Chronic Neck and Shoulder Pain

In the United States, more than 10% of the population has experienced pain in the neck and shoulder at some point in their life (Coté et al. 1998). Chronic neck and shoulder pain is another clinical entity that is commonly seen in women more than men. This clinical entity is frequently associated with certain adverse working condition such as repetitive working under time restraints (awkward and repetitive work), and the aging of the workforce appears to contribute to the widespread concern about chronic neck and shoulder pain (Cassou et al. 2002). Acupuncture and related interventions are frequently considered as treatment for this clinical entity (He et al. 2004). Irnich and colleagues (2001) found that although acupuncture was superior to massage therapy, it was not superior to "sham" acupuncture (i.e., the intervention mimicking acupuncture but can be different from the true acupuncture in the depth of needle insertion or in the locations where needles are placed). Interestingly the study data were reanalyzed by Vickers (2001) and found that acupuncture was superior to massage and to sham therapies as short-term treatments for chronic neck pain. Vickers and Irnich (Nabeta and Kawakita 2002) conducted another study and found that manual needle stimulations at specific acupuncture points are superior to both direct needling of local trigger points and laser sham acupuncture in improving motion-related pain and range of movement in chronic neck pain patients. Nabeta et al. (Irnich et al. 2002) conducted a similar study as did Vicker and Irnich, and the investigators found that acupuncture indeed provided a greater immediate relief for the neck and shoulder pain than other interventions, but the therapeutic effect did not last and there was no long-term benefits. Thus, the readers can speculate that in order to have a sustained long-term benefit, a repeated acupuncture intervention is required. Sator-Katzenschlager and colleagues (2003) compared the efficacy of 6-weekly treatments of manual and electrical auricular acupuncture for the treatment of chronic neck and shoulder pain. The investigators found that electrical auricular acupuncture is superior to manual auricular acupuncture in reducing the severity of pain, analgesic consumption, and return to full-time employment. This study again illustrated that in order to achieve long-term therapeutic effects, acupuncture should be administered continuously or with a maintenance schedule. In addition, the stimulating techniques applied to the acupuncture needles once they are in place can affect the magnitude of pain relief. In a large-scale trial that was conducted in the United Kingdom, patients were randomized to receive either transcutaneous electrical acupoint stimulation (TEAS) or sham-TEAS (White et al. 2004). In this study, a total of eight treatments were administered over a 4-week period and outcome assessments included neck pain, the neck disability index, the Short Form (SF)-36, and analgesics consumption. Patients in the TEAS group reported significantly less pain as compared to patients in the sham-TEAS group. However, the neck disability index and SF-36 scores did not differ significantly between the two groups. Finally, a small-scale sham-RCT was conducted with 24 subjects who suffered from chronic neck and shoulder pain (He et al. 2004). In this study, subjects were randomized to receive a series of 10 acupuncture or sham acupuncture treatments combined with daily acupressure at acupuncture points or at sham points over a 3-4-week period. Following this very intensive regimen, the investigators found that the patients in the acupuncture group had better sleep quality, less anxiety and pain, less depression, and a higher satisfaction with life as compared to patients in the sham acupuncture group. This difference was seen both at the 6-month and at the 3-year follow-up evaluations (He et al. 2004). Similar to the studies of acupuncture in patients with chronic LBP, the clinical data indicate that acupuncture and related interventions have decreased the pain and disability effectively in patients suffering from chronic neck and shoulder pain. Preliminary data also suggest that these interventions may have long-term benefit for chronic neck and shoulder pain, if the treatment period is sustained over a month. Lastly, the additional electrical stimulation applied to the needles may enhance the analgesic effect.

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