title: Cerebral perfusion in patients with chronic neck and upper back pain: preliminary observations.
abstract: OBJECTIVE
  The purpose of this study was to determine the correlation between cerebral perfusion levels, Neck Disability Index (NDI) scores, and spinal joint fixations in patients with neck pain.
  
  
  METHODS
  Forty-five adult patients (29 were female) with chronic neck/upper thoracic pain during exacerbation were studied. The subjects were grouped according to NDI scores: mild, moderate, and severe. The number of painful/blocked segments in the cervical and upper thoracic spine and costovertebral joints, pain intensity using the visual analog scale, and regional cerebral blood flow of the brain using single-photon emission computed tomography (SPECT) were obtained. The SPECT was analyzed semiquantitatively. Analysis of variance tests were conducted on total SPECT scores in each of the NDI groups (P < .05). Univariate correlations were obtained between blockage, pain, and SPECT scores, as well as age and duration. A multivariate analysis was then conducted.
  
  
  RESULTS
  Group 1 (mild) consisted of 14 patients. Cerebral perfusion measured by SPECT was normal in all 8 brain regions. Group 2 (moderate) consisted of 16 patients. In this group, a decrease in cerebral perfusion was observed (range, 20%-35%), predominantly in the parietal and frontal zones. Group 3 (severe) consisted of 15 patients. In this group, the decrease in cerebral perfusion observed was from 30% to 45%, again predominantly in the parietal and frontal zones. A significant difference was found between NDI groups ("moderate" and "severe" showed significantly greater hypoperfusion than "mild"). Total blockage score correlated with SPECT scores at r = 0.47, P = .001. In a multivariate analysis, NDI scores contributed 39% of the variance of SPECT scores.
  
  
  CONCLUSIONS
  In this group of patients with neck and/or upper back pain, NDI scores strongly predicted cerebral hypoperfusion. Spinal joint dysfunction may be involved via hyperactivity in the regional sympathetic nervous system.
authors.affiliation: Center for Manual Therapy, Moscow, Russia.
authors.forename: Maxim A
authors.initials: MA
authors.lastname: Bakhtadze
authors.forename: Howard
authors.initials: H
authors.lastname: Vernon
authors.forename: Anatoliy V
authors.initials: AV
authors.lastname: Karalkin
authors.forename: Sergey P
authors.initials: SP
authors.lastname: Pasha
authors.forename: Igor O
authors.initials: IO
authors.lastname: Tomashevskiy
authors.forename: David
authors.initials: D
authors.lastname: Soave
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001416:Back Pain / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy; D010147:Pain Measurement; D010808:Physical Examination / Q000379:methods; D018570:Risk Assessment; D012426:Russia; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016896:Treatment Outcome