Multidimensional Effects of Manual Therapy Combined with Pain Neuroscience-Based Sensorimotor Retraining in a Patient with Chronic Neck Pain: A Case Study Using fNIRS.

Abstract

Chronic neck pain is a multifactorial condition involving physical, psychological, and neurological dimensions. This case report describes the clinical course of a 25-year-old female with chronic neck pain and recurrent headaches who underwent a 6-week integrative intervention consisting of manual therapy and pain neuroscience-based sensorimotor retraining, administered three times per week. Outcome measures included the Headache Impact Test-6 (HIT-6), Neck Pain and Disability Scale (NPDS), Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ), pressure pain threshold (PPT), cervical range of motion (CROM), and functional near-infrared spectroscopy (fNIRS) to assess brain activity. Following the intervention, the patient demonstrated marked reductions in pain and psychological distress: HIT-6 decreased from 63 to 24 (61.9%), NPDS from 31 to 4 (87.1%), FABQ from 24 to 0 (100%), and PCS from 19 to 2 (89.5%). Improvements in PPT and CROM were also observed. fNIRS revealed decreased dorsolateral prefrontal cortex (DLPFC) activation during pain stimulation and movement tasks, suggesting a possible reduction in central sensitization burden. These findings illustrate that an integrative approach targeting biopsychosocial pain mechanisms may be beneficial in managing chronic neck pain, improving function, and modulating cortical responses. This report provides preliminary evidence in support of the clinical relevance of combining manual therapy with neurocognitive retraining in similar patients.