Georgoudis G.1,2,3, Felah B.4,5, Aggourakis M.5,6, Papandreou M.1
1Technological Educational Institute of Athens, Physiotherapy, Athens, Greece, 2PHYSIOPAIN Group, Director, www.physiopain.com, Athens, Greece, 3Hellenic Scientific Society of Algology, www.efea.gr, Athens, Greece, 4University of Ioannina, Medical School, Athens, Greece, 5PHYSIOPAIN Group, www.physiopain.com, Athens, Greece, 6University of Athens, Medical School, Aretaieio Hospital, Pain Management Unit, Athens, Greece
Background: Non-phrmacological therapies such as acupuncture and stretching exercises are a popular treatment choice for cervicogenic cephalalgia, Despite the fact that as monotherapies have shown promising analgesic effects, their combination in cervicogenic headaches has not been examined in depth.
Purpose: It was the purpose of this study to investigate the analgesic effectiveness of an acupuncture-stretching protocol in cervicogenic headaches. Specifically, it was examined the effect of the treatment on pressure pain threshold (PPT), sensory and affective pain parameters, anxiety and depression levels, quality of life, disability and catastrophising.
Methods: A prospective, single blind, multicenter, pragmatic trial was designed for this purpose. Forty-four subjects with cervicogenic headache participated in the study from 3 physiotherapy centers. A total of 10 treatment sessions were delivered in 4 weeks with measurements taking place before 1st treatment, after the 5th treatment and the 10th treatment. PPT measurements were collected from 7 measuring sites (including control points), at all times, using a mechanical algometer. Self-reported questionnaires were used to assess quality of life (SF-12), sensory and affective pain parameters (SFMPQ), pain intensity (VAS), anxiety and depression (HAD), disability (MIDAS), and catastrophizing (PCS). Standardised approach was followed for the acupuncture and stretching treatment. Approximately 20 acupuncture needles were inserted in every subject with 15 on predetermined points and 5 according to the patients current symptoms. Stretching of specific muscles and head movements were also taught to the patients and encouraged to repeat 2-3 times/day. An ANOVA repeated-measures model (SPSS v21) was used to examine for differences across time. Statistical significance was set at p 0.05.
Results: A statistical significant improvement was noted for PPT during the treatment, across time (1st , 5th and 10th treatment), at all measuring sites [Trapezius: F=610.2, p 0.001; Suboccipital: F=501.6, p 0.001; C7 both sides: F=479.9, p 0.001; levator scapulae: F=524.5, p 0.001; rhomboids: F=650.5, p 0.001; infraspinatus: F=689.7, p 0.001; deltoids: F=565.5, p 0.001]. Similarly, statistically significant changes were noted for sensory and affective pain [SFMPQ: F=161,6, p 0.001], pain intensity [VAS: F=498.2, p 0.001], anxiety [HADa: F=369.8, p 0.001], depression [HADd F=229,8, p 0.001], quality of life [SF-P: F=2113.3, p 0.001; SF-M: F=61116.4, p 0.001], disability [MIDAS: F=81.4, p 0.001] and catastrophising [PCS: F=194.8, p 0.001].
Conclusion(s): Acupuncture combined with stretching improves all parameters of reported pain together with the pressure pain threshold. Interestingly, not only affected areas are improved drastically but also extrasegmental control points improve their PPT, implying a central desensitization effect of the combined approach. This finding for central action of the approach is further enhanced by the evidenced improvements on the catastrophising scale, cognitive and psychological constructs. Furthermore, quality of life and disability are also substantially improved.
Implications: The combination of acupuncture and stretching provides an interesting treatment option for physiotherapists to treat cervicogenic headaches, ascertaining both the analgesic effect and the holistic improvement of the patient.
Implications: The combination of acupuncture and stretching provides an interesting treatment option for physiotherapists to treat cervicogenic headaches, ascertaining both the analgesic effect and the holistic improvement of the patient.
Funding acknowledgements: None
Topic: Pain & pain management
Ethics approval: Ethical approval was granted by the Research & Ethics Committee
of the T.E.I. Athens (University of Apllied Sciences of Athens)
All authors, affiliations and abstracts have been published as submitted.
