Neck Pain: Advancements in Assessment and Contemporary Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 30 April 2025 | Viewed by 7540

Special Issue Editor


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Guest Editor
School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
Interests: chronic neck pain; chronic pain; neck pain; musculoskeletal rehabilitation; physiotherapy

Special Issue Information

Dear Colleagues,

Neck pain is a complex and prevalent issue, significantly affecting the quality of life of millions of individuals. Rapid progress is being made in the field of neck pain, leading to improvements in the clinical assessment and management of patients.

Advancements in our understanding of the pathophysiological mechanisms underlying various neck pain phenotypes have broadened our scope for clinical assessments, moving beyond traditional diagnostic methods such as imaging and physical examination. Recognition of the multifactorial nature of neck pain has enabled a more person-centred approach to assessment.

Contemporary management approaches have evolved to encompass a multidisciplinary model that recognises the importance of the biopsychosocial aspects of neck pain. Treatments, including physical therapy, pain management interventions, and pharmacological management, have become much more sophisticated and personalised. Additionally, non-pharmacological interventions, such as psychologically informed therapy, have gained prominence in addressing the psychosocial aspects of neck pain.

These advancements have allowed the field to prioritise the delivery of high-value care by implementing evidence-based approaches into clinical management. In this Special Issue, we invite authors to contribute research papers highlighting the latest advancements in neck pain assessment and contemporary management. Our goal is to provide valuable insights into enhancing the quality of life for people experiencing neck pain. We aim to showcase innovative approaches and evidence-based practices that will continue to shape the landscape of neck pain care.

Dr. Rutger De Zoete
Guest Editor

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Keywords

  • neck pain
  • chronic pain
  • rehabilitation
  • pain management
  • anaesthesiology
  • physical medicine
  • musculoskeletal

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Published Papers (3 papers)

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Research

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22 pages, 1223 KiB  
Article
Can Pain Neuroscience Education Combined with Cognition-Targeted Exercise Therapy Change White Matter Structure in People with Chronic Spinal Pain? A Randomized Controlled Trial
by Iris Coppieters, Jo Nijs, Mira Meeus, Lieven Danneels, Nathalie Roussel, Barbara Cagnie, Jeroen Kregel, Ward Willaert, Emma Rheel, Robby De Pauw and Anneleen Malfliet
J. Clin. Med. 2025, 14(3), 867; https://doi.org/10.3390/jcm14030867 - 28 Jan 2025
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Abstract
Background/Objectives: White matter (WM) structural changes have been found in patients with chronic spinal pain (CSP). In these patients, pain neuroscience education followed by cognition-targeted exercise therapy (i.e., the Modern Pain Neuroscience Approach (MPNA)) was shown to be more effective than biomedically-focused education [...] Read more.
Background/Objectives: White matter (WM) structural changes have been found in patients with chronic spinal pain (CSP). In these patients, pain neuroscience education followed by cognition-targeted exercise therapy (i.e., the Modern Pain Neuroscience Approach (MPNA)) was shown to be more effective than biomedically-focused education followed by symptom-contingent exercise therapy for improving clinical outcomes. The present study examined whether an MPNA, compared to biomedically-focused treatment, can change WM structure in regions of interest and whether potential WM structural changes are associated with clinical improvements in patients with CSP. Methods: Patients with CSP were randomized into an experimental (MPNA) or control (biomedically-focused) treatment group. Diffusion-weighted Magnetic Resonance Images were acquired pre-treatment, post-treatment, and at 1-year follow-up. WM structure was assessed using diffusion tensor imaging in 8 WM regions of interest, and linear mixed models assessed differences between groups in response to treatment. Results: No significant treatment x time interaction effects were found; however, significant main effects of time were found in 7 WM tracts. Significant main effects of time revealed increased fractional anisotropy (FA), decreased mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in the cingulum hippocampus, and decreased RD and MD in the superior cerebellar peduncle at 1-year follow-up compared to baseline. In contrast, decreased FA and/or increased MD, AD, or RD values were found in other WM tracts (e.g., anterior corona radiata) from pre-treatment to 1-year follow-up. Greater reduction in kinesiophobia was moderately correlated with a smaller decrease in RD in the superior cerebellar peduncle at 1-year follow-up compared to baseline. No other significant associations were found between WM structural changes and clinical improvements. Conclusions: In conclusion, in patients with CSP, regional WM structure changed over time irrespective of prescribed treatment (timespan of 12 months). Further research, including Neurite Orientation Dispersion and Density Imaging and a healthy control group, allowing for a more specific examination of WM microstructural changes in response to multimodal treatment in patients with CSP, is warranted. Full article
(This article belongs to the Special Issue Neck Pain: Advancements in Assessment and Contemporary Management)
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17 pages, 1480 KiB  
Article
Reduced Cervical Muscle Fat Infiltrate Is Associated with Self-Reported Recovery from Chronic Idiopathic Neck Pain Over Six Months: A Magnetic Resonance Imaging Longitudinal Cohort Study
by Suzanne J. Snodgrass, Kenneth A. Weber II, Evert O. Wesselink, Peter Stanwell and James M. Elliott
J. Clin. Med. 2024, 13(15), 4485; https://doi.org/10.3390/jcm13154485 - 31 Jul 2024
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Abstract
Background: It is unclear why neck pain persists or resolves, making assessment and management decisions challenging. Muscle composition, particularly muscle fat infiltrate (MFI), is related to neck pain, but it is unknown whether MFI changes with recovery following targeted interventions. Methods: We compared [...] Read more.
Background: It is unclear why neck pain persists or resolves, making assessment and management decisions challenging. Muscle composition, particularly muscle fat infiltrate (MFI), is related to neck pain, but it is unknown whether MFI changes with recovery following targeted interventions. Methods: We compared muscle composition quantified from fat-water magnetic resonance images from the C3 to T1 vertebrae in individuals with and without chronic idiopathic neck pain at two times 6 months apart. Those with neck pain received six weeks of intervention (physiotherapy or chiropractic) after their baseline MRI; at 6 months, they were classified as recovered (≥3 on the 11-point Global Rating of Change scale) or not recovered. Results: At 6 months, both asymptomatic and recovered individuals had decreased MFI compared to baseline (asymptomatic estimated marginal mean difference −1.6% 95%; CI −1.9, −1.4; recovered −1.6; −1.8, −1.4; p < 0.001) whereas those classified as not recovered had increased MFI compared to baseline (0.4; 0.1, 0.7; p = 0.014), independent of age, sex and body mass index. Conclusions: It appears MFI decreases with recovery from neck pain but increases when neck pain persists. The relationship between cervical MFI and neck pain suggests MFI may inform diagnosis, theragnosis and prognosis in individuals with neck pain. Future development of a clinical test for MFI may assist in identifying patients who will benefit from targeted muscle intervention, improving outcomes. Full article
(This article belongs to the Special Issue Neck Pain: Advancements in Assessment and Contemporary Management)
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14 pages, 299 KiB  
Review
Exercise Therapy for Chronic Neck Pain: Tailoring Person-Centred Approaches within Contemporary Management
by Rutger M. J. de Zoete
J. Clin. Med. 2023, 12(22), 7108; https://doi.org/10.3390/jcm12227108 - 15 Nov 2023
Cited by 3 | Viewed by 4741
Abstract
Exercise therapy is considered the best evidence-based approach for managing chronic neck pain. However, the implementation of exercise therapy presents several challenges. Systematic reviews indicate that it has modest effectiveness, while clinical practice guidelines offer limited guidance on the exercise parameters required to [...] Read more.
Exercise therapy is considered the best evidence-based approach for managing chronic neck pain. However, the implementation of exercise therapy presents several challenges. Systematic reviews indicate that it has modest effectiveness, while clinical practice guidelines offer limited guidance on the exercise parameters required to optimise clinical outcomes. Moreover, recommendations often fail to differentiate between different types of neck pain. This article addresses the challenges associated with the prescription of exercise for chronic neck pain and provides recommendations for exercise therapy specific to chronic nociceptive, neuropathic, and nociplastic neck pain. The goal of this article is to facilitate the implementation of high-value evidence-based exercise therapy for these distinct types of chronic neck pain with the aim to improve its outcomes and to reduce the related individual and societal burdens. Full article
(This article belongs to the Special Issue Neck Pain: Advancements in Assessment and Contemporary Management)
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