Treatment of chronic cervicobrachialgia with the help of kinesiotherapy

The treatment of chronic non-specific neck pain (NP) is often ineffective due to the lack of a comprehensive approach. We present a case of a 32-year-old patient complaining of NP, mainly on the left side, and pain in the left shoulder with an intensity of up to 6 points on a numerical rating scale (NRS). He had this complains for 4 months, and was repeatedly consulted by neurologists and therapists, magnetic resonance imaging of the neck and other examinations had been performed, diagnosis of osteochondrosis and protrusion of the C_IV–VII discs was proposed, nonsteroidal anti-inflammatory drugs, muscle relaxants and vitamins of group B were prescribed with insufficient efficacy. During previous treatment, no attention was paid to the insufficient episodic physical activity against the background of a sedentary lifestyle and long static postures. We used an integrated approach that included kinesiotherapy and optimal drug therapy with dexketoprofen (Dexalgin). Kinesiotherapy included therapeutic exercises, postural training, ergonomic and lifestyle recommendations and kinesio taping. As a result of the treatment, educational talks (about the cause of pain, chronic factors, treatment methods, prognosis), an individually selected exercise complex and therapy with dexketoprofen (Dexalgin) there was a relatively quick (during a week) reduction of the pain to 2 points according to the NRS. Subsequently, the pain had completely subsided (observation period 3 months), the patient began to follow the rules of ergonomics, performed regular medical exercises and resumed sports. Issues related to the treatment of chronic non-specific NP are discussed.

1. Popescu A, Lee H. Neck Pain and Lower Back Pain. Med Clin North Am. 2020 Mar;104(2):279-92. doi: 10.1016/j.mcna.2019.11.003. Epub 2019 Dec 20.

2. Jahre H, Grotle M, Smedbraten K, et al. Risk factors for non-specific neck pain in youngadults. A systematic review. BMC Musculoskelet Disord. 2020 Jun 9;21(1):366. doi: 10.1186/s12891-020-03379-y

3. Cho CY, Hwang YS, Cherng RJ. Musculoskeletal symptoms and associated risk factors among office workers with high workload computer use. J Manipulative Physiol Ther. 2012 Sep;35(7):534-40. doi: 10.1016/j.jmpt.2012.07.004. Epub 2012 Aug 27.

4. Brandt M, Sundstrup E, Jakobsen MD, et al. Association between Neck/Shoulder Painand Trapezius Muscle Tenderness in Office Workers. Pain Res Treat. 2014;2014:352735. doi: 10.1155/2014/352735. Epub 2014 Mar 27.

5. Parfenov VA, Yakhno NN, Kukushkin ML, et al. Non-specific neck pain (cervicalgia). Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2023;15(5):4-12. doi: 10.14412/2074-27112023-5-4-12 (In Russ.).

6. Golovacheva VA, Golovacheva AA. Chronic neck pain and combined tension headache: a unified effective treatment approach. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(4):76-84. doi: 10.14412/2074-2711-2024-4-76-84 (In Russ.).

7. Golovacheva VA, Golovacheva AA, Belyaeva SD. Cervicobrachialgia and lumboischialgia: A single effective approach to solving the problem. Meditsinskiy sovet = Medical Council. 2024;(12):86-94. doi: 10.21518/ms2024-309 (In Russ.).

8. Elbinoune I, Amine B, Shyen S, et al. Chronic neck pain and anxiety-depression: prevalence and associated risk factors. Pan Afr Med J. 2016 May 27;24:89. doi: 10.11604/pamj.2016.24.89.8831

9. Corp N, Mansell G, Stynes S, et al. Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. Eur J Pain. 2021 Feb;25(2):275-95. doi: 10.1002/ejp.1679. Epub 2020 Nov 12.

10. Adam K, Gibson L, Cook M. Injury prevention in the meat industry: Limited evidence of effectiveness for ergonomic programs in reducing the severity of musculoskeletal injuries. Aust Occup Ther J. 2016 Feb;63(1):59-60. doi: 10.1111/1440-1630.12276

11. Johnston V, Chen X, Welch A, et al. A cluster-randomized trial of workplace ergonomics and neck-specific exercise versus ergonomics and health promotion for office workers to manage neck pain – a secondary outcome analysis. BMC Musculoskelet Disord. 2021 Jan 12;22(1):68. doi: 10.1186/s12891-021-03945-y

12. Shariat A, Cleland JA, Danaee M, et al. Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. Braz J Phys Ther. 2018 MarApr;22(2):144-53. doi: 10.1016/j.bjpt.2017.09.003. Epub 2017 Sep 6.

13. Tunwattanapong P, Kongkasuwan R, Kuptniratsaikul V. The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial. Clin Rehabil. 2016 Jan;30(1):64-72. doi: 10.1177/0269215515575747. Epub 2015 Mar 16.

14. Li Y, Li S, Jiang J, Yuan S. Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis. Medicine (Baltimore). 2019 Feb;98(8):e14649. doi: 10.1097/MD.0000000000014649

15. Rasmussen-Barr E, Halvorsen M, Bohman T, et al. Summarizing the effects of different exercise types in chronic neck pain – a systematic review and meta-analysis of systematic reviews. BMC Musculoskelet Disord. 2023 Oct 12;24(1):806. doi: 10.1186/s12891-023-06930-9

16. Akodu AK, Nwanne CA, Fapojuwo OA. Efficacy of neck stabilization and Pilates exercises on pain, sleep disturbance and kinesiophobia in patients with non-specific chronic neck pain: A randomized controlled trial. J Bodyw Mov Ther. 2021 Apr;26:411-9. doi: 10.1016/j.jbmt.2020.09.008. Epub 2020 Oct 3.

17. Varol U, Valera-Calero JA, Sanchez-Jimenez E, et al. Levator Scapulae Stiffness Measurement Reliability in Individuals with and without Chronic Neck Pain by Experienced and Novel Examiners. Sensors (Basel). 2024 Jan 3;24(1):277. doi: 10.3390/s24010277

18. Mueller J, Weinig J, Niederer D, et al. Resistance, Motor Control, and MindfulnessBased Exercises Are Effective for Treating Chronic Nonspecific Neck Pain: A Systematic Review With Meta-Analysis and DoseResponse Meta-Regression. J Orthop Sports Phys Ther. 2023;53(8):420-59. doi: 10.2519/jospt.2023.11820

19. Park SH, Lee MM. Effects of Lower Trapezius Strengthening Exercises on Pain, Dysfunction, Posture Alignment, Muscle Thickness and Contraction Rate in Patients with Neck Pain; Randomized Controlled Trial. Med Sci Monit. 2020 Mar 23;26:e920208. doi: 10.12659/MSM.920208

20. Tsiringakis G, Dimitriadis Z, Triantafylloy E, McLean S. Motor control training of deep neck flexors with pressure biofeedback improves pain and disability in patients with neck pain: A systematic review and meta-analysis. Musculoskelet Sci Pract. 2020 Dec;50:102220. doi: 10.1016/j.msksp.2020.102220. Epub 2020 Jul 24.

21. Tsang SMH, So BCL, Lau RWL, et al. Comparing the effectiveness of integrating ergonomics and motor control to conventional treatment for pain and functional recovery of work-related neck-shoulder pain: A randomized trial. Eur J Pain. 2019 Jul;23(6):1141-52. doi: 10.1002/ejp.1381. Epub 2019 Mar 11.

22. Khosrokiani Z, Letafatkar A, Gladin A. Lumbar motor control training as a complementary treatment for chronic neck pain: A randomized controlled trial. Clin Rehabil. 2022;36(1):99-112. doi: 10.1177/02692155211038099

23. Toprak Celenay S, Mete O, Sari A, Ozer Kaya D. A comparison of kinesio taping and classical massage in addition to cervical stabilization exercise in patients with chronic neck pain. Complement Ther Clin Pract. 2021 May;43:101381. doi: 10.1016/j.ctcp.2021.101381. Epub 2021 Apr 2.

24. Ay S, Konak HE, Evcik D, Kibar S. The effectiveness of Kinesio Taping on pain and disability in cervical myofascial pain syndrome. Rev Bras Reumatol Engl Ed. 2017 Mar-Apr;57(2):93-9. doi: 10.1016/j.rbre.2016.03.012. Epub 2016 May 10.

25. Solovieva EYu, Karneev AN, Ivanokov AN, Dzhutova ED. Dexketoprofen in the treatment of acute back pain. Effektivnaya farmakoterapiya. Nevrologiya i psikhiatriya = Effective Pharmacotherapy. Neurology and Psychiatry. 2012;(5):36-40. Available at: https://umedp.ru/articles/deksketoprofen_v_lechenii_ostroy_boli_v_spine.html (In Russ.).

26. Gaskell H, Derry S, Wiffen PJ, Moore RA. Single dose oral ketoprofen or dexketoprofen for acute postoperative pain in adults. Cochrane Database Syst Rev. 2017 May 25;5(5):CD007355. doi: 10.1002/14651858.CD007355.pub3

27. Shavlovskaya OA. Evaluation of the effectiveness of the therapeutic action of the drug Dexalgin (dexketoprofen trometamol) in the treatment of dorsopathy. Consilium Medicum. Neurology and Rheumatology (Suppl.). 2012;(2):66-9. Available at: https://omnidoctor.ru/library/izdaniya-dlyavrachey/consiliummedicum/cm2012/nevro_2012_pril/nevro2012_2_pril/otsenka-effektivnosti-terapevticheskogo-deystviya-preparata-deksalgin-deksketoprofena-trometamol-v-l/ (In Russ.).

28. Golovacheva AA, Golovacheva VA. Complex treatment of patients with chronic non-specific back pain and comorbid disorders: a prospective clinical study. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(6):45-52. doi: 10.14412/2074-2711-2024-6-45-52 (In Russ.).

29. Moore RA, Barden J. Systematic review of dexketoprofen in acute and chronic pain. BMC Clin Pharmacol. 2008 Oct 31;8:11. doi: 10.1186/1472-6904-8-11