Chronic Neck Pain
Conditions
Interventions
None listed
Sponsors
Universitair Medisch Centrum Sint Radboud
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: 1. Male and female patients who are 18 years or more of age. 2. Patients with a history of chronic, function-limiting neck pain of at least 3 months duration. 3. Patients who are able to provide voluntary, written informed consent to participate in this evaluation. 4. Patients willing to return for follow-ups. 5. Patients without a history of recent surgical procedures (i.e. within the last 6 months)
Exclusion criteria
Exclusion criteria: 1. Patients with uncontrolled major depression or psychiatric disorders. 2. Patients with recent history of heavy opioid usage, chronic alcoholism or substance abuse. 3. Patients with acute or uncontrolled medical illness, malignancy or poorly controlled epilepsy. 4. Patients with chronic severe conditions that could interfere with the interpretations of the outcome assessments. 5. Patients with fibromylagia or painful syndromes of unknown origin or associated with diffuse pains. 6. Female patients who are pregnant or lactating, 7. Patients unable to tolerate prone or lateral position. 8. Patients with histories of adverse reactions to local anesthetic or steroids 9. Patients with anatomical abnormalities on cervical spine X-ray that may result in technical difficulties for blocks
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Our primary endpoint is to detect generalized hyperalgesia, defined as a decrease in pressure-pain thresholds (PPT) of more than 30% in a distal site (the rectus femoris muscle) outside their reported areas of pain, vs. healthy, pain-free controls. A further objective is to subsequently track the these PPT changes in this group of patients through their diagnostic and therapeutic process, to ascertain if this hyperalgesia predisposes them to poor treatment response or if this hyperalgesia in fact, abates with the ablation of the peripheral painful input. Important secondary endpoints include electrical wind-up testing and DNIC testing which provide further information regarding vulnerability to central sensitisation or it progression, and may also help predict response to therapeutic intervention. Thermal detection testing helps identify patients with nerve damage which could also predispose to central sensitization. | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary study parameters, in particular the rest of the QST battery, further reinforces the primary objective. Windup ratio will serve to confirm the presence of spinal central sensitisation, while measurement of the DNIC response will allow insight into vulnerability for (further) progression of central sensitisaton. Thermal detection thresholds and electrical pain detection thresholds will help detect nerve damage which again can predispose a patient to supra-spinal central sensitization. Because chronic neck pain, like many other chronic pain conditions, is fraught with numerous psychosocial complications, the quality of life and degree of perceived disability will also be evaluated using the following questionnaires: 1. Quality of life (1 questionnaire): SF-36 (Medical Outcomes Study Short-Form General Health Survey (Ware, Jr. and Sherbourne 1992;Aaronson et al. 1998)) 2. Sleep disturbance (1 questionnaire): MOS Sleep Scale (Hays and Stewart, 1992 R.D. Hays and A.L. Stewart, Sleep measures) 3. Disability: Neck Disability Index (NDI) (H Vernon and S Mior, 1991) | — |
Countries
Netherlands
Outcome results
None listed