Abstract
In a controlled trial to evaluate the effectiveness of a simple educational and physical program administered to a large cohort of public servants, we previously found that 6 months following treatment the monthly frequency of headache and neck and shoulder pain and drug intake was reduced by 40% in the experimental compared with controls. These results were stable at a 12-month follow up. The program consists of brief shoulder and neck exercises to be performed several times a day, a relaxation exercise, and instructions on how to reduce parafunction and hyperfunction of the craniofacial and neck muscles during the day. The purpose of this work was to investigate whether the data previously obtained could be confirmed also in the group of 192 subjects that served as controls in first phase of the study and received the intervention in the second phase of the study. The primary endpoint was the change in frequency of headache and neck and shoulder pain expressed as the number of days per month with pain, and as the proportion of subjects with a ≥50% reduction of frequency (responder rate) at the last 2 months of the 6-month intervention period compared to the 2 months preceding the intervention (baseline). The number of days of analgesic drug consumption was also recorded. Days per month with headache at the baseline and at the end of intervention period were 6.40 and 4.58 (mean change −1.81, p < 0.0001), respectively; days with neck and shoulder pain were 7.48 and 6.18 (mean change −1.30, p = 0.0179); days of analgesic consumption were 1.67 and 1.17 (mean change −0.50, p = 0.0222). The responder rate was 42.3% for headache, 42% for neck and shoulder pain and 58.3% for drug consumption. In conclusion, this study adds further evidence on the efficacy of our program and its high acceptability in a large, unselected, working population.
Keywords: Headache, Migraine, Neck pain, Education, Exercise
Full Text
The Full Text of this article is available as a PDF (231.3 KB).
Acknowledgments
This study was primarily funded by the Compagnia di San Paolo of Torino with additional contributions from the Regione Piemonte.
References
- 1.Bronfort G, Nilsson N, Haas M, Evans R, Goldsmith CH, Assendelft WJJ, Bouter LM (2004) Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev 3:CD001878 [DOI] [PubMed]
- 2.Ghaffari M, Alipour A, Farshad AA, Yensen I, Vingard E. Incidence and recurrence of disabling low back pain and neck-shoulder pain. Spine. 2006;31:2500–2506. doi: 10.1097/01.brs.0000239133.29037.d0. [DOI] [PubMed] [Google Scholar]
- 3.Gross AR, Aker PD, Goldsmith CH, Peloso P (1996) Conservative management of mechanical neck disorders. A systematic overview and meta-analysis. Online J Curr Clin Trials Doc No 200–201 [PubMed]
- 4.Gross AR, Aker PD, Goldsmith CH, Peloso P (2000) Patient education for mechanical neck disorders. A systematic overview and meta-analysis. In: Cochrane Library; Issue 4, Update Software, Oxford
- 5.Kay TM, Gross A, Santaguida PL, Hoving J, Goldsmith C, Bronfort G (2005) Cervical Overview Group. Exercises for mechanical neck disorders. Cochrane Database Syst Rev 3:CD004250 [DOI] [PubMed]
- 6.Riddle DL, Schappert SM. Volume and characteristics of inpatient and ambulatory medical care for neck pain in the United States: data from three national surveys. Spine. 2007;32:132–140. doi: 10.1097/01.brs.0000250999.69978.24. [DOI] [PubMed] [Google Scholar]
- 7.Stovner LJ, Zwart JA, Hagen K, Terwindt GM, Pascual J. Epidemiology of headache in Europe. Eur J Neurol. 2006;13:333–345. doi: 10.1111/j.1468-1331.2006.01184.x. [DOI] [PubMed] [Google Scholar]
- 8.Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton RB, Scher AI, Steiner TJ, Zwart J-A. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193–210. doi: 10.1111/j.1468-2982.2007.01288.x. [DOI] [PubMed] [Google Scholar]
- 9.Wiendels NJ, Knuistingh Neven A, Rosendaal FR, Spinhoven P, Zitman FG, Assendelft WJ, Ferrari MD. Chronic frequent headache in the general population: prevalence and associated factors. Cephalalgia. 2006;26:1434–1442. doi: 10.1111/j.1468-2982.2006.01210.x. [DOI] [PubMed] [Google Scholar]
- 10.Mongini F, Ciccone G, Rota E, Ferrero L, Ugolini A, Evangelista A, Ceccarelli M, Galassi C. Effectiveness of an educational and physical programme in reducing headache, neck and shoulder pain: a workplace controlled trial. Cephalalgia. 2008;28:541–552. doi: 10.1111/j.1468-2982.2008.01551.x. [DOI] [PubMed] [Google Scholar]
- 11.Mongini F, Ciccone G, Rota E, Ferrero L, Ugolini A, Evangelista A, Ceccarelli M, Galassi C. Long term benefits of an educational and physical program on headache, and neck and shoulder pain in a working community. J Pain. 2009;10:1138–1145. doi: 10.1016/j.jpain.2009.01.324. [DOI] [PubMed] [Google Scholar]
- 12.Mazzi F, Morosini P, De Girolamo G, Lussetti M, Guaraldi GP (2000) SCID-I—Structured Clinical Interview for DSM-IV Axis I Disorders (Italian Edition). OS-Organizzazioni Speciali, Firenze
- 13.International Headache Society The International Classification of Headache Disorders. Cephalalgia. 2004;24(Suppl 1):1–160. [Google Scholar]
- 14.International Association for the Study of Pain (1994) Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms, 2nd edn. IASP Press, Seattle
- 15.Stewart WF, Lipton RB, Kolodner K, Liberman J, Sawyer J. Reliability of the migraine disability assessment score in population-based sample of headache sufferers. Cephalalgia. 1999;19:107–114. doi: 10.1046/j.1468-2982.1999.019002107.x. [DOI] [PubMed] [Google Scholar]
- 16.Stewart WF, Lipton RB, Whyte J, Dowson A, Kolodner K, Liberman JN, Sawyer J. An international study to assess reliability of the Migraine Disability Assessment (MIDAS) score. Neurology. 1999;53:988–994. doi: 10.1212/wnl.53.5.988. [DOI] [PubMed] [Google Scholar]
- 17.Stewart WF, Lipton RB, Kolodner KB, Sawyer J, Lee C, Liberman JN. Validity of the Migraine Disability Assessment (MIDAS) score in comparison to a diary-based measure in a population sample of migraine sufferers. Pain. 2000;88:41–52. doi: 10.1016/S0304-3959(00)00305-5. [DOI] [PubMed] [Google Scholar]
- 18.D’Amico D, Mosconi P, Genco S, Usai S, Prudenzano AMP, Grazzi L, Leone M, Puca FM, Bussone G. The Migraine Disability Assessment (MIDAS) questionnaire: translation and reliability of the Italian version. Cephalalgia. 2001;21:947–952. doi: 10.1046/j.0333-1024.2001.00277.x. [DOI] [PubMed] [Google Scholar]
- 19.White H. A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica. 1980;48:817–830. doi: 10.2307/1912934. [DOI] [Google Scholar]
- 20.Azola C, Harrell FE (2001) An introduction to S-Plus and the Hmisc and Design libraries. University of Virginia School of Medicine
- 21.Sjogren T, Nissinen KJ, Jarvenpaa SK, Ojanen MT, Vanharanta H, Malkia EA. Effects of a workplace physical exercise intervention on the intensity of headache and neck and shoulder symptoms and upper extremity muscular strength of office workers: a cluster randomized controlled cross-over trial. Pain. 2005;116:119–128. doi: 10.1016/j.pain.2005.03.031. [DOI] [PubMed] [Google Scholar]
- 22.Viljanen M, Malmivaara A, Uitti J, Rinne M, Palmroos P, Laippala P. Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomised controlled trial. BMJ. 2003;327:475–477. doi: 10.1136/bmj.327.7413.475. [DOI] [PMC free article] [PubMed] [Google Scholar]
