317: Global Perceived Effect of Multimodal Neck Rehabilitation within Chronic Nonspecific Neck Pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Non-pharmacological treatments, Physiotherapy (e.g. exercise, rehab), Physiotherapy

Background and Aims: Chronic nonspecific neck pain (CNSNP) is a prevalent condition associated with persistent pain, disability, and reduced quality of life. The Global Perceived Effect (GPE) is a patient reported outcome reflecting overall clinical change and treatment effectiveness. A multimodal neck rehabilitation program (MNRP), combining exercise and manual therapy, is recommended for CNSNP management, however adjunct electroanalgesic and phototherapeutic modalities are commonly applied despite limited evidence on patient perceived recovery. This study aimed to assess GPE following an MNRP and to investigate whether adding transcutaneous electrical nerve stimulation (TENS), interferential current (IC), or photobiomodulation therapy (PBMT) provides additional perceived clinical benefit.

Methods: This secondary analysis included data from two randomized controlled trials involving adults aged 18–65 years with CNSNP lasting longer than 90 days, pain intensity greater than three on the numerical rating scale, and Neck Disability Index scores above five. Participants were randomly allocated to four groups: MNRP, MNRP combined with PBMT, IC, or TENS; each group delivered across sixteen treatment sessions. GPE was assessed immediately after the intervention and at 30-day follow-up. Data were analyzed using parametric (ANOVA and t tests) and nonparametric (Kruskal Wallis) statistical tests based on distribution, with an additional percentage-based improvement classification.

Results: A total of 126 participants were analyzed across the four intervention groups. No statistically significant between-group differences were observed in GPE scores either immediately post-intervention or at follow-up. Within-group analyses demonstrated modest but statistically significant improvements over time in the MNRP and MNRP +TENS groups. The proportion of participants classified as clinically improved based on percentage change did not differ significantly among groups. Overall, the addition of IC, TENS, or PBMT modalities did not yield superior patient-perceived outcomes compared with the multimodal physiotherapy program alone.

Conclusions: The findings indicate that incorporating TENS, IC, or PBMT into a multimodal neck rehabilitation program does not enhance the GPE in individuals with CNSNP. While multimodal rehabilitation remains effective in promoting perceived clinical improvement, adjunct modalities should not be routinely included solely to increase patients’ overall perception of recovery. Their clinical use should be guided by demonstrated benefits in specific outcomes, such as pain intensity, functional performance, or disability reduction, rather than by expectations of a superior global treatment response.

References: de Santana, G. N. et al. Does Adding Electroanalgesic Modalities to a Multimodal Therapeutic Program Improve Clinical Outcomes in Individuals With Chronic Nonspecific Neck Pain? A Randomised Controlled Trial. Eur. J. Pain 29, e70121 (2025).
Barbosa da Silva, A. C. et al. Multimodal therapeutic intervention program associated with photobiomodulation therapy for individuals with chronic nonspecific neck pain: protocol for a clinical trial. Trials 25, 442 (2024).
Chaikla, R., Sremakaew, M., Saekho, S., Kothan, S. & Uthaikhup, S. Effects of manual therapy combined with therapeutic exercise on brain structure in patients with chronic nonspecific neck pain: A randomized controlled trial. J. Pain 29, (2025).

Presenting Author: Cid André Fidelis de Paula Gomes
Submitting Author: Barbara Greco Miura

Senior Author: Cid André Fidelis de Paula Gomes

IASP 2026 Global Year theme of Neuropathic Pain: No

• Cid André Fidelis de Paula Gomes: PhD - Universidade Nove de Julho
• Patricia Gabrielle dos Santos: MSc - Universidade Nove de Julho
• Gabriela Nascimento de Santana: PhD - Universidade Nove de Julho
• Aron Charles Barbosa da Silva: PhD - Universidade Nove de Julho
• Bruno Ruocco Verengue: MSc - Universidade Nove de Julho