Seeing the site of treatment improves habitual pain but not cervical joint position sense immediately after manual therapy in chronic neck pain patients

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Visual analgesia refers to the phenomena where people report decreased pain intensity when they see the painful or painfully stimulated body part. Alongside pain, sensorimotor impairment (i.e., disturbed proprioception) is also evident in chronic pain. This study aims to investigate whether real-time visual feedback offers additional pain relief and proprioceptive improvement when used in combination with recommended therapies in neck pain patients who received manual therapy with or without real-time visual feedback.


A total of 29 neck pain patients were recruited in an outpatient physical therapy practice. Patients were randomly allocated to receive manual therapy of the cervical spine with real-time visual feedback or to a control group where patients received manual therapy without real-time visual feedback. Habitual pain intensity, the pressure pain threshold at the zygapophyseal joint of C2–C3 and the superior angle of the scapulae and cervical proprioception were assessed before and immediately after the intervention by a blinded assessor.


A between-group comparison revealed a significant reduction in habitual pain in the real-time visual feedback group. No differences were found for the pressure pain threshold or proprioceptive performance.


Real-time visual feedback combined with manual therapy enhanced the analgesic effect of manual therapy in neck pain patients, but had no positive effect on the pressure pain threshold and cervical joint position sense. The technical demands for integrating real-time visual feedback into daily practice to reduce habitual pain are low, have low costs and are easy to apply.


Real-time visual feedback reduces habitual pain immediately after the intervention. Due to its easy integration, it may be an effective adjunct to recommended interventions (i.e., manual therapy) in patients with neck pain.

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