Diaphragmatic Breathing and Electroacupuncture for Chronic Neck Pain

Diaphragmatic Breathing and Electroacupuncture in Patients With Chronic Neck Pain

Chronic non specific neck pain is a prevalent musculoskeletal disorder with significant impact on pain, forward head posture, and neck disability. Diaphragmatic breathing has been shown to improve relaxation and reduce musculoskeletal pain, while electroacupuncture has potential benefits in modulating pain pathways. However, the combined effect of these interventions in chronic neck pain remains unexplored. This randomized clinical trial aims to evaluate the effectiveness of diaphragmatic breathing and electroacupuncture, in addition to physiotherapy care, compared to simple, focused breathing, electroacupuncture, and physiotherapy care. The primary outcomes are the numeric pain rating scale (NPRS) and neck disability index (NDI), while secondary outcome include craniovertebral angle (CVA).

Study Overview

• Status: Enrolling by invitation
• Conditions: Chronic Neck Pain
• Intervention / Treatment: Other: physiotherapy care, diaphragmatic breathing, and electroacupuncture; Other: physiotherapy care, simple focused breathing exercises, and electroacupuncture

Detailed Description

Chronic neck pain (CNP) is characterized as persisting pain for more than 3 months, which has a longer expected recovery time. It may be linked to a deficiency or modification of the proprioception of the neck muscles, which is essential for head motor control, cervical joint position, and postural stability (PS). In terms of pain and disability, neck discomfort presents a significant medical problem for patients. According to reports, neck pain is a major cause of illness and a global hardship. The most typical signs of the aforementioned condition are localized, dull, and deep muscle discomfort. Additional symptoms include exhaustion, stiffness, pain, decreased activity, involvement restriction, and difficulty performing coordinated motions.

Standard physiotherapy for persistent neck pain, which includes stretching, isometric exercises, and hot pack therapy, has been shown in recent trials (2021-2024) to effectively reduce pain and improve function. Isometric exercises, self-stretching, active range of motion, heat packs, and self-mobilization methods were all used in this recent randomized controlled experiment.

A breathing technique called diaphragmatic breathing training encourages maximum exhalation, enhances lung ventilation, and facilitates the release of secretions from the trachea. The objectives of these exercises are to modify the recruitment of respiratory muscles, decrease hyperinflation, enhance respiratory muscle function, maximise thoracoabdominal mobility, and lessen dyspnoea. Through diaphragmatic respiration, they can support trunk stability and lung function and posture correction.

CNP is also treated in traditional medicine using various techniques. Electroacupuncture (EA) is one of such techniques; it is safe and doesn't require medication, and numerous studies have shown that it effectively reduces pain and enhances patients' quality of life. Electroacupuncture (EA) is a modified form of acupuncture in which, following a traditional acupuncture procedure, weak electronic currents are applied through the needles.

• Study Type: Interventional
• Enrollment (Estimated): 72
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54782
      • University of lahore teaching hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients having a history of the previous 3 months of chronic neck pain
• NPRS 4-7
• Patients having paradoxical breathing
• CVA less than 49 degrees

Exclusion Criteria:

• Congenital abnormality of the cervical spine
• Post-traumatic neck pain
• Hemorrhagic diseases
• Radiculopathy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Physiotherapy care, Diaphragmatic breathing, Electroacupuncture; These patients will receive physiotherapy care, diaphragmatic breathing, and electroacupuncture as part of their treatment program. Total session time: 50 minutes Treatment schedule: 3 sessions on alternate days for 6 weeks	Other: physiotherapy care, diaphragmatic breathing, and electroacupuncture; Physiotherapy care: 30 minutes of physiotherapy, including 10 minutes of hot pack, neck isometrics (muscle setting exercises) (10x10) 3 sets for 10 minutes, and stretching exercises for 10 minutes.; Diaphragmatic breathing: 10 min per session in a comfortable supine position or focusing on slow, deep inhalation with diaphragmatic expansion will reduce pain threshold and prepare the patients to receive the electroacupuncture.; Electroacupuncture: Electrical stimulation with acupuncture needles will be applied to the targeted muscle group for 10 minutes per session by a certified practitioner. The targeted muscles will be the upper trapezius, levator scapulae, splenius capitis, and anterior scalene.; Treatment schedule: The session will consist of 30 minutes of physiotherapy care, 10 minutes of diaphragmatic breathing, and 10 minutes of electroacupuncture
Active Comparator: Physiotherapy care, Simple focused breathing, Electroacupuncture; These patients will receive physiotherapy care, simple focused breathing exercises, and electroacupuncture as part of their treatment program. Total session time: 50 minutes Treatment schedule: 3 sessions on alternate days for 6 weeks	Other: physiotherapy care, simple focused breathing exercises, and electroacupuncture; Physiotherapy care: 30 minutes of physiotherapy, including 10 minutes of hot pack, neck isometrics (muscle setting exercises) (10x10) 3 sets for 10 minutes, and stretching exercises for 10 minutes.; Simple focused breathing exercises: 10 minutes per session of simple, focused breathing exercises.; Electroacupuncture: Electrical stimulation with acupuncture needles will be applied to the targeted muscle group for 10 minutes per session by a certified practitioner. The targeted muscles will be the upper trapezius, levator scapulae, splenius capitis, and anterior scalene.; Treatment schedule: The session will consist of 30 minutes of physiotherapy care, 10 minutes of simple focused breathing exercises, and 10 minutes of electroacupuncture.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity	Pain intensity will be assessed using the Numeric Pain Rating Scale, an 11 point scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst pain imaginable. Higher scores indicate greater pain (worse outcome).	Baseline 1st, 3rd and at 6th week of intervention
Neck Disability	Neck disability will be assessed using the Neck Disability Index Urdu version , a 10-item questionnaire with a total score ranging from 0 to 50. Higher scores indicate greater disability (worse outcome).	Baseline 1st, 3rd and at 6th week of intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Craniovertebral Angle (CVA)	Craniovertebral angle will be measured in degrees (°) using Kinovea software version 0.8.27 (64-bit) from standardized lateral photographs. The craniovertebral angle is calculated as the angle between a horizontal line passing through the spinous process of C7 and a line joining C7 to the tragus of the ear. Higher CVA values indicate improved head and neck posture (better outcome), whereas lower values indicate greater forward head posture (worse outcome).	Baseline 1st, 3rd and at 6th week of intervention

Collaborators and Investigators

• Sponsor: University of Lahore
• Investigators: Study Chair: Sahreen Anwar, PhD, University of Lahore

Study record dates

Study Major Dates

• Study Start (Actual): November 15, 2025
• Primary Completion (Estimated): August 15, 2026
• Study Completion (Estimated): September 15, 2026

Study Registration Dates

• First Submitted: June 28, 2026
• First Submitted That Met QC Criteria: June 28, 2026
• First Posted (Actual): July 6, 2026

Study Record Updates

• Last Update Posted (Actual): July 9, 2026
• Last Update Submitted That Met QC Criteria: July 7, 2026
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: electroacupuncture; randomized clinical trial; pain management; chronic neck pain; craniovertebral angle; diaphragmatic breathing; physiotherapy care; neck disability index
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Agnosia; Therapeutics; Complementary Therapies; Physical Therapy Modalities; Rehabilitation; Anesthesia and Analgesia; Electric Stimulation Therapy; Combined Modality Therapy; Anesthesia; Analgesia; Acupuncture Therapy; Transcutaneous Electric Nerve Stimulation; Electroacupuncture
• Other Study ID Numbers: UOL/IREB/25/12/0036

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No