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Franklin Hughes


Anxiety, Vertebral Subluxation, Salivary Cortisol, Neck Pain, Headache, Mental Health


Objective:  To describe the improvement of anxiety symptoms along with decreased salivary cortisol levels and improved functional capabilities in a patient who received chiropractic care for neck pain and headache.

Clinical Features:  A 40-year-old female patient sought care for chronic, recurring neck pain and headache, which she indicated had a negative impact on her activities of daily living (ADLs).  She also noted a history of anxiety, which worsened with increasing severity of her musculoskeletal complaints. Neck pain and headache were assessed with the Neck Pain Disability Index (NDI). Anxiety and depression were screened using the PHQ-4 and GAD-7 questionnaires. She provided saliva samples for measurement by enzyme-linked immunoassay (ELISA) to study correlation with perceived anxiety and to ascertain whether or not cortisol levels were impacted by treatment. Radiographic examination of the cervical and thoracic spine revealed loss of the cervical lordosis, mild degenerative changes at C5/C6 and a mild dextroscoliosis of the thoracic spine. Abnormalities were noted along with decreased cervical range of motion (ROM).

Intervention & Outcomes: Treatment consisted of chiropractic adjustments to the cervical and thoracic spine using Diversified Technique along with Instrument-Assisted Soft-Tissue Mobilization over the course of 12 visits. A home exercise plan was also prescribed. The patient reported improvement of her musculoskeletal complaints and anxiety throughout treatment as noted on the NDI, PHQ-4 and GAD-7 questionnaires resulting in improved tolerance to ADLs.  Objectively, improvements in posture, spinal ROM and reduction of indicators for vertebral subluxation were also recorded. Salivary cortisol levels also declined with treatment.

Conclusion: Chiropractic management of chronic, recurring neck pain and headache in a patient with anxiety was associated with subjective improvement in both musculoskeletal and anxiety symptoms resulting in improved physical function. There also appeared to be a correlation between the patient’s perceived anxiety and salivary cortisol levels. This case provides an argument for the use of chiropractic management for generalized anxiety disorders in patients with chronic pain and suggests the need for further research in complementary and alternative treatments for improved mental health.


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