Physical Management of Pain and Disability among Healthcare Workers Due to Mechanical Neck Pain: A Randomized Controlled Trial

Abstract

Mechanical neck pain (MNP) in the second most common disability among healthcare workers. The main objective of this study was to compare the effects of dry needling (DN) and transcutaneous electrical nerve stimulation (TENS) for the management of MNP among healthcare workers. A single blind RCT ( n = 30) was conducted at the Neuro Counsel Clinic, Islamabad. Simple convenient sampling techniques were used to recruit participants of age 20-50 years who had no comorbidity of any kind. Two equal groups were made. Group A received DN for ×1/day for 2 weeks and Group B received TENS at the rate of ×2/day for 2 weeks. Data were evaluated on the basis of Numeric Pain Rating Scale (NPRS) and Neck Disability Index (NDI) score. Prepost data were analyzed for within group (Wilcoxon rank test) and between groups (Mann–Whitney U test). The level of significance was kept at P < 0.05. The mean ± standard deviation (SD) of age in Group A was 33.87 ± 8.18 while in Group B it was 33.67 ± 7.60. Wilcoxon rank test revealed that both techniques are effective for within-group analysis ( P < 0.001). Mann–Whitney U test revealed that both techniques showed no significant results on NPRS score as P > 0.05 but the NDI score revealed that there is a significant difference between groups ( P < 0.05). On the basis of results, it is concluded that DN is more effective when compared to TENS for disability management in MNP sufferers.

Main article text

INTRODUCTION

Neck pain is one of the most commonly encountered musculoskeletal disorders among the general population worldwide ( Walker-Bone et al., 2004). Point prevalence of this disorder ranges from 6% to around 14%, and in elderly individuals it is reported up to 38% ( Phadke et al., 2016). It is reported that life time prevalence of this condition ranges from more than 14 to 71% ( Fejer et al., 2006; Alahmari et al., 2017). International Association for study of Pain defines neck pain. Perception of pain arises from the superior-nuchal line to the inferior border of first thoracic vertebral transverse process and laterally to the superior border of trapezius at the acromion process of scapula ( Ramanand, 2015; Suchetha et al., 2018; Priya et al., 2020).

Mechanical neck pain (MNP) is also known as nonspecific neck pain or shoulder pain characterized by its mechanical characteristics such as sustained postures for a long period of time due to performance of occupational tasks ( Cerezo-Téllez et al., 2016). No specific cause of MNP has been identified so far but some clinicians describe such pain as an anatomical aberration of zygapophyseal joints of cervical and thoracic spine due to hypomobility ( Grod and Diakow, 2002). Various etiological factors, e.g. stress, long working hours, bad posture, anxiety and sleep disturbance, are the major factors which initiate or aggravate MNP. Sustain posture in abnormal position induces stress in ligaments and paraspinal muscles of cervical spine which are also considered as a major trigger for mechanical neckache ( Linton, 2000). Mechanical lengthening of deep flexor of the cervical region and the tightening of extensor muscles of this region result, which further aggravate the pain and, in some cases, refer this pain toward head or can trigger headache as well.

As reported by Janda et al. the cervical region postural muscles such as trapezius, levator scapulae and scalene muscles have a greater tendency to get shorten due to sustained contraction. Other neck flexors such as longus coli and longus capitis lengthen due to abnormal postures ( Ghaderi et al., 2019). Both region muscles play a key role in the initiation of mechanical neckache whenever imbalance occurs in their normal mechanism of joint play. Healthcare workers are considered to be the main sufferers of neck pain due to their abnormal posture.

In the literature, many techniques are available for the management of MNP, for example, nonsteroidal antiinflammatory drugs (ibuprofen), muscle relaxants (tizanidine), vitamin B12 and vitamin D, as well as physical therapy exercises. Among physical therapy interventions various modalities such as transcutaneous electrical nerve stimulation (TENS), interferential currents, shortwave diathermy (SWD), microwave diathermy, traction, stretching, joint mobilization and manipulation, KT taping, and ultrasonic therapy are some of the well-renowned techniques ( Baumann et al., 2023). Dry needling (DN) is also considered to be a safe and beneficial technique to relief the pain which is mechanical in nature. DN is a technique in which fine needles are inserted into the tight muscles which reduces the tension in muscle fibers; as a result muscles relax and pain disappears instantly along with range of motion (ROM) improvement ( Arias-Buría et al., 2020). TENS also has promising effects on the reduction of pain by acting on the mechanism of pain gate theory and opioid release from brain.

The purpose of this study was to compare the effects of ND and TENS in the management of MNP and function disability among healthcare workers.

METHODOLOGY

After getting approval from the Review Ethical Committee, this study was conducted at the Neuro Counsel Clinic, Islamabad, from March 5, 2023, to June 4, 2023.

A total of 30 participants of both genders from 20 to 50 years of age with neck pain from the previous 10 days who had no comorbidity of any kind and had an intensity of pain ≥5 on the Numeric Pain Rating Scale (NPRS) were included in this study. Those participants who had any kind of vertebral instability, cardiovascular, neurological, or disc diseases, or were taking any painkillers were excluded from this study. A simple convenient type of nonprobability sampling technique was used for data collection. The participants were divided into two groups ( n = 15 each group). Group A participants were given DN technique ×1/day for 2 weeks and Group B participants received TENS ×2/day for 2 weeks. Null hypothesis was that DN is not effective in Pain and Disability management in healthcare workers who were suffering from MNP while alternate hypothesis was that DN is an effective intervention for MNP management among healthcare workers. NPRS and Neck Disability Index (NDI) tools were used to collect patient’s response at the start of study and after 2 weeks as depicted in Figure 1.

Figure 1:

Study flow diagram.

SPSS version 21 was adopted for statistical analysis of data. Frequency and percentages were used to illustrate the demographic data. Shapiro–Wilk test was employed to check the normality of data as P < 0.5, which proved that our data are not normally distributed. So, we used NP test (Mann–Whitney U) to compare the effects of interventions between groups. P < 0.05 was kept as the level of significance in this study.

RESULTS

The frequency of age between 20 and 30 years was 07 (46.6%) in Group A whereas in Group B this frequency was 05 (33.3%). In Group A, age frequencies between 31-40 and 41-50 years of participants were 02 (13.4%) and 06 (40%), respectively. While in Group B, the frequencies of participants in the age groups 31-40 and 41-50 years of age were 07 (46.6%) and 03 (20.1%), respectively. The total number of males in Group A was 10 (66.7%) whereas of the female frequency was 05 (33.3%); in contrast, Group B constituted 07 (46.7%) males and 08 (53.3%) females. In Group A, 08 (53.3%) participants were single and 07 (46.7%) participants were married, while in Group B the frequency of single participants was 06 (40%) and that of married was 09 (60%). In this study, there were 02 (13.3%) nurses, 02 (13.3%) physicians, 06 (40%) surgeons, 03 (20.1%) physiotherapists, and 02 (13.3%) technologists in Group A. The frequencies of participants in Group B with respect to their profession included 02 (13.3%) nurses, 03 (20.1%) physicians, 05 (33.5%) surgeons, 04 (26.4%) physiotherapists, and 01 (6.7%) technologists ( Table 1).

Table 1:

Demographic data (frequency table).

Variables	Group A	Group B
Age (years)
20-30	07 (46.6%)	05 (33.3%)
31-40	02 (13.4%)	07 (46.6%)
41-50	06 (40.0%)	03 (20.1%)
Gender
Male	10 (66.7%)	07 (46.7%)
Female	05 (33.3%)	08 (53.3%)
Marital status
Single	08 (53.3%)	06 (40%)
Married	07 (46.7%)	09 (60%)
Occupation
Nurse	02 (13.3%)	02 (13.3%)
Physician	02 (13.3%)	03 (20.1%)
Surgeon	06 (40.0%)	05 (33.5%)
Physiotherapist	03 (20.1%)	04 (26.4%)
Technologist	02 (13.3%)	01 (6.7%)

The mean and standard deviation (SD) of age in Group A was 33.87 ± 8.18 while in Group B it was 33.67 ± 7.60 ( Table 2).

Table 2:

Mean ± SD of age.

Variable	Group A	Group B
Age	33.87 ± 8.18	33.67 ± 7.60

Abbreviation: SD, Standard deviation.

For within-group analysis, we employed NP test (Wilcoxon rank test) of inferential statistics as our data were nonnormally distributed. At baseline NPRS variable in Group A, median and Interquartile range (IQR) was 7(2) and after 2 weeks of intervention this Md (IQR) value was 2(4). Within-group analysis in Group A revealed a significant difference as P < 0.05 for NPRS variable. NDI also depicted a significant change within group after 2 weeks of intervention as P < 0.05. Same results ( P < 0.05) were demonstrated in Group B where TENS was used as an intervention. Therefore, within-group analysis in both groups illustrated that both techniques are equally effective in the management of pain and improving the disability which was the resultant of MNP ( Table 3).

Table 3:

Within-group analysis (Wilcoxon rank test).

Variables	Group	Baseline Md (IQR)	After 2 weeks Md (IQR)	P value
NRPS	Group A	7 (2)	2 (4)	0.00 *
	Group B	6 (3)	1 (2)	0.00 *
NDI	Group A	38 (13)	10 (7)	0.00 *
	Group B	25 (18)	4 (7)	0.00 *

Abbreviations: IQR, interquartile range; NDI, Neck Disability Index.

* P < 0.001.

Mann–Whitney U test was employed for between-groups statistical analysis. When comparison was made on the basis of NPRS, we found no significant difference between groups as P > 0.05 which depicted that both techniques are equally effective in the management of pain in participants who were suffering from MNP. When comparison was made on the basis of the NDI score, it was found that Group A participants had better improvement in neck disability when compared to Group B participants as P < 0.05; therefore, our null hypothesis is rejected and alternate hypothesis is accepted that DN is effective when compared to TENS for disability reduction in MNP participants ( Table 4).

Table 4:

Between-groups analysis (Mann–Whitney U test).

Variable	Group	Pretest Md (IQR)	Posttest Md (IQR)	U	P value
NRPS	Group A	7 (2)	2 (4)	83.00	0.35
	Group B	6 (3)	1 (2)	76.50
NDI	Group A	38 (13)	10 (7)	91.00	0.01
	Group B	25 (18)	4 (7)	55.50

Abbreviations: IQR, interquartile range; NDI, Neck Disability Index.

DISCUSSION

Current study was carried out to compare the effects of DN technique and TENS on Pain and Disability due to MNP among healthcare workers. NPRS and NDI were used as tools to compare such effects. It was concluded that both techniques are equally effective in the management of pain in MNP sufferers but DN is a more efficient technique in disability reduction as compared to TENS.

A double-blind randomized controlled trial (RCT) was conducted by Pecos Martin. D et al. to compare the efficacy of DN in the management of MNP. They formulated two equal groups ( n = 36 each) as we did in the current study. They evaluated on the basis of VAS, neck pain questionnaire, and PPT at baseline after 1week and after 1 month of intervention. They revealed that DN is more effective when used on MTrP of lower trapezius as compared to DN on just the trapezius muscle ( P < 0.001). Our results are consistent with this study in that DN is effective in the management of MNP ( Pecos-Martín et al., 2015).

A single blind RCT was executed by Gallego-Sendarrubias et al. (2020) to evaluate the effectiveness of DN in combination with manual therapy (MT) and Sham DN (SDN) plus MT for MNP patients. They administered DN+MT to the experimental group and SDN+MT to the control group. They revealed that the experimental group showed marked improvement in pain reduction, PPT, disability (NDI), and ROM when compared to the control group. This study also supports our results in that DN is an effective technique for the management of pain and reduction of disability in MNP sufferers.

Anjana et al. (2023) conducted an RCT to compare the effects of DN and TENS for neck pain due to myofascial trigger points. They administered one group with just the DN technique and TENS to another group. Data were evaluated at baseline, 14th day, and 28th day after intervention. They observed that both techniques were equally effective in the management of neck pain intensity, NDI, PPT, and CROM. But DN is more beneficial and also cost effective for short-term management. This study is also in coherence with our study in that DN is more effective when compared to TENS on the basis of disability reduction.

Escortell-Mayor et al. (2011) conducted an RCT to evaluate the efficacy of TENS and MT in the management of mechanical neck disorder. They evaluated patients after 6 months of intervention. They revealed that no significant difference was observed after such a long interval but on short-term basis both techniques are effective on the basis of VAS, disability, and QoL. This study also supports our results in that TENS is also effective when used for short intervals (within-group analysis of current study) in the management of MNP.

Almushahhim et al. (2022) conducted an RCT in KSA to evaluate the efficacy of DN and exercise program for the MNP. They administered the experimental group with DN (one session) followed by six sessions of neck exercises, and the control group received just exercises for 2 weeks at a rate of one session/day. They revealed that both groups demonstrated similar results on the basis of NPRS, NDI, BDI, and SF-36 (QoL). This showed that even one session of DN had the same results as compared to 2 weeks of exercises. Therefore, we can conclude that DN is an effective technique, supporting the current study results.

CONCLUSION

It is concluded that both techniques are effective in the management of Pain and Disability in MNP among healthcare workers. But DN is more effective on the basis of disability (NDI score) when compared to TENS for MNP.

Recommendations

A larger-scale double- or triple-blind RCT should be conducted to evaluate the efficacy of such techniques on a long-term basis, and evaluation should be done at more than two intervals. The sample size should be greater than that used in this study.

Limitations

Sample size of this study was smaller and evaluation was done at short-term intervals.

CONFLICTS OF INTEREST

The authors declare no conflicts of interest in association with the present study.

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