Chronic Neck Pain

The goal of this observational study is to compare physical findings across three adult groups. Cervicogenic headache (CGH) is a headache linked to a problem in the neck. Neck pain may affect posture, muscle function, grip strength, and sensitivity to pressure. Researchers do not know whether CGH has a distinct pattern of these findings. The main questions are: * Do posture, grip strength, muscle stiffness, elasticity, and pressure sensitivity differ among the groups? * Are any differences more closely associated with CGH than with neck pain? Researchers will compare adults ages 25 through 60. One group will include people with CGH lasting at least three months. Another group will include people with neck pain lasting at least six months. People in the neck pain group will have no headaches. Healthy participants will have no neck pain or headaches. Researchers will not provide treatment or change participants' usual care. Each participant will complete one study visit lasting about 15 minutes. Participants will: * Answer short questions about their health and pain * Stand while researchers measure their head and neck posture * Squeeze a device that measures grip strength * Complete brief tests of neck muscle stiffness and elasticity * Tell researchers when applied pressure first becomes painful Researchers will compare results across the three groups. The findings may guide future CGH assessment and treatment research.

To prospectively describe patient-centered and health utilization outcomes through 12 months after cryoneurolysis performed as routine clinical care for chronic pain at Yale.

This randomized controlled trial aims to investigate whether the timing of transcutaneous auricular vagus nerve stimulation (taVNS) relative to exercise influences clinical and autonomic outcomes in individuals with chronic neck pain. Participants will be randomly allocated to one of three groups: taVNS applied before exercise, taVNS applied after exercise, or exercise alone. All groups will receive a standardized exercise program designed for chronic neck pain. The intervention will be conducted over a 6- to 8-week period. The effects of the interventions will be evaluated using pain intensity, neck-related disability, sleep quality, heart rate variability, and exercise adherence. The study will determine whether applying taVNS before or after exercise provides additional benefits compared with exercise alone and whether the timing of stimulation influences treatment outcomes.

Chronic neck pain can affect daily activities and may be associated with pain, disability, fear of movement, and fatigue. Exercise is commonly used to manage chronic neck pain, but some people continue to experience symptoms despite exercise treatment. This study will investigate whether adding diaphragmatic myofascial release, a hands-on manual therapy directed toward the diaphragm and surrounding tissues, to a neck exercise program provides greater benefits than neck exercises alone in adults with chronic neck pain. Sixty adults aged 25 to 60 years with chronic neck pain lasting more than three months will be randomly assigned to one of two groups. The control group will receive a supervised neck exercise program, while the intervention group will receive the same neck exercise program combined with diaphragmatic myofascial release and related diaphragmatic manual therapy. Both groups will receive treatment for six weeks, with three supervised sessions per week. Pain, neck-related disability, fear of movement, and fatigue will be assessed before treatment, immediately after the six-week intervention, and four weeks after completion of treatment. The study will examine whether adding diaphragmatic myofascial release to neck exercises leads to greater improvements in these outcomes compared with neck exercises alone.

The goal of this clinical trial is to investigate whether electroencephalographic features are associated with the multidimensional clinical characteristics of adults with chronic non-specific neck pain and whether clinical and brain function measures change following physiotherapy. Participants with chronic non-specific neck pain will receive six weekly treatment sessions consisting of a manual physiotherapy and neck-specific exercise programme, including a home exercise programme. Clinical, psychophysical, and 64-channel electroencephalographic assessments will be performed at baseline and approximately one week after completion of the intervention. Clinical outcomes will also be reassessed 12 weeks after the last treatment session. Electroencephalographic recordings will be obtained while participants are seated comfortably and instructed to remain relaxed. EEG-derived measures will be examined in relation to pain intensity, neck-related disability, psychological and cognitive-affective factors, sleep quality, and psychophysical pain responses. Healthy participants without chronic neck pain will undergo a comparable baseline assessment to provide reference data for the interpretation of brain function in the clinical group.

Chronic pain is a leading cause of disability in the United States. When standard treatments fail, many patients develop treatment resistant pain and undergo Spinal Cord Stimulation (SCS) therapy. SCS uses an implanted device to send mild electrical currents to the spine to block pain signals before they reach the brain. However, long-term success is often limited by how a patient's nervous system and brain process chronic pain, as well as psychological factors like anxiety and excessive worrying about pain, also known as catastrophizing. To improve outcomes, this study combines SCS therapy with Pain Neuroscience Education (PNE). PNE is an educational approach that teaches patients how the brain and nervous system handle pain signals, reframing pain as a process that can be changed rather than just ongoing tissue damage. The goal of this pilot trial is to test the feasibility of using virtual, remote PNE sessions to help patients reduce pain catastrophizing and anxiety, while building overall psychological resilience. Additionally, the study explores an innovative, objective way to monitor pain levels by analyzing short voice recordings. Researchers want to see if specific vocal features change when a person's pain is well-controlled versus when it is uncontrolled. Participants enrolled in this study will receive either 1) standard spinal cord stimulation or 2) spinal cord stimulation plus the intervention--a virtual, multi-session PNE delivered remotely over a secure telehealth platform. Throughout the study, participants will complete standard clinical surveys to measure their physical function, anxiety, pain catastrophizing, and emotional resilience using standardized tools. Participants will also provide short voice recordings, such as holding a sustained "/ah/" vowel sound, during their virtual assessments. This allows researchers to safely evaluate the direct relationship between subtle voice patterns and reported clinical pain levels.

This randomized, single-blind, placebo-controlled clinical trial aims to investigate the immediate physiological effects of a single session of electroacupuncture (EA) on neck muscle stiffness in individuals with chronic neck pain. While acupuncture is a widely used complementary therapy for musculoskeletal pain, high-quality, objective evidence demonstrating its immediate effects on muscle biomechanics remains limited. This study will utilize Shear Wave Elastography (SWE)-a non-invasive, objective ultrasound-based technology-to measure these changes. Adult participants aged 18 to 65 with non-specific chronic neck pain (lasting ≥ 3 months) will be randomly allocated into one of two groups: 1. True Electroacupuncture (EA) Group: Participants will receive a 20-minute session of active electroacupuncture with comfortable electrical stimulation at specific neck and tender points. 2. Sham Acupuncture (Placebo) Group: Participants will receive a 20-minute session of non-penetrating sham acupuncture with a deactivated electroacupuncture device to ensure participant blinding. The primary objective is to evaluate immediate changes in the stiffness of the upper trapezius muscle, measured objectively via SWE (as Young's Modulus in kPa) before and immediately after the intervention. Secondary objectives include assessing immediate post-treatment changes in subjective pain and stiffness (Visual Analogue Scale), Pressure Pain Threshold (PPT), and active Cervical Range of Motion (CROM), alongside a 7-day post-intervention follow-up questionnaire on neck function.

This study investigates whether there is an association between periodontal disease (gum disease) and chronic neck pain and related functional disability. Participants aged 30-55 years will be grouped based on their periodontal health status (healthy, gingivitis, or periodontitis). Neck pain intensity will be assessed using the Visual Analog Scale (VAS), and functional disability will be measured using the Neck Disability Index (NDI). The study aims to determine whether periodontal disease severity is linked to the severity of neck pain and disability, which may help clarify a potential connection between oral health and musculoskeletal health.

This single-center, three-arm randomized controlled trial compares the effects of different myofascial release techniques, combined with a structured exercise program, on functional outcomes in individuals with chronic non-specific neck pain (CNNP). Eligible participants (aged 18 to 45 years, neck pain for at least 3 months, pain intensity VAS at least 3, and myofascial trigger points in the upper-quarter muscles) are allocated by simple randomization into three groups: * Conventional Therapy Group: hot pack, conventional TENS, and a structured exercise program. * Manual Myofascial Release Group: conventional therapy plus therapist-applied manual myofascial release. * Self-Myofascial Release Group: conventional therapy plus supervised self-applied myofascial release using a duo-ball, balls, and a massage stick/cane. All interventions are delivered 3 days per week for 6 weeks. The primary outcome is pain intensity. Secondary outcomes include pressure pain threshold and tolerance, cervical range of motion, muscle stiffness, craniovertebral angle, cervical proprioception, muscle strength and endurance, disability, neck awareness, multidimensional biopsychosocial status, sleep quality, quality of life, and kinesiophobia. The aim is to determine whether manual or self-applied myofascial release, added to exercise, produces greater functional improvement in people with chronic non-specific neck pain.

To investigate the neurophysiological relationship between Central Conduction Time measured via Somatosensory evoked potentials and pain intensity in individuals suffering from chronic neck pain

The aim of this study is to compare the effects of single-session motor imagery and motor control exercises on pain, pressure pain threshold, cervical proprioception, and motor imagery in individuals with chronic neck pain.

This study evaluates whether a single session of percussion therapy can reduce muscle tension and increase blood flow in the transverse cervical artery in individuals with neck pain. The investigators will evaluate muscle stiffness using ultrasound elastography, and assess blood flow in the transverse cervical artery via Doppler imaging before and after treatment. The primary objective is to determine how this therapy affects neck muscle relaxation and vascular responses, specifically within the upper trapezius region.

This prospective randomized controlled study aims to compare the analgesic effectiveness of ultrasound-guided cervical medial branch block and ipsilateral cervical erector spinae plane block in patients with cervical facetogenic pain. Patients with chronic cervical facet-mediated pain will be randomized into two intervention groups. Pain intensity, functional status, meaningful pain response rates, analgesic consumption, and patient satisfaction will be evaluated during follow-up. The primary objective is to determine whether cervical erector spinae plane block provides comparable short-term pain relief to cervical medial branch block.

This study aims to investigate the mediating role of kinesiophobia in the relationship between pain intensity and disability in individuals with chronic neck pain. Chronic neck pain is a multidimensional clinical condition influenced not only by biological factors but also by psychological components such as fear of movement. Understanding the mechanisms underlying disability may contribute to more targeted rehabilitation strategies. Participants with chronic neck pain lasting at least three months will be assessed using validated self-report questionnaires measuring pain intensity, kinesiophobia, disability, and physical activity levels.

The goal of this clinical trial is to learn if adding mindfulness to supervised rehabilitation exercises improves outcomes in office workers with chronic neck pain. It will also evaluate the impact of this combined approach on psychosocial factors and quality of life. The main questions it aims to answer are: Does mindfulness combined with supervised exercises reduce neck pain intensity more than supervised exercises alone? Does the combined intervention improve neck-related disability, psychosocial outcomes, and quality of life? Researchers will compare a mindfulness-based intervention plus supervised rehabilitation exercises to supervised rehabilitation exercises alone to determine whether the combined approach provides additional benefit. Participants will: Be randomly assigned to receive either mindfulness plus supervised exercises or supervised exercises alone for 8 weeks Attend weekly 60-minute mindfulness sessions (experimental group only) and twice-weekly supervised exercise sessions Undergo assessments at the beginning and at the end of the intervention period

This study will be conducted to compare the effect of adding respiratory exercises versus deep neck flexor training to conventional program on pain, cervical ROM, cervical muscle endurance, function, and chest expansion in patients with chronic mechanical neck pain. Sixty-six (66) of both genders ranging in age from 18 to 35 years old, with a history of mechanical neck pain longer than 3 months (chronic neck pain) will be invited to participate in this study. Participants will be randomly assigned into one of the three experimental groups as follow: Group A will receive respiratory exercises in form of diaphragmatic breathing \& respiratory muscle stretch gymnastics plus conventional program. Group B will receive deep neck flexor training in the form of low-load craniocervical flexion using feedback from an air-filled pressure sensor placed behind the neck plus conventional program. Group C (control group) will receive conventional program in form of TENS, infrared, isometric neck strengthening exercises and stretching exercises.

The primary objective of our study is to compare the thickness of the masseter muscle, measured by ultrasound, in individuals with chronic neck pain to that of healthy individuals. The secondary objective of the study is to examine the relationships between masseter muscle thickness and pain intensity, neck disability level, pain catastrophizing level, and clinical diagnostic criteria in individuals with chronic neck pain.

A research study will be conducted at Physiotherapy department of the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan. Overall 156 patients with 18-40 years old individuals with neck pain will be eligible and they will be included through non-probability, purposive sampling technique. The written informed consent will be taken from all the patients. They will be divided through Simple random sampling (computer generated software) method into two groups, 78 in each group. Group A (experimental group) will receive PNF Symmetrical Scapula-Pelvis Patterns (PNF-SSPP), group B (control group) will receive sub occipital muscle inhibition technique (SMI) and static stretching (SS) of hamstring muscle. All participants will be assessed using assessment form. Outcome measures will be Pain, disability, disability, neck range of motions, hamstring tightness, head posture, and levator scapulae index. An independent assessor blinded to the treatment will assess all the patients for treatment outcome assessment at baseline, after first session and post treatment. Treatment sessions will be given thrice a week for 6 weeks.

This study aims to investigate the effects of different exercise approaches on physical status, cognitive functions, brain structures, and blood biomarkers in individuals with chronic neck pain.

The goal of this clinical trial is to study if kinematic training based on novel kinematic assessment clasification approach can decrease chronic neck pain and prevent its reoccurance better than conventional kinematic training in adults. The main question\[s\] it aims to answer \[is/are\]: Does clustering patients with neck pain based on head and neck movement characteristics lead to more efficient kinematic rehabilitation training and improved clinical outcomes Researchers will compare effects of cluster specific kinematic training to see if it effects pain levels and its reoccurance. Participants will \[describe the main tasks participants will be asked to do, interventions they'll be given and use bullets if it is more than 2 items\].

Many people experience long-lasting neck pain, which can affect daily life, work, and overall well-being. This study aims to find out which type of exercise program is most effective in reducing neck pain, improving neck movement, and making daily activities easier. What Is Being Studied?: The study compares three different types of treatment: DNS Exercises (Dynamic Neuromuscular Stabilization): Whole-body exercises focusing on posture, breathing, and core stability. Localized Neck Exercises: Targeted exercises for the neck and shoulder muscles. Standard Care: Usual physiotherapy treatment commonly provided in clinical practice. Study Procedures: Participants are randomly assigned to one of the three groups. Each participant receives individual exercise instruction from a physiotherapist. Participants are also given simple home exercises to perform on their own. The study lasts for about 12 weeks. What Will Be Measured?: At the beginning, during, and at the end of the study, the following will be assessed: Neck pain intensity (pain scale) Neck range of motion How much the pain affects daily life and activities Possible Benefits: Participants may experience: Less neck pain Improved neck mobility Better overall body awareness Even if not every participant notices improvement, taking part will help researchers improve future treatment options for chronic neck pain. Risks: No major risks are expected. All exercises are supervised by qualified physiotherapists and adjusted to each participant's abilities. Participation can be stopped at any time if discomfort or pain occurs. Voluntary Participation and Data Privacy: Participation is completely voluntary. All personal data will be kept confidential and analyzed anonymously for research purposes only. Participants may withdraw from the study at any time without any disadvantages.

The objective of this randomized controlled trial is to assess the potential effectiveness of Progressive muscle relaxation technique (PMRT) vs Muscle energy technique (MET) as an intervention for releasing trigger points in SCM and upper trapezius in prolonged computer users. The study will be conducted in a workplace setting, where desk-type computer users are expected to regularly engage in their professional activities for ≥ 6 hours throughout the day, intermittently. This study will be conducted at the Outpatient Physiotherapy department of Sindh Institute of Physical Medicine and Rehabilitation, Karachi among 60 patients with nonspecific chronic neck pain on the basis of non-probability purposive sample technique. After taking informed consent, all participants will be randomly allocated into two groups through a investigator (blinded) the same investigator will be screening the individuals, doing baseline assessment, and post treatment assessment while another investigator will be providing intervention. Group 1 will receive Progressive muscle relaxation technique while Group 2 will receive Muscle Energy Technique on sternocleidomastoid and upper trapezius bilaterally. Patients will also be blinded. A total of 12 sessions will be provided. Outcomes will be assessed at baseline and post treatment after 2 weeks intervention.

This study aims to compare the effects of post-isometric relaxation (PIR) and post isometric stretching (PIS) techniques on reducing neck pain, improving range of motion, and decreasing neck disability in individuals with neck pain. A randomized controlled trial will be conducted with 50 participants, who will be randomly assigned to one of two groups: one receiving PIR and the other receiving PIS. A single-blind method will be used, meaning the participants will not know which group they belong to. Participants will be selected based on specific criteria related to neck pain and will then be randomly allocated to the PIR or PIS group. Initially, all participants will receive two standard treatments: Transcutaneous Electrical Nerve Stimulation (TENS) and hot pack application. After these treatments, one group will undergo post-isometric relaxation (PIR), which involves 3-5 repetitions of muscle contraction and relaxation, conducted over five consecutive sessions. The other group will receive post-isometric stretching (PIS), which involves stretching after muscle contraction and relaxation, also administered over five consecutive sessions. At the end of the intervention, pain, range of motion, and neck disability will be measured. Pain will be assessed using a standardised pain scale, range of motion will be measured with a goniometer or other appropriate tools, and neck disability will be evaluated using the Neck Disability Index (NDI). Statistical analysis will be performed to compare the effectiveness of PIR and PIS in terms of pain reduction, range of motion improvement, and decreased neck disability.

Chronic pain significantly impacts individuals and society, with about 30% of Norwegian adults affected, making it the leading cause of long-term sick leave and disability benefits. Concerns over addiction to pain medications highlight the need for non-pharmacological treatments, though many such therapies, often complementary or alternative, are not widely available in conventional healthcare. Unclear biomechanisms of these therapies pose challenges for clinical trials and acceptance. This pilot study aims to explore the effects of two types of massage-cupping massage (CM, intense) and tactile massage (TM, soft)-on chronic neck pain, focusing on their mechanisms of action. Quantitative sensory testing (QST) will be used as a biomarker to assess changes in the pain pathway. A previous feasibility study on CM and QST conducted in Germany informs this research. The study will recruit 60 patients with chronic neck pain, randomized to CM or TM, with six weekly treatment sessions. QST will be measured before and after treatment to understand therapy-induced changes in the pain pathway. Findings will help tailor massage therapies to individual needs, improve clinical trial quality, and promote the integration of non-pharmacological treatments into conventional care, benefiting a large population in need.

The normal thoracic kyphosis angle of the spine is 20-40°, however, an angle of more than 40° is referred to as postural kyphosis, increased kyphosis or hyperkyphosis. Although postural kyphosis negatively affects individuals' general health status, physical performance, and quality of life, there is still no standardized protocol for correcting the thoracic kyphosis angle. Conservative treatment approaches such as postural training and exercises, manual therapy, postural corrective kinesiotaping, and orthotic use have been recommended for managing increased thoracic kyphosis. While numerous studies have demonstrated the effectiveness of three-dimensional exercise programs in the treatment of scoliosis, research examining their impact on kyphosis remains considerably limited.Nevertheless, the potential of these exercises to promote neuromuscular reorganization suggests that they may be similarly effective in individuals with thoracic kyphosis. This randomized controlled trial aims to evaluate the effects of a Schroth-based three-dimensional exercise program on kyphosis angle, trunk muscle strength, balance, pain, and quality of life in individuals with postural hyperkyphosis and chronic neck pain.