Page 17 - Journal of Special Operations Medicine - Spring 2016

Physical Therapy Treatment of Chronic Neck Pain

A Discussion and Case Study
Using Dry Needling and Battlefield Acupuncture

Richard M. Guthrie, PT, DPT, CSCS; Rita Chorba, PT, DPT, MAT, ATC, CSCS

ABSTRACT
Purpose: Chronic mechanical neck pain can have a com- serious/systemic pathology, psychosocial, or mechani-
plex clinical presentation and is often difficult to treat. cal etiologies. Mechanical neck pain syndromes may
This case study illustrates a successful physical therapy be further differentiated as primarily nociceptive (e.g.,
treatment approach using dry needling and auricular bone/joint, discogenic, or myofascial involvement) or
acupuncture techniques. Case Report: A 51-year-old neuropathic (e.g., spinal cord or peripheral nerve root).
active-duty, male US Marine was treated by a physical Chronic conditions are often complicated by features of
therapist in a direct-access military clinic for chronic both nociceptive and neuropathic pain combined with
neck pain poorly responsive to previous physical therapy, the additional burden of nervous system sensitization
pharmacologic, and surgical interventions. Needling syndromes. 4
techniques were combined with standard physical ther-
apy interventions to address the comprehensive needs of Chronic mechanical neck pain is a complex clinical entity
the patient. Within five treatments, the patient reported to treat, requiring a multifaceted approach for optimal
reduced pain levels from 8–9/10 to 0–2/10, improved outcomes. Current methods of treatment often combine
sleep quality, and increased function with daily activi- physical therapy (PT) with adjunctive pharmacologic
ties. Over several months, the patient reduced multiple interventions. PT strategies for mechanical neck pain
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medication use by greater than 85%. The effects of typically combine pain management modalities aimed at
treatment were lasting, and the patient accomplished reducing peripheral and central nervous system (CNS)
a successful transition to an independent maintenance sensitization with mechanical interventions selected to
program. Conclusion: Needling techniques have the po- restore joint alignment, myofascial mobility, and motor
tential to expedite favorable physical therapy outcomes control of the cervicothoracic spine complex. Recently,
for active-duty service members suffering from chronic the addition of cognitive behavioral therapy has been in-
mechanical and degenerative neck pain. The dramatic troduced as an intervention to be used by physical thera-
improvements observed in this case warrant additional pists in the treatment of chronic spinal pain. 6
exploration of treatment efficacy and delineation of best
practices in the delivery of these techniques. Pharmacotherapy for chronic pain uses an algorithmic
treatment approach that begins with nonopioid anal-
Keywords: pain, neck; physical therapy; dry needling; acu- gesic intervention, and progresses to opioid analgesics
puncture, battlefield; pain management and antidepressants based on individualization or poor
response to first-line medications. The pharmacologic
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management of chronic pain is difficult to standardize
because of the variability of accepted guidelines by pain
Introduction
management practitioners and the multifactorial etiol-
Neck pain is the fourth leading cause of disability for ogy of chronic pain. While pharmacologic adjuncts can
the global population, following low back pain, depres- assist with pain relief, patients may experience counter-
sion, and arthralgia. Close to 50% of patients experi- productive side-effects such as drowsiness and lethargy.
5,8
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encing a first acute episode of neck pain will develop These side-effects can interfere with PT, lead to decreased
recurrent symptoms and disability, with chronicity af- ability to perform activities of daily living or job duties,
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fecting between 10% and 21% of the US population. and are complaints often associated with pharmacologic
2,3
Neck pain may be generally classified as caused by management of pain. 7,9

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