Objectives: To validate the German version of OMPSQ (OMPSQ-G) for patients with chronic neck pain. Results: After translating OMPSQ to German, we assessed the discriminant validity between patients and healthy adults. Convergent validity was assessed using Pearson’s correlation coefficients between domains of OMPSQ-G and the German version of neck disability index (NDI-G) and visual analogue scale (VAS) of neck pain intensity. Floor and ceiling effects, internal consistency, test–retest and relative reliability were assessed. Fifty patients with chronic neck pain (mean age, 43.6 years; 34 females) and 24 healthy adults (mean age, 50.4 years; 18 females) participated. Mann–Whitney U tests showed significant differences in OMPSQ scores between both groups at the baseline (z = − 4.6; p < 0.001) and second time point (z = − 4.8; p < 0.001). OMPSQ-G scores highly and moderately correlated with NDI-G (ρ = 0.70) and VAS (ρ = 0.41) scores, respectively. There were no floor or ceiling effects. Cronbach’s alpha was 0.94. OMPSQ-G showed high reliability (intraclass correlation 2.1: 0.93; standard error of measurement, 6.9; smallest detectable change, 20 points). The Bland–Altman plot indicated no systematic error. OMPSQ-G showed good validity and reliability in patients with neck pain. Trial registration NCT02540343

Mechanisms underlying chronic pain are insufficiently understood, hampering effective treatment approaches. Preclinical evidence suggests a potential contribution of decreased excitatory (glutamatergic) and increased inhibitory (γ-aminobutyric acid [GABA]ergic) neurotransmission in the periaqueductal gray (PAG), a key descending pain modulatory brainstem area. This magnetic resonance spectroscopy (MRS) study investigated (1) whether a lower excitatory/inhibitory balance is also observed in the PAG of patients with nonspecific chronic low back pain (CLBP) and (2) whether the excitatory/inhibitory balance relates to psychophysical measures of descending pain modulation and pain sensitivity. Magnetic resonance spectroscopy was acquired on a 3T MR system in 41 patients with CLBP and 29 age- and sex-matched controls. Descending pain modulation and pain sensitivity were evaluated using conditioned pain modulation and pressure pain stimuli, respectively, which were both assessed at the lower back as the most painful area and the nondominant hand as a pain-free, remote area. Patients with CLBP presented with a lower glutamate + glutamine (Glx)/GABA ratio compared with controls (P = 0.002), driven by both decreased Glx (P = 0.012) and increased GABA (P = 0.038). Controls with lower Glx/GABA were more sensitive to pressure pain in both areas, but this association was missing in the patients (lower back: P = 0.004; hand: P = 0.002). Patients with more severe clinical pain showed impaired descending pain modulation at the hand (P = 0.003). In line with preclinical evidence, these findings support a dysregulated PAG in patients with CLBP that might be associated with dysfunctional descending pain inhibition.

Background: Spinal manipulative therapy uses high-velocity low-amplitude (HVLA) thrusts which are clinically effective, but underlying mechanisms are still unknown. Objective: To summarize the evidence for biomechanical effects of HVLA thrusts in asymptomatic and symptomatic humans as well as for a possible link between biomechanical effects and clinical effectiveness. Study design: Systematic review of randomized controlled trials. Methods: An information specialist conducted systematic literature searches in six databases [Medline (OvidSP), Premedline (PubMed), CINAHL, EMBASE, Cochrane, and Biosis]. Studies were selected by two authors and classified using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Results were qualitatively summarized per biomechanical output [range of motion (ROM) according to the spinal region where HVLA thrusts were applied, facet joint gapping, and spinal stiffness]. Results: The thirty-three included studies were heterogeneous regarding participant characteristics, intervention frequency and outcomes. Twenty-seven studies reported on the effects of HVLA thrusts on spinal ROM. There is evidence increased cervical ROM following cervical HVLA thrusts on cervical ROM [9/15 studies with a positive treatment effect (5 low risk of bias/4 some concern) and increased cervical ROM following thoracic HVLA thrusts [8/8 studies (4 low risk of bias/4 some concern)]. The effects of a thoracic and lumbar HVLA thrusts on the respective ROM were less clear. Three (2 low risk/1 some concern) studies on facet joint gapping showed increased gapping following HVLA thrusts compared to side-posture positioning, and a single study (some concern) on spinal stiffness showed no effect of HVLA thrusts. Only one study (some concern) linked the biomechanical to clinical outcomes. Conclusion: HVLA thrusts, either applied to the cervical or the thoracic spine, appear to increase cervical ROM, based on studies with low risk and studies with some concern regarding risk of bias. For all other outcomes, the included studies were too heterogeneous and too few to draw any sound conclusion. Future studies on the biomechanical effects of HVLA thrusts should link the biomechanical to clinical outcomes such as pain and disability. PROSPERO registration: CRD42018096963.

Neck muscle dysfunction has been considered as risk factor or consequence of voice disorders. This study investigates the correlation between neck and voice-related subjective symptoms in patients with voice disorders. Retrospective case-control study. 100 adult patients (59 female and 41 male) over 18 years with a mean age of 50.01 years (SD 16, range 24-87), of which 68 were under 60 years, were included. 50 patients had organic voice pathologies and 50 functional dysphonia. Outcome measures were the Voice Handicap Index 9 international (VHI-9i) and the Neck Disability Index (NDI-G). Spearman rank order coefficient was applied to determine the correlation between overall and single item VHI and NDI results. Subanalyses were done for functional vs. organic disorder, gender and age ± 60 years. Mean overall VHI-9i (13.93, SD = 7.81, range = 0-31) and mean NDI-G (6.07, SD = 7.71, range = 0-43) showed a significant mild correlation (rs = 0.220, P = 0.02). Split into subgroups the relation was stronger in patients with organic pathologies (rs = 0.297, P = 0.03), but not significant in functional disorders (r = 0.148, P = 0.30). There was a moderate relation in men (rs = 0.317, P = 0.04). Single item correlation was highest between VHI-9i item P4 (physiological) and NDI-G item reading (cognitive functioning) (rs = 0.480, P = 0.002). Specifically patients with organic voice disorders showed increased voice symptoms with the presence of neck dysfunction. This indicates a risk for a functional imbalance of the muscles surrounding the larynx, which in extreme cases may hinder functional voice rehabilitation even after phonosurgery. Therefore, neck dysfunction should be considered in voice diagnostics.

Introduction: In 85% of patients with chronic low back pain (CLBP), no specific pathoanatomical cause can be identified. Besides primary peripheral drivers within the lower back, spinal or supraspinal sensitization processes might contribute to the patients' pain. Objectives: The present study conceptualized the most painful area (MP) of patients with nonspecific CLBP as primarily affected area and assessed signs of peripheral, spinal, and supraspinal sensitization using quantitative sensory testing (QST) in MP, a pain-free area adjacent to MP (AD), and a remote, pain-free control area (CON). Methods: Fifty-nine patients with CLBP (51 years, SD = 16.6, 22 female patients) and 35 pain-free control participants individually matched for age, sex, and testing areas (49 years, SD = 17.5, 19 female participants) underwent a full QST protocol in MP and a reduced QST protocol assessing sensory gain in AD and CON. Quantitative sensory testing measures, except paradoxical heat sensations and dynamic mechanical allodynia (DMA), were Z-transformed to the matched control participants and tested for significance using Z-tests (α = 0.001). Paradoxical heat sensations and DMA occurrence were compared between cohorts using Fisher's exact tests (α = 0.05). The same analyses were performed with a high-pain and a low-pain CLBP subsample (50% quantile). Results: Patients showed cold and vibration hypoesthesia in MP (all Ps < 0.001) and mechanical hyperalgesia (P < 0.001) and more frequent DMA (P = 0.044) in AD. The results were mainly driven by the high-pain CLBP subsample. In CON, no sensory alterations were observed. Conclusion: Mechanical hyperalgesia and DMA adjacent to but not within MP, the supposedly primarily affected area, might reflect secondary hyperalgesia originating from spinal sensitization in patients with CLBP.