The Study: Changes in chronic neck pain following the introduction of a visco-elastic polyurethane foam pillow and/or chiropractic treatment.                   

The Facts:

a. Pillows to improve sleep ergonomics are commonly prescribed in chiropractic practices.  

b. It is postulated that putting patients into a better sleeping position improves sleep quality and tissue repair in the area of the facet joints.

c. This study included 30 subjects suffering from chronic neck pain.

d. 15 subjects received chiropractic care every three to four days for a total of six treatments.

e. The other 15 received identical care but also received a visco-elastic pillow (VEP) for sleeping.

f. The chiropractic care consisted of: “chiropractic manipulation of the cervical spine using a diversified technique…”

g. Palpation was used to find areas of restriction which were then manipulated.

h. A “VEP pillow (Memory Foam®, Sleep Active, South Africa) which included instructions on the pillow’s use.” was given to those subjects who received both manipulation and a pillow for their chronic neck pain.

i. Both the group that received manipulation and the one that received manipulation and a pillow showed improvement.

j. The authors concluded, “While both the chiropractic treatment and the combined treatment proved effective, the clinical performance of the CHI+P (chiropractic plus pillow) group with regard to NRS (numerical pain rating scale) indicates a potential synergistic effect of the VEP foam pillow with cervical manipulation in the treatment of chronic neck pain.”

k. In the discussion the author stated, “By addressing sleep ergonomics during the time of receiving chiropractic manipulation, it may be hypothesized that the facet joints may have had an improved chance to repair an injury.”  

Take Home:

The use of chiropractic care along with this pillow (and instructions in its use) showed better improvement as indicated by a numerical pain rating scale as compared to chiropractic alone.

 Reviewer's Comments:

I agree with the authors that, “The small sample does allow for some insights, but no definitive conclusions can be made.” and also that further research into this area is needed. People tend to move about during sleep and I see that as a potential confounder in these types of studies. Nevertheless, this is an interesting study.  I did feel encouraged that the addition of the pillow along with the instructions on its use showed an improved outcome and I look forward to upcoming papers in this area.  

Reviewer:  Roger Coleman DC

Editor: Mark R. Payne DC 

Reference: Soal LJ, Bester CM, Shaw BS, Yelverton C. Changes in chronic neck pain following the introduction of a visco-elastic polyurethane foam pillow and/or chiropractic treatment. Health SA. 2019 Oct 9;24:1099. doi: 10.4102/hsag.v24i0.1099. eCollection 2019. 

Link to Abstract:  https://www.ncbi.nlm.nih.gov/pubmed/31934412

Link to Article:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917418/pdf/HSAG-24-1099.pdf