{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T18:04:47Z","timestamp":1788026687813,"version":"build-2784847793"},"reference-count":45,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Chronic cervical radiculopathy (CR) is a common cause of pain and disability in adults. The primary objective of our study was to evaluate the efficacy of a structured, multimodal rehabilitation program, with or without adjunct neurotrophic supplementation, in chronic cervical radiculopathy; secondarily, this study investigates which patients are most likely to benefit from neurotrophic supplementation and aims to assess effects on pain, cervical mobility, disability, and daily activities to guide individualized care. Patients and Methods: In this prospective, randomized controlled trial, 82 patients with chronic CR were allocated to a study group (SG, n = 42) receiving a three-month multimodal rehabilitation program plus daily neurotrophic supplementation (named PHSD) or a control group (CG, n = 40) receiving the same rehabilitation alone. Outcome measures included the Visual Analogue Scale (VAS), Neck Disability Index (NDI), cervical mobility indexes (CSI\u2014Chin-Sternum Index; OWI\u2014Occiput-Wall Index; TAI\u2014Tragus-Acromion Index), and Katz ADL (Activity of Daily Living) Index, assessed at baseline and after three months. Results: Both groups showed significant improvements, but the SG demonstrated greater reductions in pain (median VAS change: 8.16 \u00b1 0.72 vs. 5.11 \u00b1 0.70, p &lt; 0.001) and disability (mean NDI change: 24.71 \u00b1 5.13 vs. 20.90 \u00b1 4.49, p &lt; 0.001). Cervical mobility indexes improved in both groups, with larger gains in the SG (p &lt; 0.01), supporting the potential benefits of adding neurotrophic supplementation. Conclusions: A structured multimodal rehabilitation program significantly improves pain, mobility, and disability in chronic CR, while combining it with PHSD may enhance these effects. Further randomized trials are needed to confirm these findings and establish standardized conservative treatment protocols.<\/jats:p>","DOI":"10.3390\/life15111690","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T02:48:28Z","timestamp":1761878908000},"page":"1690","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Assessment and Rehabilitation in Cervical Radiculopathy\u2014Efficacy of Structured Program with or Without Neurotrophic Agents"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6555-5731","authenticated-orcid":false,"given":"Rodica Magdalena","family":"Tr\u0103istaru","sequence":"first","affiliation":[{"name":"Department of Physical Rehabilitation, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal Constantin","family":"Kamal","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Kamal","sequence":"additional","affiliation":[{"name":"Department of Physical Rehabilitation, Filantropia Hospital, 200134 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana-Lidia","family":"Tache-Codreanu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Colentina University Hospital, 020125 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adina Maria","family":"Kamal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/j.mcna.2014.04.001","article-title":"Cervical radiculopathy","volume":"98","author":"Corey","year":"2014","journal-title":"Med. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s005860050001","article-title":"Cervical radiculopathy and myelopathy: When and what can surgery contribute to treatment?","volume":"9","author":"Yonenobu","year":"2000","journal-title":"Eur. Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"70S","DOI":"10.1177\/2192568217701914","article-title":"A clinical practice guideline for the management of patients with degenerative cervical myelopathy","volume":"7","author":"Fehlings","year":"2017","journal-title":"Global Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.mcna.2018.10.012","article-title":"Entrapment neuropathies of the upper extremity","volume":"103","author":"Doughty","year":"2019","journal-title":"Med. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"35","DOI":"10.4103\/sni.sni_441_17","article-title":"Treatment of cervical radiculopathy: A review of the evolution and economics","volume":"9","author":"Ament","year":"2018","journal-title":"Surg. Neurol. Int."},{"key":"ref_6","unstructured":"Magnus, W., Viswanath, O., Viswanathan, V.K., and Meskin, F.B. (2025). Cervical radiculopathy. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"44","DOI":"10.3399\/bjgp17X694361","article-title":"Cervical radiculopathy and cervical myelopathy: Diagnosis and management in primary care","volume":"68","author":"McCartney","year":"2018","journal-title":"Br. J. Gen. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12998-016-0126-7","article-title":"Effectiveness of manual therapy for cervical radiculopathy, a review","volume":"24","author":"Thoomes","year":"2016","journal-title":"Chiropr. Man. Therap."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kwon, J., Oh, D., Lee, B., Lee, H., Ko, M., Moon, S., Park, Y., Kim, S., and Kim, S. (2022). Neuropathic pain component in patients with cervical radicular pain: A single-center retrospective study. Medicina, 58.","DOI":"10.3390\/medicina58091191"},{"key":"ref_10","first-page":"58","article-title":"A three-stage concept of spine pathology treatment\u2014A different perspective","volume":"62","author":"Koszela","year":"2024","journal-title":"Reumatologia"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2242","DOI":"10.1007\/s00586-017-5121-8","article-title":"National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy","volume":"26","author":"Kjaer","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_12","unstructured":"North American Spine Society (NASS) (2025, August 25). Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care: Diagnosis and Treatment of Cervical Radiculopathy from Degenerative Disorders. NASS., Available online: https:\/\/www.spine.org\/Research-Clinical-Care\/Quality-Improvement\/Clinical-Guidelines."},{"key":"ref_13","first-page":"CD004250","article-title":"Exercises for mechanical neck disorders","volume":"2016","author":"Gross","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1080\/10669817.2024.2425788","article-title":"Manual physical therapy for neck disorders: An umbrella review","volume":"33","author":"Reynolds","year":"2025","journal-title":"J. Man. Manip. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"468","DOI":"10.2519\/jospt.2025.12757","article-title":"Effectiveness of articular and neural mobilization for cervical radiculopathy: A meta-analysis","volume":"55","year":"2025","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1007\/s00586-004-0864-4","article-title":"The prevalence of neck pain in the world population: A systematic critical review","volume":"15","author":"Fejer","year":"2006","journal-title":"Eur. Spine J."},{"key":"ref_17","first-page":"33","article-title":"Cervical radiculopathy: Nonoperative management of neck pain and radicular symptoms","volume":"81","author":"Eubanks","year":"2010","journal-title":"Am. Fam. Physician"},{"key":"ref_18","first-page":"e088","article-title":"Validation of digital visual analog scale pain scoring","volume":"2","author":"Delgado","year":"2018","journal-title":"J. Am. Acad. Orthop. Surg. Glob. Res. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.jmpt.2008.08.006","article-title":"The Neck Disability Index: State-of-the-art, 1991\u20132008","volume":"31","author":"Vernon","year":"2008","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_20","unstructured":"Fern\u00e1ndez de las Pe\u00f1as, C., Cleland, J.A., and Huijbregts, P.A. (2011). Mechanical neck pain. Neck and Arm Pain Syndromes, Churchill Livingstone."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1111\/j.1532-5415.1983.tb03391.x","article-title":"Assessing self-maintenance: ADL, mobility and IADL","volume":"31","author":"Katz","year":"1983","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1111\/j.1748-3743.2007.00074.x","article-title":"A comparative review of the Katz ADL and the Barthel Index","volume":"2","author":"Hartigan","year":"2007","journal-title":"Int. J. Older People Nurs."},{"key":"ref_23","first-page":"770","article-title":"Prognosis of acute and persistent neck pain: A systematic review and meta-analysis","volume":"153","author":"Michaleff","year":"2012","journal-title":"Pain"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s00586-012-2297-9","article-title":"Lack of uniform diagnostic criteria for cervical radiculopathy in conservative intervention trials: A systematic review","volume":"21","author":"Thoomes","year":"2012","journal-title":"Eur. Spine J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"j3221","DOI":"10.1136\/bmj.j3221","article-title":"Advances in the diagnosis and management of neck pain","volume":"358","author":"Cohen","year":"2017","journal-title":"BMJ"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"A1","DOI":"10.2519\/jospt.2008.0303","article-title":"Neck pain: Clinical practice guidelines","volume":"38","author":"Childs","year":"2008","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Engebretsen, K.B., Taso, M., Bjorland, S., Jenssen, H.K., Skaara, H.E., and Brox, J.I. (2024). A functional intervention within a cognitive approach to chronic cervical radiculopathy: Study protocol. BMC Musculoskelet. Disord., 25.","DOI":"10.1186\/s12891-024-07743-0"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kuligowski, T., Skrzek, A., and Cie\u015blik, B. (2021). Manual Therapy in Cervical and Lumbar Radiculopathy: A systematic review of the literature. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18116176"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"441","DOI":"10.4103\/kleuhsj.kleuhsj_368_23","article-title":"Management of cervical radiculopathy: Current systematic reviews","volume":"16","author":"Rissardo","year":"2023","journal-title":"Indian J. Health Sci. Biomed. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2217\/pmt.15.60","article-title":"Uridine monophosphate, folic acid and vitamin B12 in symptomatic peripheral entrapment neuropathies","volume":"6","author":"Nunes","year":"2016","journal-title":"Pain Manag."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"397","DOI":"10.2147\/JPR.S123045","article-title":"A double-blind randomized study of uridine triphosphate, cytidine monophosphate and hydroxocobalamin","volume":"10","author":"Goldberg","year":"2017","journal-title":"J. Pain Res."},{"key":"ref_32","first-page":"763","article-title":"Morphometric findings in avascular necrosis of the femoral head","volume":"53","author":"Kamal","year":"2012","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_33","first-page":"4105","article-title":"Boswellia derivates and rehabilitation program in knee osteoarthritis patients","volume":"69","author":"Alexandru","year":"2018","journal-title":"Rev. Chim."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"507","DOI":"10.31925\/farmacia.2018.3.17","article-title":"The role of herbal extracts in knee osteoarthritis females rehabilitation","volume":"66","author":"Alexandru","year":"2018","journal-title":"Farmacia"},{"key":"ref_35","first-page":"1265","article-title":"The placebo and nocebo effects in neuropathic pain clinical trials: Systematic review and meta-analysis","volume":"163","author":"Woldeamanuel","year":"2022","journal-title":"Pain"},{"key":"ref_36","first-page":"45","article-title":"B-vitamins in the treatment of neuropathic pain: A systematic review and meta-analysis","volume":"26","author":"Baltrusch","year":"2023","journal-title":"Pain Physician"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/S0074-7742(02)50083-0","article-title":"Nerve growth factor for the treatment of diabetic neuropathy","volume":"50","author":"Apfel","year":"2002","journal-title":"Int. Rev. Neurobiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/ALN.0000000000002130","article-title":"Neuroinflammation and central sensitization in chronic pain","volume":"129","author":"Ji","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1038\/nri3621","article-title":"Pathological pain and the neuroimmune interface","volume":"14","author":"Grace","year":"2014","journal-title":"Nat. Rev. Immunol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev.neuro.051508.135531","article-title":"Neuropathic pain: A maladaptive response of the nervous system to damage","volume":"32","author":"Costigan","year":"2009","journal-title":"Annu. Rev. Neurosci."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"MaMatei, D., Traistaru, R., Amzolini, A.M., Ianosi, L.S., Neagoe, C.D., Mitrea, A., Clenciu, D., and Avramescu, T.E. (2024). A comparative study on the pain threshold experienced by fibromyalgia patients following acute SARS-CoV-2 infection. Life, 14.","DOI":"10.3390\/life14080942"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"b3883","DOI":"10.1136\/bmj.b3883","article-title":"Cervical collar or physiotherapy versus wait-and-see policy for recent onset cervical radiculopathy: Randomized trial","volume":"339","author":"Kuijper","year":"2009","journal-title":"BMJ"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1097\/BRS.0b013e31829ff095","article-title":"Surgery versus nonsurgical treatment of cervical radiculopathy: A prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alonewith a 2-year follow-up","volume":"38","author":"Engquist","year":"2013","journal-title":"Spine"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2509","DOI":"10.1001\/jama.289.19.2509","article-title":"Active neck muscle training in chronic neck pain in women: A randomized controlled trial","volume":"289","author":"Ylinen","year":"2003","journal-title":"JAMA"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Carrasco-Uribarren, A., Ceballos-Laita, L., P\u00e9rez-Guill\u00e9n, S., Jim\u00e9nez-Del-Barrio, S., Rodr\u00edguez-Rubio, P.R., Pantale\u00f3n-Hern\u00e1ndez, D., and Cabanillas-Barea, S. (2025). Is manual therapy effective for cervical dizziness? A systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet. Disord., 26.","DOI":"10.1186\/s12891-025-08899-z"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/11\/1690\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T03:13:12Z","timestamp":1761880392000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/11\/1690"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":45,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["life15111690"],"URL":"https:\/\/doi.org\/10.3390\/life15111690","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]}}}