Resolving Specific Psychological Stressors Can Instantly Reduce or Relieve Chronic Neck Pain and Upper Back Pain: Case Reports

Introduction: The goal of this study was to use a novel approach to pain relief which includes a participant using their mind to reduce or relieve their neck pain in a matter of minutes and taking continuous thermal medical imaging scans during the process to capture any concurrent temperature changes at the location of the self-reported pain. Previous studies using multidisciplinary approaches have shown that it is possible for a person to achieve a moderate reduction in pain over a period of time (typically two or more months). However, in this innovative study, the goal was to demonstrate rapid pain relief (in a matter of minutes) using only the mind. Case report: For this study, six subjects were selected, all of whom were experiencing long-term chronic neck pain. The subjects consisted of five adult females and one adult male. Several of the subjects also had pain that radiated into their upper back region. Each subject participated in one talk therapy session during which the subject’s neck was actively scanned by a thermal imaging (TI) camera that was programmed to take a new thermal image every thirty (30) seconds. The goal of the talk therapy session was to create a strong emotional shift by encouraging the subject to let go of negative emotions and replace buried painful feelings with feelings of positive expectation and optimism. Then, as the subject created this emotional shift, the goal was to observe if this change affected the subject’s self-reported physical pain, as well as noting any visible effects in thermal images. Results: All six subjects reported that they were able to relieve some or all of their pain by the end of the talk therapy session. As they did, there was simultaneously a significant decrease in temperature recorded on the TI images in the corresponding location in their neck and upper back region. This suggested that the pain relief the subjects reported was not merely “mind over matter”, since there were marked physiological changes taking place. Discussion and Conclusion: It’s worth noting that three of the subjects had moments during their talk therapy session where they thought about a specific painful memory that increased their negative emotions. At that moment, their self-reported pain also increased, and simultaneously, the infrared camera detected an increase in temperature in the corresponding location where the subjects reported increased pain. Subsequently, when the subjects were able to change the painful memory and once again move towards feelings of optimism, they reported pain relief, and simultaneously, the TI camera reported a decrease in temperature. Neither this potential outcome nor any other potential outcome was discussed with the subjects before or during the session. This research shows that talk therapy may be used as a new therapeutic option for people not only with neck pain, but possibly other types of pain, and that under certain circumstances, the results can be rapid.

Ultrasound-Guided Dorsal Scapular Nerve Blockade in the Diagnosis and Management of Neck Pain

Neck pain is common and has multiple sources, but correct diagnosis and matched treatment provide the best outcomes. The first description of ultrasound-guided dorsal scapular nerve blockade using a single-shot local anesthetic technique for the diagnosis and treatment of neck pain is reported. A 38-year-old female patient presented with neck pain, and the history and clinical examination strongly suggested myofascial pain affecting the middle scalene muscle. The pain had been unresponsive to pharmacological therapy or physiotherapy. After identifying the dorsal scapular nerve (DSN) in the body of the middle scalene muscle, an ultrasound-guided nerve block was performed using a single injection of local anesthetic to alleviate the patient’s pain. It has been demonstrated that the dorsal scapular nerve can be identified in the neck and effectively blocked using ultrasound guidance. This technique has the potential to assist in the diagnosis and treatment of neck pain originating from the middle scalene muscle.

Case-control study on regular Ba Duan Jin practice for patients with chronic neck pain

Purpose:To observe the long-term effects of regular Ba Duan Jin exercises for patients with chronic neck pain.Methods:Participants with chronic neck pain were instructed to perform
30 min/d of Ba Duan Jin exercises(n?36)or assigned to a control group(n?36)for six months.Data from a visual analogue scale,Northwick Park Neck Pain Questionnaire,and the 36-item Shortform Health Survey(SF-36)were collected before,and three and six months after intervention began.Results:Participants undergoing Ba Duan Jin exercises achieved significantly greater improvement than the controls in visual analogue scale,Northwick Park Neck Pain Questionnaire and SF-36 health transition scores(all p<0.05).However,no significant differences were observed in SF-36 physical or mental component summaries.Conclusion:Regular Ba Duan Jin practice reduces suffering and pain,and increases health satisfaction in individuals with chronic neck pain.

Neck pain and absence of cranial nerve symptom are clues of cervical myelopathy mimicking stroke:Two case reports

BACKGROUND Cervical myelopathy is a potential stroke imitator,for which intravenous thrombolysis would be catastrophic.CASE SUMMARY We herein present two cases of cervical myelopathy.The first patient presented with acute onset of right hemiparesis and urinary incontinence,and the second patient presented with sudden-onset right leg monoplegia.The initial diagnoses for both of them were ischemic stroke.However,both of them lacked cranial nerve symptom and suffered neck pain at the beginning of onset.Their cervical spinal cord lesions were finally confirmed by cervical computed tomography.A literature review showed that neck pain and absence of cranial nerve symptom are clues of cervical myelopathy.CONCLUSION The current report and the review remind us to pay more attention to these two clues in suspected stroke patients,especially those within the thrombolytic time window.

Research progress of non-specific neck pain in traditional Chinese medicine and western medicine

Non-specific neck pain is a common disease in clinic,and its pathogenesis is not clear.With the progress of the times and the change of living and working habits,the incidence of non-specific neck pain is increasing year by year,which has a great impact on people’s physical and mental health,work and life.Traditional Chinese medicine mainly treats non-specific neck pain by acupuncture and massage,while western medicine generally uses exercise and manipulation therapy,but the quality of clinical evidence of all kinds of therapy is not high,which needs to be verified.This paper summarizes the research progress of traditional Chinese medicine and western medicine in the treatment of non-specific neck pain from the aspects of pathogenesis,etiology and pathogenesis of traditional Chinese medicine,and treatment of traditional Chinese medicine and western medicine,so as to provide reference for doctors in clinical treatment of this disease.

Results of Chronic Neck Pain Rehabilitation at Cotonou

Background: Neck pain is a real public health problem. Its treatment uses different techniques, such as functional rehabilitation, whose results are not widely popularized, from developing countries in Black Africa. Objective: To assess the result of rehabilitation of chronic common neck pain (CCNP) at the CNHU-HKM in Cotonou. Methods: Cross-sectional, retrospective, descriptive and analytical study. It was carried out from May to September 2020, based on the files of former patients followed in functional rehabilitation department at CNHU-HKM in Cotonou, from 2015 to 2019, for CCNP. The result of rehabilitation was assessed based on the progress, between the start and the end of the rehabilitation sessions, of pain intensity, mobility of the cervical spine, muscle strength and functional capacity of the patient. Anova and chi-square tests were used for the analysis of factors associated with the result of rehabilitation. Results: The sample consisted to 73 patients. They were predominantly female (58.90%), with a mean age of 53.60 ± 14.08 years. The neck pain, at least of moderate intensity (97.26%), was present since 12.54 ± 8.54 months, on average. Patients have done 10 to 20 functional rehabilitation sessions, the result of which was satisfactory in 67.12%. This result was mainly associated with patient’s age, sports practice and the seniority of pain progression. Discussion-Conclusion: Rehabilitation results in the management of CCNP are interesting. They prove the need to sensitize patients and prescribers on the importance of early treatment of CCNP.

Potential impact of early physiotherapy in the emergency department for non-traumatic neck and back pain

BACKGROUND: Musculoskeletal complaints, especially non-traumatic neck and back pain, are routinely encountered in the emergency department(ED) and lead to ED overcrowding, a burgeoning wait time for physiotherapy and outpatient orthopedic reviews. The study aimed to evaluate the impact of early physiotherapy evaluation and treatment(EPET) vs. standard care(SC) on clinical outcomes for patients presenting to the ED with non-traumatic neck and back pain.METHODS: A retrospective observational study of 125 patients who presented to the ED with non-traumatic neck and back pain with/without peripheral symptoms from July 2010 to February 2011. Neck Disability Index(NDI), Modifi ed Oswestry Low Back Pain Disability Questionnaire(MODI) and 11-point Numeric Pain Rating Scale were used as outcome measures and compared between groups at a mean of 34 days from their initial ED visit.RESULTS: We identifi ed a total of 125 patients. EPET group comprised 62 patients(mean age, 45 years; men, 63%) and SC group comprised 63 patients(mean age, 45 years; men, 43%). The EPET and SC groups received physiotherapy at a median of 4 and 34 days respectively from their fi rst ED visit. EPET patients had signifi cantly lower levels of disability(9.0% vs. 33.4%, Welch t-test, P<0.001) and pain(median value, 1 vs. 4 points, Mann-Whitney U-test, P<0.001) compared with SC patients.CONCLUSION: Early access to physiotherapy in ED was associated with reduced pain and disability levels. EPET protocol can potentially decrease the demand on outpatient orthopedic services, thereby freeing up available resources to treat patients who are more likely to benefi t from it.

Effectiveness of pulsed radiofrequency on the medial cervical branches for cervical facet joint pain

BACKGROUND Cervical facet joint pain(CFP)is one of the most common causes of neck pain and headache.Persistent CFP deteriorates the quality of life of patients and reduces their productivity at work.AIM To investigate the effectiveness of pulsed radiofrequency(PRF)stimulation of cervical medial branches in patients with chronic CFP.METHODS We retrospectively included 21 consecutive patients(age=50.9±15.3 years,range 26-79 years;male:female=8:13;pain duration=7.7±5.0 mo)with chronic CFP,defined as≥4 on the numeric rating scale(NRS).We performed PRF stimulation on the cervical medial branches.The outcomes of the PRF procedure were evaluated by comparing the NRS scores for CFP before treatment and 1 and 3 mo after treatment.Successful pain relief was defined as a≥50%reduction in the NRS score at 3 mo when compared with the pretreatment NRS score.RESULTS No patient had immediate or late adverse effects following PRF.The average NRS score for CFP decreased from 5.3±1.1 at pre-treatment to 2.4±0.6 at the 1 mo follow-up,and 3.1±1.1 at the 3 mo follow-up.Compared to the NRS scores before PRF stimulation,those at 1 and 3 mo after PRF stimulation had significantly decreased.Eleven of the 21 patients(52.4%)reported successful pain relief 3 mo after the PRF procedure.PRF stimulation on cervical medial branches may be a useful therapeutic option to control chronic CFP.CONCLUSION PRF stimulation of the cervical medial branches may be used as an alternative treatment method in patients with CFP.PRF can effectively alleviate CFP,and is safe to perform.

Dredging hand Yang meridians with deep tissue massage combined with neck movement in stiff-neck syndrome:A randomized controlled trial

Objective:The objective of this study is to observe the therapeutic effects of dredging hand Yang meridian with deep tissue massage combined with neck movement on stiff-neck syndrome.Materials and Methods:This is a randomized controlled trial.The consecutive patients with the stiff-neck syndrome were randomly allocated into the intervention group and patch group(1:1)according to the random number table.The intervention group was treated with dredging hand Yang meridian with deep tissue massage combined with neck movement once a day for 3 days,while the patch group therapy was treated with a 3-patch therapy and every patch included 24-h patch and 24-h patch-free.A needle electromyogram would be exerted if the patients were at their willingness in different stages.The pain of patients was assessed by Visual Analog Scale in the two groups at every 24 h time point.Results:Finally,212 patients completed the trial,106 in each group.The curative rate in the intervention group was higher than in the patch group(99.06%vs.84.91%,χ^(2)=0.890,P<0.01).Repeated measures of the general linear model showed a significant difference in pain score within the subject-factors(factor of time F=4548.577,P<0.001;factor of time-group F=490.034,P<0.001).There was a significant difference between groups regarding pain score(F=3016.315,P<0.001).Conclusion:Dredging hand Yang meridian with deep tissue massage combined with neck movement is better than patch therapy in stiff-neck syndrome,with a shorter duration and instant effects.

Ultrasound-Guided Greater Occipital Nerve Hydrodissection for Treatment of Cervicogenic Headache: A Case Report

We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic with severe chronic cervicogenic headache impacting her sleep, work and activities of daily living. Conservative management had failed to adequately resolve her pain. Ultrasound-guided suboccipital hydrodissection of the greater occipital nerve was performed with the patient in the prone position. After skin sterilization, the linear ultrasound transducer was oriented in a transverse orientation at the level of the C2-C3 vertebrae. The needle was advanced from medial to lateral “in-plane” under direct ultrasound visualization, until the needle was positioned at the C2 lamina. After confirming the needle tip position, 10 ml of hydrodissection fluid was injected with good visualization of distribution of the solution. The patient described immediate and significant improvement in her symptoms. She reported a sustained decrease in pain scores when followed up in the pain clinic at six and twelve weeks respectively. To the best of our knowledge this is the first application of ultrasound-guided hydrodissection of the GON for cervicogenic headache. It offers a novel, safe and effective technique to aid in the diagnosis and treatment of a common pain condition.

颈痛方对椎动脉型颈椎病的疗效观察

目的观察颈痛方对椎动脉型颈椎病的疗效及其安全性。方法 80例椎动脉型颈椎病患者随机分成两组,观察组采用口服颈痛方冲剂,配合康复治疗;对照组仅进行康复治疗。治疗后按症状、体征评定疗效。结果经过3周系统治疗后,观察组的症状、体征评分均较对照组有明显改善(P<0.05)。结论颈痛方结合康复治疗对椎动脉型颈椎病有较好的疗效。

Cervical intervertebral disc degeneration and dizziness

Clinical studies have found that patients withcervical degenerative disease are usually accompanied by dizziness.Anterior cervical surgery can eliminate not only chronic neck pain,cervical radiculopathy or myelopathy,but also dizziness.Immunohistochemical studies show that a large number of mechanoreceptors,especially Ruffini corpuscles,are present in degenerated cervical discs.The available evidence suggests a key role of Ruffini corpuscles in the pathogenesis of dizziness caused by cervical degenerative disease(i.e.cervical discogenic dizziness).Disc degeneration is characterized by an elevation of inflammatory cytokines,which stimulates the mechanoreceptors in degenerated discs and results in peripheral sensitization.Abnormal cervical proprioceptive inputs from the mechanoreceptors are transmitted to the central nervous system,resulting in sensory mismatches with vestibular and visual information and leads to dizziness.In addition,neck pain caused by cervical disc degeneration can play a key role in cervical discogenic dizziness by increasing the sensitivity of muscle spindles.Like cervical discogenic pain,the diagnosis of cervical discogenic dizziness can be challenging and can be made only after other potential causes of dizziness have been ruled out.Conservative treatment is effective for the majority of patients.Existing basic and clinical studies have shown that cervical intervertebral disc degeneration can lead to dizziness.

Post-Marketing Surveillance of Qishe Pill(芪麝丸)Use for Management of Neck Pain in a Chinese Patient Cohort to Determine Its Safety,Tolerability and Effectiveness

Objective:To evaluate the safety and effectiveness of Qishe Pill(芪麝丸)on neck pain in realworld clinical practice.Methods:A multi-center,prospective,observational surveillance in 8 hospitals across Shanghai was conducted.During patients receiving 4-week Qishe Pill medication,Visual Analogue Scale(VAS)and Neck Disability Index(NDI)assessments have been used to assess their pain and function,while safety monitoring have been observed after 2 and 4 weeks.Results:Results from 2,023 patients(mean age 54.5 years)suggest that the drug exposure per unit of body mass was estimated at 3.41±0.62 g/kg.About 8.5%(172/2,023)of all participants experienced adverse events(AEs),while 3.8%(78/2,023)of all participants experienced adverse reaction.The most common AEs were gastrointestinal events and respiratory events.The VAS score(pain)and NDI score(function)significantly decreased after 4-week treatment.An effect-quantitative analysis was also conducted to show that the normal clinical dosage may be consider as 3–4 g/kg,at which dosage the satisfactory pain-relief effect may achieve by 40-mm reduction in VAS.Conclusion:These findings showed that patients with cervical radiculopathy who received Qishe Pill experienced significant improvement on pain and function.(Registration No.NCT01875562).

Is Manipulative Therapy Clinically Necessary for Relief of Neck Pain？A Systematic Review and Meta-Analysis

Objective：To summarize and critically assess the efficacy of Eastern and Western manipulative therapies for the treatment of neck pain in adults. Methods：A search of Pub Med/MEDLINE, the Cochrane Central Register of Controlled Trials, Clinical Trials.gov, EMBASE, etc. from their inception date to January 2014 with Chinese, Japanese, and Korean databases. Two reviewers independently selected randomized controlled trials（RCTs） with negative control or blank control, extracted data and assessed methodological quality. Meta-analysis and levels of evidence were performed by Revman5.1 and Grades of Recommendations Assessment, Development and Evaluation（GRADE） approach. Results：Nineteen clinical trials with adequate randomization were included in this review, 11 of them had a low risk of bias. The primary outcome for shortterm pain had no significant differences, however, the secondary outcome, only the Numerical Pain Rating Scale（NPRS） score of intermediate-term [n=916, pooled mean differences（MD） =–0.29, P=0.02], the Neck Disability Index（NDI） score of short-term（n=1,145, pooled MD=–2.10, P〈0.01）, and intermediate-term（n=987, pooled MD=–1.45, P=0.01） were significantly reduced with moderate quality evidence. However, it supported the minimally clinically important difference（MCID） of the Visual Analogue Scale and NPRS pain score to be 13 mm, while NDI was 3.5 points. The meta-analysis only suggested a trend in favor of manipulative therapy rather than clinical significance. Conclusions：The results do not support the existing evidences for the clinical value of Eastern or Western manipulative therapy for neck pain of short-term follow-up according to MCIDs. The limitations of our review related to blinding, allocation concealment and small sample size.

针灸对脑卒中后遗偏瘫侧颈肩痛患者疼痛程度及日常生活能力的影响

目的分析针灸对脑卒中后遗偏瘫侧颈肩痛患者疼痛程度及日常生活能力的影响。方法选取三明市大田县中医院2018年5月至2020年4月103例脑卒中后遗偏瘫侧颈肩痛患者,按随机数字表法分为两组,研究组51例,对照组52例。对照组使用常规治疗,在此基础上,研究组进行针灸干预,对比两组治疗效果、疼痛程度、日常生活能力、肢体功能与心理状态,分别采用视觉模拟评分法(VAS)、Barthel指数、Fugl-Meyer运动功能评估量表(FMA)、抑郁自评量表(SDS)及焦虑自评量表(SAS)进行评估。结果研究组总有效为92.16%,高于对照组的76.92%(P<0.05);治疗30 d后,两组患者VAS评分均较治疗前降低,Barthel指数均较治疗前提高,且研究组显著优于对照组(P<0.05);治疗30 d后,两组上肢部分、下肢部分评分及总分均较治疗前提高,SDS、SAS评分均治疗前降低,且研究组显著优于对照组(P<0.05)。结论针灸可有效提高脑卒中后遗偏瘫侧颈肩痛患者治疗效果,改善患者疼痛程度、肢体功能及日常生活能力,还可调节患者心理状态。

Kinematic Effect of Chinese Herbal Fomentation on Patients with Chronic Neck Pain

Objective：To clarify the effectiveness of Chinese herbal fomentation in treating chronic neck pain by means of changes in cervical kinematics.Methods：Seventy-six patients with chronic neck pain were included in the study and were randomized into two groups based on the random number generator of the SPSS software：fomentation combined with Chinese herbal（Group 1） and fomentation without any medicine（Group 2）.In both groups,the fomentation lasted for 60 min and heated to 35 ℃,once a day for 28 consecutive days.Standard lateral radiographs of the cervical spine were obtained including the neutral,full flexion,and full extension positions.Before and after intervention,the following parameters were used to evaluate the changes in kinematics：range of motion（ROM）,sagittal alignment and instantaneous center of rotation（ICR）.Results：After treatment,the ROM was significantly higher than that of before treatment in Group 1（51.5,95%CI：49.8-55.9;P〈0.05）.There was no significant difference between before and after treatment in Group 2（P〉0.05）.Although C2-C7 cervical alignment was increased in both groups after treatment,no significant difference was detected between before and after treatment（P〉0.05）.For Group 1,the significant X coordinate variation was only observed at C5/C6 level（38.1;95%CI：34.0,42.1;P〈0.05）.There was a significant upward trend in the Y coordinate of the ICR at C5/C6（-30.5;95%CI：-34.3,-26.8;P〈0.05） and C6/C7 after treatment（-6.1;95%CI：-6.7,-5.4;P〈0.05）.For Group2,the ICR location of each level was not statistically different between the pre- and post-treatment（P〉0.05）.Conclusions：Chinese herbal fomentation could improve abnormal mobility in terms of ROM and ICR.Chinese herbal fomentation might be an effective treatment for chronic neck pain.

Management of symptomatic cervical facet cyst with cervical interlaminar epidural block: A case report

BACKGROUND Symptomatic cervical facet cysts are relatively rare compared to those in the lumbar region.These cysts are usually located in the 7th cervical and 1st thoracic vertebral(C7/T1)area,and surgical excision is performed in most cases.However,facet cysts are associated with degenerative conditions,and elderly patients are often ineligible for surgical procedures.Cervical interlaminar epidural block has been used in patients with cervical radiating symptoms and achieved good results.Therefore,cervical interlaminar epidural block may be the first-choice treatment for symptomatic cervical facet cysts.CASE SUMMARY A 70-year-old man complained of a tingling sensation in the left hand,focused on the 4th and 5th fingers,for 1 year,and posterior neck pain for over 5 mo.The patient’s numeric rating scale(NRS)score was 5/10.The patient was diagnosed with symptomatic cervical facet cyst at the left C7/T1 facet joint.Fluoroscopyguided cervical interlaminar epidural block at the C7/T1 level with 20 mg triamcinolone and 5 mL of 0.5%lidocaine was administered.The patient's symptoms improved immediately after the block,with an NRS score of 3 points.After 3 mo,his left posterior neck pain and tingling along the left 8th cervical dermatome were relieved,with an NRS score of 2.CONCLUSION A cervical interlaminar epidural block is a good alternative for managing symptomatic cervical facet cysts.

Dynamic alterations of amplitude of low-frequency fluctuations in patients with chronic neck pain

Background:The pathogenesis of neck pain in the brain,which is the fourth most common cause of disability,remains unclear.Furthermore,little is known about the characteristics of dynamic local functional brain activity in cervical pain.Objective:The present study aimed to investigate the changes of local brain activity caused by chronic neck pain and the factors leading to neck pain.Methods:Using the amplitude of low-frequency fluctuations(ALFF)method combined with sliding window approach,we compared local brain activity that was measured by the functional magnetic resonance imaging(fMRI)of 107 patients with chronic neck pain(CNP)with that of 57 healthy control participants.Five pathogenic factors were selected for correlation analysis.Results:The group comparison results of dynamic amplitude of low-frequency fluctuation(dALFF)variability showed that patients with CNP exhibited decreased dALFF variability in the left inferior temporal gyrus,the middle temporal gyrus,the angular gyrus,the inferior parietal marginal angular gyrus,and the middle occipital gyrus.The abnormal dALFF variability of the left inferior temporal gyrus was negatively correlated with the average daily working hours of patients with neck pain.Conclusions:The findings indicated that the brain regions of patients with CNP responsible for audition,vision,memory,and emotion were subjected to temporal variability of abnormal regional brain activity.Moreover,the dALFF variability in the left inferior temporal gyrus might be a risk factor for neck pain.This study revealed the brain dysfunction of patients with CNP from the perspective of dynamic local brain activity,and highlighted the important role of dALFF variability in understanding the neural mechanism of CNP.

Disparities in chiropractic utilization by race,ethnicity and socioeconomic status:A scoping review of the literature

Background Chiropractic is the largest complementary and alternative medicine profession in the United States,with increasing global growth.A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles.Objective There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race,ethnicity,and socioeconomic status.The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race,ethnicity,education level,employment status,and income and poverty level.Search strategy Systematic searches were conducted in PubMed,Ovid MEDLINE,Cumulative Index of Nursing and Allied Health Literature(CINAHL),Cochrane Database of Systematic Reviews,and Index to Chiropractic Literature from inception to May 2021.Inclusion criteria Articles that reported race or ethnicity,education level,employment status,income or poverty level variables and chiropractic utilization rates for adults(≥18 years of age)were eligible for this review.Data extraction and analysis Data extracted from articles were citation information,patient characteristics,race and ethnicity,education level,employment status,income and poverty level,and chiropractic utilization rate.A descriptive numerical summary of included studies is provided.This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity,education level,income and poverty level,and employment status.Results A total of 69 articles were eligible for review.Most articles were published since 2003 and reported data from study populations in the United States.Of the race,ethnicity and socioeconomic categories that were most commonly reported,chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian(median 20.00%;interquartile range 2.70%-64.60%),those with employment as a main income source(median utilization 78.50%;interquartile range 77.90%-79.10%),individuals with an individual or household/family annual income between$40,001 and$60,000(median utilization 29.40%;interquartile range 25.15%-33.65%),and individuals with less than or equal to(12 years)high school diploma/general educational development certificate completion(median utilization 30.70%;interquartile range 15.10%-37.00%).Conclusion This comprehensive review of the literature on chiropractic utilization by race,ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations.Heterogeneity existed among definitions of key variables,including race,ethnicity,education level,employment status,and income and poverty level in the included studies,reducing clarity in rates of chiropractic utilization for these populations.

肽能神经元对颈部急性炎性痛模型大鼠穴位敏化的调节作用

Objective:Pain is a health problem frequently reported in the clinical and general populations.Acupoint therapy is one of the most effective ways to treat pain;however,its mechanism remains unclear.Therefore,this study aimed to explore the relationship between distal acupoints,dorsal root ganglion(DRG)neurons,and spinal cord dorsal horn(SDH) neurons in neck acute inflammatory pain(NAIP).Methods:NAIP model rats were used to explore the relationship between acupoint sensitization and pain.Out of fourteen rats,ten rats were grouped into control and NAIP groups,five rats in control and five rats in NAIP.Mustard oil was subcutaneously injected on one side between the C4 and C7 vertebrae of the neck to establish an NAIP model.Evans blue(EB) was injected through the tail vein to detect sensitized acupoints after NAIP modeling.EB exudation in the body,Liè qūe(列缺 LU7),and Língdào(灵道 HT4) were evaluated.An immunofluorescence assay was conducted to detect the expression of calcitonin generelated peptide(CGRP),isolectin B4(IB4),and c-Fos in the dorsal root ganglion(DRG)and spinal cord dorsal medullae spinalis(CDMS).Four rats were used for the retrograde labeling of neurons of the LU7 region to the DRG and CDMS using CTB-488 and CTB-555 microinjection.Results:NAIP was shown to lead to oozing and pain sensitization in the LU7 and HT4 and increased the proportion of c-Fos^(+)/CGRP^(+)and c-Fos^(+)/IB4^(+)cells in both the DRG and CDMS.CTB-488 and CTB-555injected into the LU7 and sensitization point areas were observed in the DRG and CDMS regions of NAIP rats.Conclusions:Our study revealed that NAIP could lead to oozing and pain sensitization in the LU7 and HT4regions and that the pain point around LU7 might result from the transfer of peptidergic(CGRP-positive)and non-peptidergic(IB4-positive) neurons in the DRG and CDMS.