Factors Affecting Patients With Chronic Idiopathic Neck Pain

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1. Title: “Does the number of visits of mobilizations influence the MCID* on pain improvement in patients with chronic idiopathic neck pain- A cross-sectional study?”
*MCID= Minimum clinically important difference

2. The specific aim of this cross-sectional study is to reduce cost and improve pain outcome in patients with chronic idiopathic neck pain (CINP). To do this, the study will examine whether the number of visits of mobilization (hypothesis) affect the MCID on pain reduction for patients to begin exercising. In addition, the study will also identify which patients are likely to respond or not to mobilization based on their conditioned pain modulation (CPM) profile? (research questions). These findings could potentially cut costs
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- Providing 1 session of joint mobilization has been shown to immediately improve the impaired CPM in those with knee osteoarthritis (Courtney et al., 2016) compared to placebo.
- Some patients with chronic pain related to knee osteoarthritis have impaired CPM while others do not (Courtney et al 2016)
- However, because Courtney et al did not apply joint mobilization to those whose CPM is not impaired, it is unclear if joint mobilization is or is not effective in changing pain in those with normal functioning CPM
- More importantly, it is not clear whether the positive results Courtney et al 2016 achieved in chronic pain related to knee osteoarthritis carries over to patients with CINP.

4. Scope of the problem
- The high cost of CINP may be related to the fact that these patients typically seek on average 5 providers over 21 visits every year and receive largely ineffective treatments (Carlesso et al., 2014).
- Heat, NSAID, exercise, cold and spinal manipulation/mobilization are the most common treatments received (Goode et al., 2010).
- Only exercise and spinal manipulation/mobilization, however, have good evidence for effectiveness based on multiple systematic reviews and meta-analyses.
- In fact, current practice guidelines suggest combining exercise and spinal mobilization for better pain and functional outcomes than mobilization or exercise alone.
- To prevent long term disability
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