Pillow preferences of people with neck pain and known spinal degeneration: a pilot randomized controlled trial.

Background: In people without cervical pathologies, changing to a latex or polyester pillow is reported to decrease waking cervical symptoms. Whether this also occurs for people with spinal degeneration in the neck is unknown.

Aim: This pilot study tested recruitment strategies for people with cervical spine degeneration, and the effect of different pillows on cervical waking symptoms, sleep quality, cervical range of motion, neck disability index and quality of life.

Design: A randomized sequential-block double-blind controlled trial.

Setting: A community-based study.

Population: Adult volunteers (18+ years) with regular waking cervical symptoms (headache, cervical pain and/or stiffness, scapular pain), confirmed radiologic evidence of cervical spine degeneration, side sleeper and "usual" use of one pillow.

Methods: Participants were recruited, through community advertising at medical and physiotherapy practices, local community groups, and via newspaper, radio and websites. After screening for eligibility, they tested latex and polyester pillows for 28 days each, interspersed with 28 days on "usual" pillow for washout, and comparison. Subjects ceased using a trial pillow if it affected sleep quality or waking symptoms. Cervical range of motion, neck disability index and quality of life were measured pre-post each pillow trial, whilst waking symptoms and sleep quality were assessed daily.

Results: Of 117 local volunteers, 92 had radiologically-confirmed cervical spondylosis, and a further 45 (48.9%) were excluded for medical conditions, sleep position and/or pillow use. Approximately 70% "usual" pillows were polyester. Overall no pillow significantly altered any outcome measure. Considering trends however, the polyester pillow significantly increased side flexion range of movement on waking and showed some effect on nocturnal-waking cervical pain. The latex pillow did not perform well on any outcome measure. Significantly more subjects completed the polyester pillow trial than the latex pillow trial (post-hoc power 80% vs. 55%).

Conclusions: Well-powered studies to truly detect pillow impact on waking symptoms and sleep quality require 400+ symptomatic subjects.

Clinical Rehabilitation Impact: It has previously been reported that using a latex or polyester pillow significantly improves waking cervical symptoms in the general population. This pilot study did not replicate these results in people with known cervical spine degeneration.