THE EFFECT OF NEURAL MOBILISATION ON CERVICO-BRACHIAL PAIN

Basson A.¹, Stewart A.¹, Mudzi W.¹

¹University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa

Background: Neck pain is one of the most common, debilitating musculoskeletal complaints. Cervico-brachial pain syndrome is an upper quarter pain syndrome in which neural tissue sensitivity to mechanical stimulus is thought to play a role.
Neuropathic pain is often associated with neck and arm pain and is linked to more pain and disability as well as poor treatment outcomes. Psychosocial factors, e.g. catastrophising, have also been shown to play an important role in treatment outcomes.
Neural mobilisation (NM) is often used to treat conditions with signs of neural involvement. It seems reasonable to use NM in cervico-brachial pain as neural structures plays an important role in this condition. The optimal treatment intervention for cervico-brachial pain has yet to be established.

Purpose: To establish the effect of NM on the pain, function and quality of life of patients with cervico-brachial pain.
To establish if high catastrophising scores and neuropathic pain have an influence on treatment outcomes.

Methods: A randomised control trial was conducted to establish the effect of NM on cervico-brachial pain. Inclusion criteria were pain less than 3 months, neck /arm pain and a positive upper limb neurodynamic test. A sample of 86 patients had 85% power to detect an increase of 2 for the change in the Numerical Pain Rating (NPR). The intervention group (IG) received cervical and thoracic mobilisation, exercises, advice and NM. The usual care (UC) (control) had this treatment without NM. Outcomes were assessed at 3 weeks, 6 weeks, 6 months and 12 months. The NPR was used to determine the effect of NM on pain, the Patient Specific Functional Scale for the effect on function and the EuroQual5D instrument for quality of life. The DN4 was used to classify patients with neuropathic pain and the Pain Catastrophising Scale to identify catastrophisers. Changes in groups were analysed with an ANCOVA; covariates were baseline scores, catastrophising and neuropathic pain. An ITT analysis was done with significance set at p=0.05.

Results: All patients improved significantly in terms of pain, function and quality of life over the 12-month period. However, the IG had significantly less pain than the UC at 6 months (p=0.0330 95% CI 0.9606 - 2.0281) and this more so in patients with neuropathic pain (p=0.0134). There were no significant differences between groups in terms of function or quality of life. Patients with neuropathic pain had significantly more pain at 6 (p=0.0001) and 12 months (p=0.0102) compared to those without neuropathic pain. At 12 months, function was also negatively affected in neuropathic pain (p=0.0412). Catastrophisers had significantly more pain at 6 (p=0.0213) and 12 months (p=0.181) compared to non-catastrophisers. Function was not affected, however at baseline they reported lower quality of life (p=0.0018).

Conclusion(s): NM added to usual care improved pain significantly at 6-month follow-up especially for patients with neuropathic pain. Catastrophising and presence of neuropathic pain results in higher pain levels at follow-up.

Implications: NM added to usual care is effective in the management of cervico-brachial pain especially for patients with neuropathic pain.

Funding acknowledgements: Orthopaedic Research Investment Fund of the SASP
Faculty Research Committee Individual Grants of the University of the Witwatersrand

Topic: Musculoskeletal: spine

Ethics approval: Ethical approval was obtained from the Human Research Ethics Committee of the University of the Witwatersrand, South Africa, M111002.

All authors, affiliations and abstracts have been published as submitted.