Claudia Hohmann

Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain.

Objectives:Chronic neck pain is a significant public health problem with only very few evidence-based treatment options. There is growing evidence for the effectiveness of yoga for relieving musculoskeletal disorders. The aim of this study was to evaluate the effect of Iyengar yoga compared with exercise on chronic nonspecific neck pain. Methods:Patients were randomly assigned to either yoga or exercise. The yoga group attended a 9-week yoga course and the exercise group received a self-care manual on home-based exercises for neck pain relief. The main outcome measure was the present neck pain intensity (100 mm visual analog scale). Secondary outcome measures included functional disability (Neck Disability Index), pain at motion (visual analog scale), health-related quality of life (Short Form-36 questionnaire), cervical range of motion, proprioceptive acuity, and pressure pain threshold. Results:Fifty-one patients (mean age 47.8 y ; 82.4% female) were randomized to yoga (n=25) and exercise (n=26) intervention. After the study period, patients in the yoga group reported significantly less neck pain intensity compared with the exercise group [mean difference: −13.9 mm (95% CI, −26.4 to −1.4), P=0.03]. The yoga group reported less disability and better mental quality of life. Range of motion and proprioceptive acuity were improved and the pressure pain threshold was elevated in the yoga group. Discussion:Yoga was more effective in relieving chronic nonspecific neck pain than a home-based exercise program. Yoga reduced neck pain intensity and disability and improved health-related quality of life. Moreover, yoga seems to influence the functional status of neck muscles, as indicated by improvement of physiological measures of neck pain.

The Effect of Traditional Cupping on Pain and Mechanical Thresholds in Patients with Chronic Nonspecific Neck Pain: A Randomised Controlled Pilot Study

Introduction. Cupping has been used since antiquity in the treatment of pain conditions. In this pilot study, we investigated the effect of traditional cupping therapy on chronic nonspecific neck pain (CNP) and mechanical sensory thresholds. Methods. Fifty CNP patients were randomly assigned to treatment (TG, n = 25) or waiting list control group (WL, n = 25). TG received a single cupping treatment. Pain at rest (PR), pain related to movement (PM), quality of life (SF-36), Neck Disability Index (NDI), mechanical detection (MDT), vibration detection (MDT), and pressure pain thresholds (PPT) were measured before and three days after a single cupping treatment. Patients also kept a pain and medication diary (PaDi, MeDi) during the study. Results. Baseline characteristics were similar in the two groups. After cupping TG reported significantly less pain (PR: −17.9 mm VAS, 95%CI −29.2 to −6.6; PM: −19.7, 95%CI −32.2 to −7.2; PaDi: −1.5 points on NRS, 95%CI −2.5 to −0.4; all P < 0.05) and higher quality of life than WL (SF-36, Physical Functioning: 7.5, 95%CI 1.4 to 13.5; Bodily Pain: 14.9, 95%CI 4.4 to 25.4; Physical Component Score: 5.0, 95%CI 1.4 to 8.5; all P < 0.05). No significant effect was found for NDI, MDT, or VDT, but TG showed significantly higher PPT at pain-areas than WL (in lg(kPa); pain-maximum: 0.088, 95%CI 0.029 to 0.148, pain-adjacent: 0.118, 95%CI 0.038 to 0.199; both P < 0.01). Conclusion. A single application of traditional cupping might be an effective treatment for improving pain, quality of life, and hyperalgesia in CNP.

Randomized Controlled Trial of Pulsating Cupping (Pneumatic Pulsation Therapy) for Chronic Neck Pain

Background: Pneumatic pulsation therapy may combine the effects of cupping therapy and massage. This study investigated the effect of pneumatic pulsation therapy on chronic neck pain compared to standard medical care. Methods: 50 patients (79.15% female; 46.17 ± 12.21 years) with chronic nonspecific neck pain were randomized to treatment group (TG; n = 25) or control group (CG; n = 25). The TG received 5 pneumatic pulsation treatments over a period of 2 weeks utilizing a mechanical device. Treatment was applied as a combination of moving and stationary pulsating cupping. Main outcome measure was pain intensity in pain diaries (numerical rating scale). Secondary outcome measures included functional disability (NDI), quality of life (SF-36), and pain at motion. Sensory thresholds, including pressure pain threshold, were measured at pain-related sites. Results: After the intervention, significant group differences occurred regarding pain intensity (baseline: 4.12 ± 1.45 in TG and 4.20 ± 1.57 in CG; post-intervention: 2.72 ± 1.62 in TG and 4.44 ± 1.96 in CG; analysis of covariance: p = 0.001), NDI (baseline: 25.92 ± 8.23 and 29.83; post-intervention: 20.44 ± 10.17 and 28.83; p = 0.025), and physical quality of life (baseline: 43.85 ± 7.65 and 41.66 ± 7.09; post-intervention: 47.60 ± 7.93 and 40.49 ± 8.03; p = 0.002). Further significant group differences were found for pain at motion (p = 0.004) and pressure pain threshold (p = 0.002). No serious adverse events were reported. Conclusion: Pneumatic pulsation therapy appears to be a safe and effective method to relieve pain and to improve function and quality of life in patients with chronic neck pain.

Yoga for Chronic Neck Pain: A 12-Month Follow-Up

OBJECTIVES To assess the effects of a 9-week yoga intervention on chronic nonspecific neck pain 12 months after completion. DESIGN Twelve-month follow-up of the pooled data of both arms of a randomized, controlled trial. SETTING Department of Internal and Integrative Medicine at an academic teaching hospital. SUBJECTS Fifty-one patients with chronic nonspecific neck pain (mean age 47.8 years; 82.4% female). INTERVENTIONS A 9-week yoga group intervention. OUTCOME MEASURES Neck pain intensity (100-mm visual analog scale), functional disability (neck disability index), health-related quality of life (short-form 36 questionnaire, SF-36), generic disability (days with restricted activities), and global improvement. RESULTS From baseline to 12-month follow-up, pain intensity improved from 48.81 ± 17.71 to 32.31 ± 20.68 (P < 0.001), neck-related disability decreased from 25.26 ± 9.02 to 19.49 ± 11.52 (P = 0.001), and bodily pain in the SF-36 improved from 49.37 ± 12.40 to 59.26 ± 17.57 (P = 0.005). Improvements in pain intensity were predicted by weekly minutes of yoga practice during the past 4 weeks (r(2)  = 0.12, P = 0.028); improved neck-related disability (r(2)  = 0.24, P = 0.001) and bodily pain (r(2)  = 0.26, P = 0.006) were predicted by regular yoga practice during the past 12 months. Generic disability did not decrease significantly. Twenty-four patients (68.6%) rated their health as at least somewhat improved. CONCLUSIONS A 9-week yoga intervention improved pain and neck-related disability for at least 12 months after completion. Sustained yoga practice seems to be the most important predictor of long-term effectiveness.

The Benefit of a Mechanical Needle Stimulation Pad in Patients with Chronic Neck and Lower Back Pain: Two Randomized Controlled Pilot Studies

Objectives. The objective was to investigate whether a treatment with a needle stimulation pad (NSP) changes perceived pain and/or sensory thresholds in patients with chronic neck (NP) and lower back pain (BP). Methods. 40 patients with chronic NP and 42 patients with chronic BP were equally randomized to either treatment or waiting list control group. The treatment group self-administered a NSP over a period of 14 days. Pain ratings were recorded on numerical rating scales (NRSs). Mechanical detection thresholds (MDTs) and pressure pain thresholds (PPTs) were determined at the site of maximal pain and in the adjacent region, vibration detection thresholds (VDT) were measured at close spinal processes. The Northwick Park Neck Pain Questionnaire (NPQ) and the Oswestry Disability Index (ODI) were utilized for the NP and BP study, respectively. Results. NRS ratings were significantly reduced for the treatment groups compared to the control groups (NP: P = .021 and BP: P < .001), accompanied by a significant increase of PPT at pain maximum (NP: P = .032 and BP: P = .013). There was no effect on VDT and MDT. The NPQ showed also a significant improvement, but not the ODI. Conclusions. The mechanical NSP seems to be an effective treatment method for chronic NP and BP.

The Effects of Cupping Massage in Patients with Chronic Neck Pain - A Randomised Controlled Trial

Background: Chronic neck pain is a major public health burden with only limited evidence for the effectiveness of complementary therapies. This study aimed to test the efficacy of cupping massage in patients with neck pain. Patients and Methods: Patients with chronic non-specific neck pain were randomly assigned to cupping massage or a wait list control. The intervention group received 5 cupping massages on a twice-weekly basis while the control patients continued their usual treatments. The primary outcome measure was neck pain intensity (0-100 mm visual analogue scale (VAS)) after 3 weeks. Secondary outcomes included pain on movement, functional disability, health-related quality of life, mechanical detection and pain thresholds and adverse events. Results: 50 patients (52.6 ± 10.3 years, 92% female) were randomised to either cupping massage or a wait list (N = 25 each). Patients in the cupping group reported significantly less neck pain post intervention (difference per protocol -14.3 mm, 95% confidence interval (CI) -27.7 to -1.0, p = 0.037; difference intention-to-treat -10.8 mm, 95% CI -21.5 to -0.1, p = 0.047). Significant group differences in favour of the intervention were further found for pain on movement (p = 0.019) and functional disability (p < 0.001), the quality-of-life subscales pain (p = 0.002) and mental health (p = 0.003) and the mental component summary (p = 0.036). Changes were also found for pressure pain sensitivity at the site of maximal pain (p = 0.022). Five adverse events were reported. Conclusions: Cupping massage appears to be effective in reducing pain and increasing function and quality of life in patients with chronic non-specific neck pain. More rigorous studies are needed to confirm and extend these results.

Auftreten eines Lipoms nach einmaliger Schröpfkopfmassage – ein Fallbericht

Hintergrund: Die Schröpfkopfmassage ist eine Form des unblutigen Schröpfens. Insbesondere bei Verspannungen und muskulär bedingten Schmerzen des Bewegungsapparats, wie z.B. chronischen Nackenschmerzen, findet diese Art des Schröpfens Anwendung. Die Datenlage hinsichtlich Wirkmechanismen und möglichen Nebenwirkungen ist jedoch nicht zufriedenstellend. Fallbericht: Im Rahmen einer Studie über die Wirksamkeit der Schröpfkopfmassage bei Patienten mit chronischen Nackenschmerzen kam es bei einer Patientin nach der ersten Anwendung zur Ausbildung eines Lipoms im Schröpfgebiet. Schlussfolgerung: Aufgrund des kurzen Zeitabstandes zwischen Therapie und Lipomentwicklung ist eine primäre Verursachung unwahrscheinlich. Dieses unerwünschte Ereignis ist in der Literatur jedoch bislang nicht beschrieben. Der vorliegende Fallbericht stellt den Fall zusammenfassend dar.

Phytotherapie in Europa: Neue Entwicklungen

ESCOP geht online mit dem erweiterten Aufbau einer wissenschaftlichen Dokumentation pflanzlicher Arzneimittel Die European Scientific Cooperative on Phytotherapy (ESCOP) ist die Dachorganisation der nationalen Phytotherapie-Gesellschaften in Europa, mit Delegierten aus Österreich, Belgien, Schweiz, Deutschland, Dänemark, Spanien, Frankreich, Irland, Italien, den Niederlanden, Polen, Türkei und Großbritannien. Sie verfolgt seit über 20 Jahren das Ziel, die wissenschaftliche und regulatorische Anerkennung von pflanzlichen Arzneimitteln in Europa zu fördern. Das Scientific Committee besteht aus Experten der Pharmazie, Medizin, Biologie und Chemie. Es verfasst Monografien mit einer Kontinuität, die ihresgleichen sucht. Die Monografien bieten eine übersichtliche Darstellung der wissenschaftlichen und traditionellen Informationen über die sichere und wirksame Anwendung pflanzlicher Arzneimittel, welche von Herstellern, Gesundheitsbehörden, Universitäten und Wissenschaftlern häufig nachgefragt wird. Das Komitee bearbeitet und wählt aus der zum Teil immensen Anzahl an Publikationen für jede Arzneipflanze die relevanten Arbeiten sorgfältig aus und verwendet gerne auch Vorschläge von spezialisierten externen Experten [1]. Mittlerweile sind von der ESCOP 107 Monografien zu Arzneipflanzen in 2 Bänden [2, 3] publiziert worden. Die Gruppe der Supervising Editors der ESCOP gewährleistet eine redaktionelle Überarbeitung der Monografien, welche die hohe Qualität maßgeblich mitbestimmt. Ganz neu werden Online-Veröffentlichungen von neuen und aktualisierten Monografien in Angriff genommen. Der Vorteil ist, dass die Monografien einzeln erhältlich sind und nicht mehr gesammelt in Buchform erscheinen müssen. Die Monografien werden aktueller sein, als es in Buchform möglich wäre. Die erste Monografie der neuen Online-Reihe (www.escop.com) ist Cimicifugae rhizoma (Traubensilberkerzen-Wurzel). Sie kann nach Bezahlung herunter geladen werden [4]. Weitere 18 Online-Versionen sind in Arbeit. Folgende werden aktualisiert: Uvae ursi folium, Symphytii radix, Plantaginis lanceolatae folium/herba und Hamamelidis aqua. Inhaltlich wird es sich um «State-of-the-art»-Monografien handeln, so wie wir das von der ESCOP gewohnt sind. Die frühen ESCOP-Monografien wurden formell bei der European Medicines Agency (EMA) eingereicht, als Basis für europäische Community Herbal Monographs für die Zulassung bzw. Registrierung von «traditionellen» und «regulären» pflanzlichen Arzneimitteln. Nach der Gründung des Herbal Medicinal Product Commitee (HMPC) sieht es die ESCOP als wichtige Aufgabe, die Entwürfe zu HMPC-Monografien zu prüfen und Kommentare abzugeben, die auf den ESCOP-Monografien basieren.