Oscar Javier Pico-Espinosa | MD, MSc, PhD (c) Epidemiology
PainRelief.com: What is the
background for this study?
Response: Persistent neck pain is a common condition and one of the main causes of sick leave worldwide. Patients often utilize non-pharmacological therapies such as massage or exercises. However, the evidence supporting the effectiveness of such treatments is either lacking or conflicting. With that in mind, we designed the Stockholm Neck (STONE) trial, where we compared deep tissue massage, strengthening and stretching exercises and a combination of those two (up to six sessions over six weeks), versus advice (up to three sessions of advice to stay active).
Manuela L. Ferreira PhD
Institute of Bone and Joint Research
The Kolling Institute, Sydney Medical School
Paulo H. Ferreira PhD
Musculoskeletal Health Research Group
Faculty of Health Sciences
University of Sydney, Sydney, NSW, Australia
PainRelief.com: What is the
background for this study? What are the
Response: One in four Australians experience back pain or neck pain. Diabetes
is also a worldwide prevalent condition, and currently affects over 382 million
people. These two diseases often co-exist and have very similar underlying
mechanisms, such as obesity and physical inactivity. We were unsure whether
having one condition would lead to developing the other, however.
We have found 11 studies published to date, and assessing the relation between back or neck pain and diabetes. The studies included over 165,000 participants published in the USA, Canada, Finland, Denmark, Iran and Spain.
When we pooled the results of these studies together, we observed that people with type 2 diabetes are 35% more likely to also have low back pain (compared to people without diabetes). The risk of having severe back pain symptoms in people with type 2 diabetes is 63% higher and the risk of having severe neck pain is almost 30% higher, than in people with no diabetes. We could not identify, however, whether type 2 diabetes can lead to back or neck pain, and it is possible that the two conditions are associated via other underlying mechanisms such as obesity and physical inactivity.
PainRelief.com Interview with:
Steven Z. George, PT, PhD
Director of Musculoskeletal Research
Duke Clinical Research Institute
Vice Chair of Clinical Research
PainRelief.com: What is the background for this study? What are the main findings?Response: This study adds to existing health services research investigating the sequence of services/providers for musculoskeletal pain and its impact on opioid use.
The study suggest that early physical therapy (PT) for the 4 most common musculoskeletal conditions (back, neck, shoulder, and knee) can be protective of chronic/long term opioid use for individuals that were opioid naïve when presenting for their care. What is different about this study is that the 4 conditions were studied in the same cohort and the same definition of early PT was used (many of the previous studies just looked at 1 conditions, and used different definitions of early physical therapy). The other thing that was different is that we used a larger dataset of private insurance providers, so this study cuts across different regions of the study (many of the previous studies included one health system).
There was notable consistency in the findings for the 4 conditions and protection of any opioid use, but there were some contingencies.
First was that there was no benefit on decreased dosage for individuals with neck pain – as that was not expected.
Second was that in a follow up sensitivity analysis it looked like the largest benefit of early physical therapy may be for those with back and knee pain. Continue reading
This review from the British Medical Journal presents and overview of the types, causes and potential treatments of neck pain.
Advances in the diagnosis and management of neck pain