Effects of Transcutaneous Neuromodulation and Cervical Exercise in Students With Chronic Nonspecific Cervical Pain

Chronic non-specific neck pain is one of the most prevalent musculoskeletal disorders worldwide and represents a significant socioeconomic burden. It affects a large proportion of the adult population and shows increasing prevalence among university students, largely associated with prolonged electronic device use and sustained static postures. Chronic neck pain is defined as pain lasting three months or longer without a specific identifiable pathology.

Psychosocial factors such as stress, anxiety, and depression have been strongly associated with the onset and persistence of neck pain. These factors may contribute to functional disability and reduced quality of life. In university students, persistent neck pain may also negatively impact concentration and academic performance.

Exercise therapy targeting deep cervical flexor muscles has demonstrated improvements in pain, muscular endurance, posture, and functional outcomes in individuals with chronic non-specific neck pain. Additionally, prolonged upper trapezius muscle spasm and possible involvement of the spinal accessory nerve have been suggested as contributing mechanisms in chronic neck pain. Low-frequency electrical stimulation (below 10 Hz), particularly at 4 Hz, has been associated with analgesic effects mediated by endogenous opioid mechanisms.

Placebo interventions have also been shown to activate endogenous analgesic pathways involving cortical and subcortical pain modulation circuits, emphasizing the relevance of patient expectations in rehabilitation outcomes.

This study will compare cervical exercise, transcutaneous neuromodulation of the spinal accessory nerve, and a placebo intervention in a randomized, controlled, parallel-group design with blinded outcome assessment. Both physical and psychosocial variables will be evaluated before and after a six-week intervention period.