerciello S. Comparison of high-intensity laser therapy and combination of ultrasound treatment and transcutaneous nerve stimulation in patients with cervical spondylosis: a randomized controlled trial. Lasers Med Sci. 2019; 34: 947-953.
19. 19. Swenson RS. Therapeutic modalities in the management of nonspecific neck pain. Phys Med Rehabil Clin N Am. 2003;14: 605-627.
20. 20. Noori SA, Rasheed A, Aiyer R, Jung B, Bansal N, Chang KV, et al. Therapeutic Ultrasound for Pain Management in Chronic Low Back Pain and Chronic Neck Pain: A Systematic Review. Pain Med. 2020; 21: 1482-1493. 21. Yesil H, Hepguler S, Dundar U, Taravati S, Isleten B. Does the Use of Electrotherapies Increase the Effectiveness of Neck Stabilization Exercises for Improving Pain, Disability, Mood, and Quality of Life in Chronic Neck Pain?: A Randomized, Controlled, Single-Blind Study. Spine (Phila Pa 1976). 2018; 43: E1174-E1183.
21. 22. Cho WS, Park CB, Kim BG. Effects of exercise therapy on pain and disability in patients with non-specific neck pain: A systematic review and meta-analysis. J Bodyw Mov Ther. 2023; 36: 213-220. 23. Griffiths C, Dziedzic K, Waterfield J, Sim J. Effectiveness of specific neck stabilization exercises or a general neck exercise program for chronic neck disorders: a randomized controlled trial. J Rheumatol. 2009; 36: 390-397.
22. 24. Graham N, Gross AR, Carlesso LC, Santaguida PL, Macdermid JC, Walton D, et al. An ICON Overview on Physical Modalities for Neck Pain and Associated Disorders. Open Orthop J. 2013; 7: 440-460.
23. 25. Resende L, Merriwether E, Rampazo ÉP, Dailey D, Embree J, Deberg J et al. Meta-analysis of transcutaneous electrical nerve stimulation for relief of spinal pain. Eur J Pain. 2018; 22: 663-678.
24. 26. Qing W, Shi X, Zhang Q, Peng L, He C, Wei Q. Effect of Therapeutic Ultrasound for Neck Pain: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2021; 102: 2219-2230.
25. 27. Booth J, Moseley GL, Schiltenwolf M, Cashin A, Davies M, Hübscher M. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care. 2017; 15: 413-421.
26. 28. Lluch E, Arguisuelas MD, Coloma PS, Palma F, Rey A, Falla D. Effects of deep cervical flexor training on pressure pain thresholds over myofascial trigger points in patients with chronic neck pain. J Manipulative Physiol Ther. 2013; 36: 604-611.
27. 29. Schomacher J, Farina D, Lindstroem R, Falla D. Chronic trauma-induced neck pain impairs the neural control of the deep semispinalis cervicis muscle. Clin Neurophysiol. 2012; 123: 1403-1408.
28. 30. Javdaneh N, Saeterbakken AH, Shams A, Barati AH. Pain Neuroscience Education Combined with Therapeutic Exercises Provides Added Benefit in the Treatment of Chronic Neck Pain. Int J Environ Res Public Health. 2021; 18: 8848.
29. 31. Karaarslan F, Yılmaz H, Akkurt HE, Kaya FM, Şafak Yılmaz E. Comparison of the efficacy of mud-pack and hot-pack treatments in chronic non-specific neck pain: A single-blind, randomized-controlled study. Turk J Phys Med Rehabil. 2022; 68: 381-390.
30. 32. Yılmaz R, Karpuz S, Akdere E, Yılmaz H. Evaluation of sexual dysfunction in females with neck and upper back myofascial pain syndrome: a cross-sectional study. Rheumatol Int. 2023; 43: 1723-1732.