February 17, 2025

NECK PAIN IS COMMON! 

Neck Pain is the 4th leading cause of disability in the United States. Each year about 30-50% of Americans suffer with it. The prevalence of neck pain is higher in women compared to men and peaks around 45 years of age. At any given time 10-20% of the population reports neck pain with 54% of individuals experiencing neck discomfort within the past 6 months.

WHO GETS NECK PAIN? 

People who are more at risk for neck pain are those who are: 

• Sedentary desk workers

• Manual laborers

• Health care workers.

• Suffering from depression or anxiety

• Have Sleep disorders

• Smokers

• Have a Sedentary lifestyle

• Have a history of trauma - traumatic brain injury, car accident/whiplash, sports injuries and/or concussion.

THE MOST COMMON TYPES OF NECK PAIN:

1. Muscle pain. Aching or sore neck and shoulder muscles may occur in response to overexertion, chronic tension, or prolonged emotional stress. The neck muscles may develop hard knots that are tender to the touch, sometimes called trigger points.

2. Muscle spasm. This is a sudden, powerful tightening of neck muscles. Muscle spasm can result from a muscle injury, but it may also occur in response to a spinal disc or nerve problem.

3. Headache. Neck-related headache is most often felt in the back of the head and upper neck. Neck-related headache pain is usually dull or aching, and your neck might also feel stiff or tender. Moving your neck makes it worse.

4. Facet joint pain. Described as deep, sharp, or aching pain in the back or facet joints. Moving your head to one side typically worsens the pain. The pain may radiate to your shoulder or upper back. With arthritis or degenerative joint disease in the facet joints, you may feel worse in the morning or after a period of inactivity.

5. Nerve pain. Irritation or pinching of the roots of the spinal nerves causes pain that may be sharp, severe, or accompanied by pins and needles. Depending on the nerve involved, the pain may shoot down the arm or even into the hand. Often this is related to a herniated disc.

6. Referred pain. Sometimes neck pain is triggered by a problem in another part of the body. For example, neck pain that worsens with exertion may indicate a heart problem, while neck pain that occurs when you eat may stem from a problem in the esophagus.

7. Bone pain. Pain and tenderness from the neck (cervical) vertebrae are far less common than neck pain from the soft tissues. Bone pain needs medical attention because it may signal a more serious health problem.

How long you have had your neck pain is one of the greatest predictors of how fast and how well you recover. The shorter duration of your neck pain the greater likelihood of it resolving faster. Chronic neck pain takes much longer to resolve and often lingers on.

Acute Neck Pain: pain is present 6 weeks or less.

Subacute Neck Pain: pain is present less than 3 months 

Chronic Neck Pain: pain that lasts more than 3 months.

Symptoms to take seriously and get examined immediately (as in stop reading this and get help right now!) are: 

• Severe head, neck, or back pain accompanied with fever, chills, or sweats;

• Neurological signs such as weakness or clumsiness, numbness or tingling, loss of bowel or bladder control, stumbling or falling;

• Symptoms of brain dysfunction such as confusion, speech problems, or visual disturbances,

• Sudden onset of neck pain with a severe “thunderclap” headache;

• Recent physical trauma, especially if you are elderly, on immunosuppression drugs or prolonged steroid use.

SELF TEST YOUR NECK PAIN: 

The following 5 self-tests can help you and your doctor determine the cause of your neck pain. THESE ARE NOT INTENDED TO MAKE A DIAGNOSIS OR TREATMENT RECOMMENDATION. They are for informational purposes only. 

1. POSTURE:
Have someone take a picture of your posture from behind and the side.

2. NECK ROTATION TEST:

Turn your head all the way to the left and then all the way to the right. If you can’t see over your shoulder you have restricted range of motion in your neck. If it causes pain you likely have a problem in the facet joints or discs of your neck. If it causes arm, shoulder, or mid-back pain your cervical nerves may be irritated.

3. NECK EXTENSION AND QUADRANT TESTS:

Look up and bend your neck backwards. Then, twist your head to the left and then to the right.  Pain on either these movements indicates a probable facet joint problem.  If these positions cause pain or tingling into the arm, hand, shoulder, mid back, or chest, it’s possible you have nerve irritation. 

4. COMPRESSION TEST:

Sit upright in a chair. Put your hands on the top of your head (if you can’t reach the top of your head you probably have a shoulder issue too). Keep your neck straight and press down on your head compressing your neck. Then bend your head left and compress, and then right and compress.  If you get a pain likely have a facet or disc problem. If it produces pain or tingling into your shoulder or arms, a cervical nerve is irritated as well. 

5. NERVE STRETCH TEST:

Stand tall. Bend your wrist backward and bring your arm behind you. Then bend your head to the opposite side. Pain or tingling in the arm or hand indicates you may have a nerve problem in your neck or arm. 

TREATMENT OPTIONS: 

There are several treatment options for patients with neck pain. Here a dozen of the most common and the evidence of their benefits and risks.

1. Chiropractic Manipulation (Adjustments) and Manual Therapy

Benefits: Among the benefits of chiropractic care are included:

• Relief from back and neck pain.

• Relief from headaches.

• Relief from pregnancy-related backache.

• Correction of hip, gait, and foot problems

• Improved flexibility, stability, balance and coordination.

• Prevention of work-related muscle and joint injuries.

• Improved function and ability to better perform normal activities of daily living.

• Reduced odds of using opioid drugs or having surgery.

• Chiropractic care protects against or slows declines in functional and self- rated health among Medicare patients.

• The use of chiropractic adjustments is the most effective method of care for most people with spinal pain and other conditions, whether used by itself or in combination with standard medical care. (1, 2, 3, 4)

Risks: Any treatment that increases movement in people (including manipulation, stretching, exercise, massage, etc.) commonly produces transient symptoms. (5) The most common side effects of chiropractic manipulation are temporary muscle soreness, stiffness, headaches, fatigue or a temporary increase in pain. Occasionally dizziness, nausea, radiating discomfort, or bruising may occur. These are self-limited and resolve without further problems within 24-48 hours. (6) Serious complications are rare and remote, with estimates ranging from ~ 1 in 2 million to ~1in 8 million. These may include disc injury, dislocations, fractures, or possible damage to the arteries of the neck that may lead to complications such as stroke.” (7) Many reported injuries of Chiropractic manipulation occur with non-Chiropractic providers attempting to apply Chiropractic-like procedures, without the highly developed skill and experience of a doctor of Chiropractic. (8) The relative risk of all chiropractic manipulation and manual therapy is estimated to be 37,000-148,000 times safer than drugs and 55,500–444,000 times safer than spinal surgery. (9)

2. Over the Counter Drugs

Benefits: Over the counter drugs such as Aspirin, Ibuprofen (Motrin, Advil), Acetaminophen (Tylenol), Naproxen (Aleve) and other non-steroidal anti- inflammatory medications (NSAIDs) can be used to temporarily reduce pain and inflammation in mild and moderate pain joint and muscle conditions.

Risks: Short-term use (~ 1-2 days) usually cause no significant problems, although side effects such as nausea, vomiting, rashes, dizziness, and allergic reactions may occur. (10)

Approximately 1 in 50 people taking NSAIDs have an adverse reaction, most commonly of the Gl and cardiovascular systems. Long term use of NSAIDs can cause serious side effects in the form of stomach and intestinal irritation, ulcers, and bleeding in as many as 60% of users. (11) Always take NSAIDs with meals to help decrease this risk. There is an increased rate of heart attacks and stroke with prolonged NSAIS use. (12) People most at risk are those older than 60 years of age; are already taking an anticoagulant, corticosteroids, and/or low-dose aspirin; have a history of peptic ulcer disease; have had stomach problems before; have cardiovascular disease; have Helicobacter pylori infection. (13)  Acetaminophen has no pain-relief effect on back pain, accounts for more than 50 percent of drug overdose related liver failure and about 20 percent of liver transplant cases, as well as kidney disease. (14) Each year, the side effects of long-term NSAID use cause nearly 103,000 hospitalizations and 16,500 deaths. (15)  

3. Prescription Medicines: Muscle Relaxant, Anti-inflammatory, and Pain Relief Medications

Benefits: Short-term use of prescription pain relievers can temporarily reduce pain and inflammation and are used in severe cases. The short-term use of steroid (e.g., prednisone, cortisone, and methylprednisolone) and non-steroidal anti-inflammatory COX-2 inhibitor medications (e.g., Celebrex, Vioxx, Voltaren, Cataflam. and Diclofenac) may help decrease inflammation and the pain it causes temporarily. The short-term use of muscle relaxants has been shown to be questionable. 

Opioid drugs such as oxycodone (Oxycontin) and hydrocodone (Vicodin) are used to treat severe pain after surgery, and sometimes to treat chronic pain. They are powerful painkillers that block messages of pain to the brain, decrease the body's perception of discomfort, and may also create a feeling of euphoria. Gabapentinoids (Gabapentin and Pregabalinare) are also used for chronic back and nerve pain. Studies have shown little to no benefit from their use, and an increase risks of dizziness fatigue, visual disturbances, and cognitive functions. (16) Muscle relaxants are no more effective than NSAIDs, and the combination of muscle relaxants and NSAIDs brings no further benefit. Antidepressants have shown no benefit for spinal pain.(17) 

Risks: Short term use of prescription drugs usually causes no significant problems, but side effects such as nausea, drowsiness, vomiting, rashes and dizziness may occur. No research supports the long-term effective use of these drugs. Long-term use could cause a number of significant complications that vary from drug to drug. COX-2 inhibitor drugs are NSAIDs that have less GI complications than their over-the counter counterparts, but have found to have a 42% increase in heart attacks (myocardial infarction) and adverse effects on the liver and kidneys. (18)  Opioids are harmful and come with many risks, including addiction. Long-term opioid use may cause nausea, itching, drowsiness, constipation, bowel distention, falls, slowed reaction time, and slowed breathing. Taking opioids for 4 weeks or longer puts you at risk for dependence or addiction. The World Health Organization estimates that worldwide, about 0.5 million deaths are attributable to drug use. More than 70% of these deaths are related to opioids, with more than 30% of those deaths caused by overdose. (19) 

4. Hospitalization

Benefits: In-patient hospitalization is unnecessary and ineffective for almost all back problems. The only clear candidates for hospitalization have had severe trauma or injury, spinal fracture, internal disease, or need surgery.  Chiropractic care provides more effective long and short-term benefits than hospital treatment.  

Risks: The average hospital stay for back or neck pain is about 5 days. (20) Hospitalization increases one’s chance of a hospital-acquired infection, muscle weakness, falling, and medical error. (21, 22, 23, 24)  Research by Harvard Medical School found a 1% risk of serious injury due to medical error during a hospital admission. (17) 

5. Physical Therapy

Benefits: Modalities such as electrical muscle stimulation, TENS, ultrasound, hot packs, ice packs, etc. have very limited benefit and short-term effectiveness. (25, 26) Chiropractic manipulation and manual therapy are more effective than physical therapy for back and musculoskeletal problems. (27, 28) 

Risks: Various risks depending on the specific form of therapy utilized. No serious consequences when applied by a professional under the direction of a chiropractic, DPT or medical doctor.  

6. Surgery

Benefits: There are many different types of surgery for the spine for various conditions. These include fusion, laminectomy, minimally invasive, neurostimulator insertion, etc. Potential benefits from surgery are variable and specific to each patient. Patient selection is essential, and a patient should always get a second opinion before consenting to spinal surgery. Only 1% of spinal cases (like fractures, dislocations or certain nerve damage cases) can reliably benefit from surgery. The benefits of most spinal surgeries by itself are regarded as small. (29) Lumbar fusion surgeries have poor outcomes and commonly require reoperation. (30, 31, 32) Repeat spinal surgery have diminishing returns with each additional surgery. (33)

Risks: Complications include blood clots, infection or sepsis, wound infections, pneumonia, superficial wound infections, and reactions to anesthesia. The overall complication rate for spinal surgery is varied depending on the type of surgery, the patient’s health status, etc.. (34, 35) 1 in 5 spinal surgery patients develop PTSD. (36)

7. Massage 

Benefits: Massage may reduce pain and relax muscles in the short term. It has not been proven to speed the recovery of musculoskeletal problems. (37, 38, 39, 40)  

Risks:  Small when applied by a professional under the direction of a chiropractic medical doctor. Muscle soreness, skin irritation, and increased pain are possible and depend on the type of massage technique used. (41) 

8. Acupuncture & Dry Needling

Benefits: Acupuncture may give short-term easing of chronic low back pain, neck pain, osteoarthritis/knee pain, and headaches. (42) Acupuncture produces poor long-term results. (43 44) 

Risks:  The most common side effects of acupuncture include bleeding, soreness, or bruising at the site of needle insertion. When applied by a licensed professional, there is a very rare chance of significant problems. 

9. Bed Rest
Benefits: Bed rest may reduce pain, but should not exceed 1 to 2 days. Bed rest is never recommended as the sole treatment method for spinal problems. (45) However, good mattress and pillow support is crucial for healing. 
 

Risks: Exceeding 2 days of bed rest slows recover and weakens the muscles and bones of the spine – which can lead to chronic back problems. (46) 

10. Exercise

Benefits: Exercise is an integral component of any successful rehabilitative spinal program. When performed properly, exercise can improve the strength and endurance of spinal muscles and reduce pain. There is no evidence that some specific types of exercises are superior to others. (47) Strengthening exercises, endurance or stretching exercises have shown to be beneficial as part of an overall plan in the treatment of chronic neck pain, cervicogenic headache and cervical radiculopathy. (48) Exercise is mildly beneficial in the treatment of acute and chronic back pain, but is moderately helpful in preventing recurrences of back pain. (49)  Mind-body movement exercises such as yoga, tai chi, chi-kung, and Pilates are helpful. (50, 51) Aerobic exercise is helpful.
 

Risks: Under the supervision of a doctor or therapist there are little risks. However, when performed improperly, exercise can complicate and worsen a spinal condition. 

11. Injections: Epidural Steroid, Facet & Sacroiliac Joint, Medial Bundle Branch Blocks, and Trigger Point Injections.

Benefits: Short-term benefits were found in some studies; other studies have found no benefit. (52, 53) 

Risks: Common side effects after an epidural include nausea, headache, dizziness, fainting, temporary headache and flushing. Serious complications are possible, including infection, bleeding, and allergic reactions. (54, 55)  

12. Psychological Therapies

Benefits: Cognitive Behavior Therapy, Hypnosis, Mindfulness, and other forms of psychological and behavioral therapies can be helpful with all kinds of chronic pain conditions.  They can be incorporated into a holistic treatment program. (56) 

Risks: Virtually none if done under professional care and training. The main risk is using these as stand-alone treatments and ignoring the physical and chemical factors.

13. No Tro Treatment

Benefits: Some minor and acute spinal pains might go away without treatment (Ask about the 3-day & 22-week rules).  Pain is not an accurate indicator of the need for treatment.  

Risk: Delaying treatment can result in reduced mobility and increased scarring of spinal tissues. Acute pain may go away, but the underlying condition remains and progresses silently into a chronic condition that is often more difficult to treat. It might turn a simple case into a complicated condition that will  be costly to treat and will yield less favorable results. (57, 58)

Most neck pain can be managed with a combination of professional help, exercise, and good self-care. You do have options! Don’t let back pain ruin your life.  

Our chiropractic office specializes in treating patients with all kinds of neck pain. We use cutting edge hands-on care, traction, focused exercise, nutrition, and other effective therapies.  If you have any questions or would like to discuss how our care may help you, your family members, or friends, feel free to contact me by phone or email at:

David I. Graber, DC, DACBSP 

GRABER CHIROPRACTIC CENTER

 140 Littleton Road Suite 200

 Parsippany, NJ 07046 

973-335-1100

drgraber@drgraber.com 

www.DrGraber.com 

Dr. David Graber is a nationally recognized Chiropractic Sports Physician who has been in practice since 1987. Thousands of patients over the past 30 years have found relief through his care. He is the 2012 New Jersey Chiropractor of the Year, and lectures around the country for several chiropractic colleges on the diagnosis and non-surgical treatment of the spine and extremities. He has developed over 25 cutting edge hands-on courses on chiropractic adjustments, manual care, and rehabilitation. 

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2 Kelsey L Corcoran, DC, et al,  Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis, Pain Medicine, Volume 21, Issue 2, February 2020 . 

3 Keeney, Benjamin J., PhD*;et al,  Early Predictors of Lumbar Spine Surgery After Occupational Back Injury: Results From a Prospective Study of Workers in Washington State, Spine: May 15, 2013 - Volume 38 - Issue 11. 4 Weigel PA, et al, Chiropractic use in the Medicare population: prevalence, patterns, and associations with 1-year changes in health and satisfaction with care. J Manipulative Physiol Ther. 2014 Oct;37(8):542-51. 

5 Paanalahti, Kari, et al,  Adverse events after manual therapy among patients seeking care for neck and/or back pain: A randomized controlled trial. BMC musculoskeletal disorders, 2014. 

6 Walker BF, et al, Outcomes of usual chiropractic. The OUCH randomized controlled trial of adverse events. Spine (Phila Pa 1976). 2013 Sep 15;38(20):1723-9. 

7 Nielsen SM, Tarp S, Christensen R, Bliddal H, Klokker L, Henriksen M. The risk associated with spinal manipulation: an overview of reviews. Syst Rev. 2017;6(1):64. 

8 Chapman-Smith, D: The Chiropractic Profession. West Des Moines, Iowa, NCMIC Group Inc., 2000. 

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10 https://www.fda.gov/consumers/consumer-updates/benefits-and-risks-pain-relievers-. 

11 Jones R, Rubin G, Berenbaum F, Scheiman J. Gastrointestinal and cardiovascular risks of nonsteroidal anti-inflammatory drugs. Am J Med. 2008;121:464-474. 

12 Wongrakpanich, S., et al,  (2018). A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. Aging and disease, 9(1), 143–150.  

13 Chi, Tian-Yu et al. “Risk factors associated with nonsteroidal anti-inflammatory drugs (NSAIDs)-induced gastrointestinal bleeding resulting on people over 60 years old in Beijing.” Medicine vol. 97,18 (2018). 

14  Rane MA, Gitin A, Fiedler B, Fiedler L, Hennekens CH. Risks of Cardiovascular Disease and Beyond in Prescription of Nonsteroidal Anti-Inflammatory Drugs. Journal of Cardiovascular Pharmacology and Therapeutics. 2020;25(1):3-6. 

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16 Shanthanna H,  et al. (2017) Benefits and safety of gabapentinoids in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. PLOS Medicine 14(8): e1002369 

17 Roger Chou, Richard Deyo, Janna Friedly, et al. Systemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern 

Med.2017;166:480-492. 

18 Hennekens CH, Borzak S. Cyclooxygenase-2 Inhibitors and Most Traditional Nonsteroidal Anti-inflammatory Drugs Cause Similar Moderately Increased Risks of Cardiovascular Disease. Journal of Cardiovascular Pharmacology and Therapeutics. 2008;13(1):41-50.. 

19 https://www.who.int/news-room/fact-sheets/detail/opioid-overdose. 

20 https://www.boneandjointburden.org/2014-report/iib2/hospitalization. 

21 Toh, Hui Jin et al. “Factors associated with prolonged length of stay in older patients.” Singapore medical journal vol. 58,3 (2017). 

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23 Johns Hopkins Medical Institutions. "Muscle Weakness A Common Side Effect Of Long Stays In Intensive Care Units." ScienceDaily. ScienceDaily, 29 October 2009. 

24 Schimmel, E M. “The hazards of hospitalization. 1964.” Quality & safety in health care vol. 12,1 (2003): 58-63. 25 Khadilkar  A, Odebiyi  DO, Brosseau  L, Wells  GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low‐back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD003008. 26 Robertson, Valma J; Baker, Kerry G A Review of Therapeutic Ultrasound: Effectiveness Studies, Journal of Women's Health Physical Therapy: September/December 2010 - Volume 34 - Issue 3 - p 99-110 

27 Cambron JA, Gudavalli MR, McGregor M, et al. Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain. Chiropractic and Osteopathy 2006:14:19. 

28 Khodakarami N. Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation. Healthcare (Basel). 2020 Feb 24;8(1):44.  

29 Bogduk, Nikolai, and Gunnar Andersson. “Is spinal surgery effective for back pain?.” F1000 medicine reports vol. 1 60. 27 Jul. 2009, doi:10.3410/M1-60 

30 Nguyen TH, Randolph DC, Talmage J, Succop P, Travis R. Long-term outcomes of lumbar fusion among workers' compensation subjects: a historical cohort study. Spine (Phila Pa 1976). 2011 Feb 15;36(4 

31 Harris IA, Traeger A, Stanford R, Maher CG, Buchbinder R. Lumbar spine fusion: what is the evidence? Intern Med J. 2018 Dec;48(12) 

32 Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine (Phila Pa 1976). 2007 Feb 1;32(3): 

33 Daniell, James R, and Orso L Osti. “Failed Back Surgery Syndrome: A Review Article.” Asian spine journal vol. 12,2 (2018) 

34 Schoenfeld AJ, et al. Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the National Surgical Quality Improvement Program. The Journal of bone and joint surgery American volume. 2011 Sep 7;93(17): 

35 Wolters Kluwer Health. "New model predicts complication risks in surgery for spinal cord compression." ScienceDaily. ScienceDaily, 21 June 2016. 

36 Oregon Health & Science University. "One-fifth of spine surgery patients develop PTSD symptoms." ScienceDaily. ScienceDaily, 28 September 2012. 

37 Hsieh LL, et al. Treatment of low back pain by acupressure and physical therapy: randomised controlled trial. BMJ. 2006 Mar 25;332(7543):696-700. doi: 10.1136/bmj.38744.672616.AE. 

38 Field, Tiffany. “Massage therapy research review.” Complementary therapies in clinical practice vol. 24 (2016): 19-31

39 Diederik C Bervoets, et al, Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review,Journal of Physiotherapy,Vol 61, Issue 3,2015,Pages 106-116, 

40 Furlan  AD, Giraldo  M, Baskwill  A, Irvin  E, Imamura  M. Massage for low‐back pain. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD001929. 

41 Cambron JA, Dexheimer J, Coe P, Swenson R. Side-effects of massage therapy: a cross-sectional study of 100 clients. J Altern Complement Med. 2007 Oct;13(8):793–6. 

42 National Center for Complementary and Integrative Health (NCCIH). Acupuncture: In depth. January 2016. https://nccih.nih.gov/health/acupuncture/introduction. 

43 Gattie Eric, et al, The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis, Journal of Orthopaedic & Sports Physical Therapy 2017 47:3, 133-149.

44 Mu  J, Furlan  AD, Lam  WY, Hsu  MY, Ning  Z, Lao  L. Acupuncture for chronic nonspecific low back pain. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD013814.

45 Koes B. Moderate quality evidence that compared to advice to rest in bed, advice to remain active provides small improvements in pain and functional status in people with acute low back pain. Evidence-Based Medicine.

2010;15(6):171-172.

46 Fernandez M, Hartvigsen J, Ferreira ML, et al. Advice to Stay Active or Structured Exercise in the Management of Sciatica. Spine. 2015;40(18):1457-1466.

47 Malfliet A, et al. Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain. J Clin Med. 2019 Jul 19;8(7):1063. doi: 10.3390/jcm8071063.

48 Gross A, et al.  Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD004250.

49 Choi BKL, Verbeek JH, Tam WWai-San, Jiang JY. Exercises for prevention of recurrences of low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006555.

50 Juyoung Park, Cheryl A. Krause-Parello, Chrisanne M. Barnes. A Narrative Review of Movement-Based Mind-Body Interventions. Holistic Nursing Practice, 2020; 34 (1):

51 Yamato TP, et al. Pilates for low back pain. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD010265.

52 Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care: Diagnosis & Treatment of Low Back Pain. North American Spine Society. 2020.

53 Ter Meulen BC, Maas ET, Vyas A, et al. Treatment of acute sciatica with transforaminal epidural corticosteroids and local anesthetic: design of a randomized controlled trial. BMC Musculoskelet Disord. 2017;18(1):215. 

54 Manchikanti L, Buenaventura RM, Manchikanti KN, et al. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012;15(3):E199-245. 

55 Ter Meulen BC, Maas ET, Vyas A, et al. Treatment of acute sciatica with transforaminal epidural corticosteroids and local anesthetic: design of a randomized controlled trial. BMC Musculoskelet Disord. 2017;18(1):215. 

56 Castelnuovo, Gianluca et al. “Psychological Treatments and Psychotherapies in the Neurorehabilitation of Pain: Evidences and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation.” Frontiers in psychology vol. 7 115. 19 Feb. 2016. 

57 A Feizerfan, FRCA, G Sheh, BHB MBChB FAFRM(RACP) FFPMANZCA, Transition from acute to chronic pain, Continuing Education in Anaesthesia Critical Care & Pain, Volume 15, Issue 2, April 2015, Pages 98–102. 58 When does acute pain become chronic? Voscopoulos, C et al. British Journal of Anaesthesia, Volume 105, i69 - i85

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