For the main analysis which included all participants - i.e. both cases and non-cases - analysis of variance controlled for gender showed a significant group by time effect for pain in the neck (p < 0.001) and a tendency for the shoulders (P = 0.07). Compared with the control group, pain intensity in the neck decreased significantly (-0.6, 95% confidence interval -1.0 to -0.1) in the training group, and pain intensity in the shoulder tended to decrease (-0.2, 95% confidence interval -0.5 to 0.1). Rehabilitative effect of training Table 3 shows for cases and non-cases separately, pain intensity in the neck and shoulder at baseline and follow-up. Despite the well-known seasonal variation and thus a decrease of pain in the control group, we found a significantly better rehabilitative effect of strength training than control (OR 2.0). In contrast to the evidence on neck pain, only few high quality studies on training have been able to provide evidence for the effectiveness on shoulder symptoms [30 , 31 ]. Among workers with shoulder pain at baseline, the odds ratio for being a non-case - i.e. having a pain intensity less than 3 at follow-up - were 3.9 in the training group compared with the control group.

Results No differences were observed between the groups in any of the variables in the control period (p = 0.27–0.97) or training period (p = 0.37–0.68). When merging the two groups, the mean and worst pain was reduced by 25 and 43% (p = 0.05 and 0.3) for pain relief (primary outcome) defined as a clinical effect [28 ]. With a statistical level set to 0.05, the statistical power to 80%, and using the pain relief from comparable studies [8 , 20 ], 14 participants were required to significant difference. To be included, participants should have mild to moderate pain (10 – 60 mm VAS) [8 , 18 , 24 ] in the neck and/or shoulder region lasting at least 3 months and having computer work or low-intensity isometric contraction during work (i.e. dentist, hairdresser). Thirty-three respondents (26 women and 7 men) volunteered to participate in the study, but only 30 attended the pre-testing (23 women and 7 men). Among these, three were hairdressers, six were dentists and 21 were office workers with computer work as their main task). People with considerable pain (> 60 mm VAS) was excluded as a resistance training can cause increased acute pain following the session [13 ]. In addition, participants receiving treatment the last 6 months by health care professionals were also excluded.

Clinical Orthopaedics and Related Research (1976-2007): September 1990 Buy Abstract The complex problem of combined neck and shoulder pain was investigated in 26 operations in 13 patients who had a shoulder procedure (subacromial decompressions or rotator cuff repairs)and an anterior cervical spine fusion. Good pain relief was accomplished after 24 of the 26 surgical procedures (average follow-up, 4.3 years). In the 13 patients, eight presented with nearly equal neck and shoulder pain as the chief complaint, whereas in the remaining five patients, the initial complaint was predominantly neck pain with only minor shoulder involvement.

Each week the participants received an email asking them "How intense was your worst pain in the neck-shoulder area during the last week on a 0-9 scale?" (0 means no complaints and 9 means pain as bad as it can be). Musculoskeletal pain symptoms of the neck, shoulder, arm, hand, and back were evaluated using scales concerning both intensity and duration of symptoms. Productivity was rated on an 11-step ordinal scale: "How do you perceive your overall productivity the last 4 weeks?" The rating went from 0 (the worst a worker could do) to 10 (the best a worker in the same job could do)[15 ]. Participants rated work disability at baseline and follow-up by the work module of the Disability of the Arm, Shoulder and Hand questionnaire (DASH): "In the past week did you have any difficulty:" 1) "using your usual technique for your work?", 2) "doing your usual work because of arm, shoulder or hand pain?", 3) "doing your work as well as you would like?", 4) "spending your usual amount of time doing your work?". Participants replied on a 5-point Likert scale from "No difficulty" to "Unable".

Preview From their experience at a pain clinic, Dr Grosshandler and coauthors offer insight into the frustrating problem of chronic neck and shoulder pain. Their discussion centers on one frequently overlooked cause, the myofascial syndrome, which begins with a tiny trigger point in muscle and culminates in a complex problem with psychological as well as physical dimensions.

Pharmacy-based patient surveys have provided valuable information in the context of TTH and migraine (5 , 6 ) and other indications that include abdominal spasms and pain (7 ) or cough and cold (8 , 9 ). To better understand the complaints of headache patients with and without accompanying NSP and their treatment responses, a pharmacy-based survey was performed on patients suffering from headaches that were treated with an OTC analgesic, the fixed-dose combination of 400 mg ibuprofen, and 100 mg caffeine (IbuCaff). Patients and Methods This non-interventional, prospective survey was run in 126 community pharmacies in Germany between February and June 2019. A preprint of a previous version of the manuscript has been made available at https://www.preprints.org/manuscript/202011.0631/v1 . Based on the suggestion of a referee, additional post-hoc analyses were performed to explore the effects of concomitant NSP within the group of headache patients with and without self-reported migraine (see Supplementary Material ). Results Among 1,124 participants fulfilling the inclusion criteria and providing analyzable questionnaires, 895 reported using IbuCaff for the treatment of headache and 110 for pain other than headache; no information on the type of pain was given in 119 questionnaires (Figure 1 ). Since no formal headache diagnosis was performed, data for self-reported “headache” (n = 735) and “migraine” (n = 160) were pooled and constituted the efficacy population.

Further, a dose–response relationship also exists from being inactive to performing moderate amounts of physical activity with only minor additional benefits of further increasing activity levels (13 ). When dealing with neck and shoulder disorders, specific strength training is an effective remedy (3,26,29 ), but the optimal amount of training remains to be detailed beyond the minimum requirements presented in a systematic review (7 ). In parallel with the medical model, exercise scientists and physical therapists are searching for a quantifiable relationship between dose (training) and response (pain relief). When training for pain relief, knowledge of this dose–response relationship is vital for prescribing proper doses of training. Our strength training protocol was based on best practice experience with neck–shoulder training combined with knowledge from resistance training studies in healthy individuals (3,6 ). Physiological adaptations to specific strength training occurs only for a period before variation is needed, so increasing the demands placed upon the body is necessary for further improvement (19 ). We induced a progressive overload by periodizing exercise intensity and total repetitions performed because systematic variation of volume and intensity is most effective for long-term progression (19 ). This allowed the training stimulus to remain challenging and effective throughout the 20-week period, and the training weights were steadily increased during the entire intervention period (Table 2 ). One might speculate that participants in the low adherence group have trained less frequently due to higher levels of pain.

Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review Free http://orcid.org/0000-0001-6901-2569 Ivan Lin 1 , Louise Wiles 2 , Rob Waller 3 , Roger Goucke 4 , Yusuf Nagree 5 , 6 , Michael Gibberd 7 , http://orcid.org/0000-0002-7786-4128 Leon Straker 8 , Chris G Maher 9 , Peter P B O’Sullivan 10 Correspondence to Dr Ivan Lin, WA Centre for Rural Health, University of Western Australia, Western Australia, 6531, Australia; ivan.lin@uwa.edu.au Abstract Objectives To identify common recommendations for high-quality care for the most common musculoskeletal (MSK) pain sites encountered by clinicians in emergency and primary care (spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis [OA] and shoulder) from contemporary, high-quality clinical practice guidelines (CPGs). Design Systematic review, critical appraisal and narrative synthesis of MSK pain CPG recommendations. Results 6232 records were identified, 44 CPGs were appraised and 11 were rated as high quality (low back pain: 4, OA: 4, neck: 2 and shoulder: 1). We identified 11 recommendations for MSK pain care: ensure care is patient centred, screen for red flag conditions, assess psychosocial factors, use imaging selectively, undertake a physical examination, monitor patient progress, provide education/information, address physical activity/exercise, use manual therapy only as an adjunct to other treatments, offer high-quality non-surgical care prior to surgery and try to keep patients at work.

Abstract Objective: To determine the effectiveness of neck and shoulder stretching exercises for relief neck pain among office workers. Participants: A total of 96 subjects with moderate-to-severe neck pain (visual analogue score ⩾5/10) for ⩾3 months.