الفهرس 
A NATOMY OF C ERVICAL S PINEOnly 14 pages are availabe for public view
 |  | from | 178 |  |  |
| | | from | 178 | | |
Abstract
Background: Neck pain is the second most prevalent musculoskeletal dysfunction in the active population, generating a high economic cost to health systems because it is commonly related to some degree of disability. Trigger points (TrPs) can be involved in pain processes in patients with neck pain. The approach to the treatment of pain should be conservative and multidisciplinary, and should include education, pharmacological treatment, physical therapy, massage therapy, gentle stretching, exercise and injection therapy.
Objective: Our study was aimed to detect the most effective in pain relief in treatment of chronic neck pain with different injections (mesotherapy, prolotherapy and dry needling).
Methods: This study was conducted at the Department of Physical Medicine, Rheumatology and Rehabilitation at Ain Shams University Hospitals as well as Railway Hospital on 45 patients with chronic neck pain. Their age group 30 to 70 years old and the disease duration ranged from 3 to 36 months. All patients were subjected to history taking, clinical examination, neurological examination and investigations as CBC, ESR and cervical plain x ray. Pain and functional assessment using Northwick park neck pain questionnaire (NPQ), the visual analog scale (VAS), chronic pain grade scale (CPGS) and Neck Disability Index (NDI). All patients were randomly assigned into one of three groups: group I who received mesotherapy injection, group II who received prolotherapy injection and group III who received dry needling injection.
Results: As regard age, sex and duration of pain there was no significant difference between the three groups. group I who received mesotherapy, as regard Northwick park neck pain questionnaire, Neck Disability Index (NDI), visual analog scale (VAS) and chronic pain grade scale (CPGS): pain intensity, there were highly statistically significant difference between the patients before and after injection (improvement) (p<0.001). group II who received prolotherapy, as regard Northwick park neck pain questionnaire, Neck Disability Index (NDI), visual analog scale (VAS) and chronic pain grade scale (CPGS): pain intensity, there were highly statistically significant difference between the patients before and after injection (improvement) (p<0.001). group III who received dry needling, as regard Northwick park neck pain questionnaire, Neck Disability Index (NDI), visual analog scale (VAS) and chronic pain grade scale (CPGS): pain intensity, there were highly statistically significant difference between the patients before and after injection (improvement) (p<0.001). No significant difference between all groups before and after injection at all the parameters. As regard the percentage of change there was significant difference between group I and group II in the visual analog scale (VAS) and chronic pain grade scale (CPGS): pain intensity and also between group II and group III in Northwick park neck pain questionnaire (NPQ), the visual analog scale (VAS) and chronic pain grade scale (CPGS): pain intensity, i.e significant improvement in group I versus group II and significant improvement in group III versus group II. There was significant positive correlation between age and duration of pain of all cases before injection and significant positive correlation between duration of pain and chronic pain grade scale (CPGS): disability points and pain intensity of all cases before injection.
Conclusion: The present study showed that the three methods of injection were effective from the first session of injection in treatment of chronic neck pain. The most effective method was the mesotherapy and dry needling over prolotherapy. The three methods of injection were easily and quickly carried out with no local or allergic reactions, less invasive than intradural injection and facet joint injection but the easiest and least cost method was dry needling. Injection therapy seems to represent an alternative therapeutic technique especially in the presence of other diseases or comorbidities where there is a high risk of drug interaction or when conventional therapy of NSAIDs is contraindicated.