A Systematic Review of Case Reports on the Neck-Tongue Syndrome

Background and Objectives: Neck-tongue syndrome (NTS) is rare, and characterized by unilateral upper neck or occipital pain and paresthesia in the ipsilateral hemisphere of the tongue due to neck movement. Treatment for NTS is mainly conservative, but the symptoms, causes, and rationale for treatment remain controversial. This study aimed to provide a framework for NTS treatment in clinical practice based on recent treatment directions. Materials and Methods: Case reports published from the past 20 years to August 2021 were searched through MEDLINE, EMBASE, and PEDro databases. Since there is no established management for NTS, the search terms were neck-tongue syndrome and case reports. The Critical Appraisal Checklist for Case Reports was used for the quality assessment of case reports. Through descriptive analysis, NTS symptoms, interventions, and results were reviewed. Results: Among the 16 studies searched, six case reports were selected and analyzed based on eight criteria. Symptoms included neck pain and ipsilateral tongue paralysis when the head was turned. As an intervention, six and four studies showed immediate symptom relief through manual therapy and exercise, respectively. Conclusions: Based on the reviewed evidence, management through physical therapy and chiropractic therapy with conservative methods such as manual therapy and exercise for patients with neck-tongue syndrome is recommended.

Management of Nonsurgical Refractory Low Back Pain in the United States: A Retrospective Analysis

INTRODUCTION Low back pain (LBP) is the leading cause of disability worldwide. Patients with persistent LBP despite multiple interventions and who are ineligible for spine surgery are considered to have nonsurgical refractory back pain (NSRBP). We investigated the utilization of medications and nonpharmacologic therapies in this population in the United States. METHODS The IBM MarketScan® Research databases were used to identify adult patients with LBP diagnoses (excluding instability and nonmechanical etiologies) and a negative history of failed back surgery syndrome or spine surgery within the study period (2009-2016). Patients must have had medications prescribed within 2 wk of diagnosis or nonpharmacologic therapies for >30 d within the 3 to 24 mo following LBP diagnoses. The frequency of utilization of these therapies was calculated at 0 to 6, 6 to 12, and 12 to 24 mo postdiagnosis. RESULTS Among 55 945 patients, 69.8% of patients used nonpharmacologic therapy in the first 6 mo, 66.0% over the next 6 to 12 mo, and 78.7% in the second year. At all time points, the most-utilized therapies were chiropractic therapy, physical therapy (PT), and epidural or facet joint steroid injections. In the first 6 mo, 42.1% of patients saw a chiropractor, and 43.5% of patients attended PT; 13.6% of patients underwent ≥1 steroid injection. Over the next 6 mo, 38.5% of patients visited a chiropractor, 37.2% used PT, and 12.6% received ≥1 steroid injection. During the second year, 45.3% saw a chiropractor, 45.1% engaged PT, and 16.6% had ≥1 steroid injection. On average, 49.1% of patients used prescription pain medications over the 2 yr, most commonly opioids (40.5%), muscle relaxants (21.5%), and anticonvulsants (17.8%). CONCLUSION The majority of NSRBP patients used nonpharmacologic therapy, and almost half used prescription medications throughout the 2 yr. The most-utilized therapies were chiropractic therapy, PT, opioids, muscle relaxants, and anticonvulsants. Over 40% of patients engaged chiropractors or PT or used opioids.

The Role of Chiropractic in Mind–Body Health

The chiropractic approach is based on the principles that diseases, both psychiatric and medical, are caused by disturbances in the nervous system and that such disturbances are often related to musculoskeletal problems. Thus chiropractic therapies utilize an integrative approach to health and well-being that includes various spinal manipulations as well as an integrative approach to the patient. Chiropractic therapies are most well known for the management of chronic and acute pain, which frequently can be accompanied by anxiety and depression symptoms. There is little direct evidence that chiropractic care improves mental health outside of the benefits related to pain alleviation. However, based on the overall chiropractic model, chiropractic therapy can potentially benefit a wide variety of psychological symptoms, but more research is needed. This chapter reviews the principles of chiropractic care, particularly in the context of psychiatric conditions, and provides information for future clinical and research programs.