Choosing a Pillow? Which is best?

I am often asked by my neck pain and headache sufferers, “What is the best type of pillow to use when sleeping?” I’ve always been of the opinion that the pillow depends on the person and the problem they are experiencing but is this what the research says?

So what is the best pillow? Is it the chiropractic pillow? Is it a regular pillow? Does the material matter?  Rather than sticking with my own opinion, I decided to see what the research had to say regarding the subject. Take a look at the end of this blog to read the research papers I found. I used a pubmed search using the search term “neck/cervical pain and pillows“.

Highlights of the research papers I read:

  • The rubber pillow performed better than subjects’ own pillow in most instances. Subjects’ own pillow performed similarly to foam and polyester pillows, and there is no evidence that the use of a foam contour pillow has advantages over the regular shaped pillows. Feather pillows should not be recommended.
  • From a patient’s perspective, neck support is an important part of a comprehensive physiotherapy program. Most participants preferred the more rigid support of a Shape of Sleep pillow.
  • The results suggest that the ARCP  (Align-Right (roll-shaped) cervical pillow) has clinically important beneficial effects on the neck pain severity of most chronic neck-pain sufferers. 
  • The water-based pillow was associated with reduced morning pain intensity, increased pain relief, and improved quality of sleep. The duration of sleep was significantly shorter for the roll pillow. 
  • The ideal pillow should be soft and not too high, should provide neck support and should be allergy-tested and washable. The pillow that included two firmer supporting cores for neck lordosis received the best rating. 
  • The opinion was that an ideal pillow should be soft and with good support for the neck lordosis (curve). A specially selected and individually tested pillow with good shape, comfort and support to the neck lordosis (curve in the neck) can reduce neck pain and headache and give a better sleep quality.
Impression
 
It is evident that not many articles are available to review.  From what I see, there is no specific pillow that is best for everyone.  The conclusion of the last article provides the best advice, “a specially selected and individually tested pillow” is best.  Therefore, try different pillows, those that support the neck, until the best results are experienced.  
 
Dr Notley
 
Articles
 

Pillow use: the behaviour of cervical pain, sleep quality and pillow comfort in side sleepers.
Gordon SJ, Grimmer-Somers K, Trott P.
Man Ther. 2009 Dec;14(6):671-8. Epub 2009 May 7.

Abstract
A random allocation single blind block design pillow field study was undertaken to investigate the behaviour of cervico-thoracic spine pain in relation to pillow use. Participants (N=106) who reported preference for side sleep position with one pillow were recruited via a telephone survey and newspaper advertisement. They recorded sleep quality and pillow comfort ratings, frequency of retiring and waking cervical pain and duration of waking cervical pain while sleeping for a week on their usual pillow, polyester, foam, feather and rubber pillows of regular shape and a foam contour pillow. Analysis was undertaken comparing sleep quality, pillow comfort, waking and temporal cervical pain reports, between the usual pillow and the trial pillows, between pillows of differing content and foam pillows of differing shape. This study provides evidence to support recommendation of rubber pillows in the management of waking cervical pain, and to improve sleep quality and pillow comfort. The rubber pillow performed better than subjects’ own pillow in most instances. Subjects’ own pillow performed similarly to foam and polyester pillows, and there is no evidence that the use of a foam contour pillow has advantages over the regular shaped pillows. Feather pillows should not be recommended.

A comparison of three types of neck support in fibromyalgia patients.
Ambrogio N, Cuttiford J, Lineker S, Li L.
Arthritis Care Res. 1998 Oct;11(5):405-10.

Abstract
OBJECTIVE:
To determine the effectiveness of 3 types of neck support for patients with fibromyalgia (FMS) and their preference for the type of support.
METHODS:
Thirty-five patients with FMS chose the order of application and used each type of neck support for a 2-week period, followed by a 2-week washout. The same schedule was repeated a second time. The neck supports included a Shape of Sleep pillow, two neck ruffs with one standard pillow, and a single standard pillow. All subjects received a physiotherapy treatment and educational program in the home. Outcome measures included visual analog scales (VAS) for neck pain and quality of sleep, the Fibromyalgia Impact Questionnaire (FIQ), and a neck and shoulder pain distribution diagram.
RESULTS:
Analysis using Friedman’s 2-way analysis of variance revealed no significant differences in any outcome measure, although there was a trend towards improvement in the FIQ and VAS neck pain and quality of sleep scores for some patients. Most participants (62.9%) preferred the Shape of Sleep pillow, 20.0% preferred cervical ruffs with one standard pillow, and 17.1% preferred a single standard pillow.
CONCLUSIONS:
The results of this study are inconclusive due to the small sample size. However, from a patient’s perspective, neck support is an important part of a comprehensive physiotherapy program. Most participants preferred the more rigid support of a Shape of Sleep pillow. Further research into the efficacy of the use of neck support in people with FMS is warranted.

Before/after study to determine the effectiveness of the align-right cylindrical cervical pillow in reducing chronic neck pain severity.
Hagino C, Boscariol J, Dover L, Letendre R, Wicks M.
J Manipulative Physiol Ther. 1998 Feb;21(2):89-93.

Abstract
OBJECTIVE:
To determine the effectiveness (at the 0.1 level of statistical significance) of the Align-Right (roll-shaped) cervical pillow (ARCP) on neck pain severity and headache/neck pain medication use in chronic neck pain subjects.
DESIGN:
The design was a “before/after” (i.e., a “pre/post” trial).
SUBJECTS:
Twenty-eight subjects, 25-45 yr of age with cervical spine pain of biomechanical origin of > 2 on an 11-point ordinal pain scale.
OUTCOME MEASURES:
The primary outcome measure was severity of morning and evening neck pain. The secondary outcome measure was daily quantity of analgesics ingested. The data were analyzed descriptively and inferentially for clinically and statistically significant pre/post intervention differences.
METHODS:
Eligible subjects who successfully finished a 2-wk baseline data-gathering period by mailing in two properly completed diaries each received a pillow and four more diaries (to be filled in over the subsequent 4 wk). Three repeated-measures analyses of variance were performed using the Bonferroni-corrected level of statistical significance of 0.03. Ninety-five percent confidence intervals (for paired-samples mean differences) were also calculated for those pre/post differences that seemed descriptively clinically important.
RESULTS:
The clinically and statistically significant reductions in neck/shoulder pain severity in this sample of chronic neck pain subjects suggest that the ARCP is an effective therapy for target populations with the same profile as this sample. Patient characteristics predicting suitability were not studied in this project.
CONCLUSION:
The results suggest that the ARCP has clinically important beneficial effects on the neck pain severity of most chronic neck-pain sufferers. Further randomized clinical trial research comparing the ARCP with other commonly used cervical pillows is recommended.

Cervical pain: A comparison of three pillows
Robert A. Lavin, MD, Marco Pappagallo, MD, Keith V. Kuhlemeier, PhD
Archives of Physical Medicine and Rehabilitation Volume 78, Issue 2 , Pages 193-198, February 1997

Abstract
Objective: To compare three pillows with regard to pain intensity, pain relief, quality of sleep, disability, and overall satisfaction in subjects with benign cervical pain. The three pillows evaluated were the subjects’ usual pillow, a roll pillow, and a water-based pillow.

Study Design: Subjects used their usual pillows for the first week of this 5-week randomized crossover design study. They were subsequently randomly assigned to use each of the other two pillows for 2-week periods.

Patients: Forty-one subjects with benign cervical pain syndromes and free of cognitive impairments.

Main Outcome Measures: Visual analog scale (VAS), Sleep Questionnaire, Sickness Impact Profile (SIP), and a satisfaction scale rating the pillows.

Results: The water-based pillow was associated with reduced morning pain intensity, increased pain relief, and improved quality of sleep. The duration of sleep was significantly shorter for the roll pillow. Overall SIP findings showed a significant advantage for the water-based pillow over the roll pillow and standard pillow.

Conclusions: Proper selection of a pillow can significantly reduce pain and improve quality of sleep but does not significantly affect disability outcomes measured by the SIP.

Neck support pillows: a comparative study.
Persson L, Moritz U.
 J Manipulative Physiol Ther. 1998 May;21(4):237-40.

BACKGROUND:
Special neck support pillows claiming to improve rest and reduce neck pain are currently being advertised.
OBJECTIVE:
To test whether neck pillows have any positive effect on neck pain and quality of sleep compared with usual pillows and, if so, to find the optimal characteristics of such a pillow.
METHODS:
Thirty-seven hospital employees and 18 neck patients were asked to test six neck pillows with different shapes and consistency randomly over the course of 3 wk, to grade them according to comfort and to describe the characteristics of an ideal pillow.
RESULTS:
Thirty-six of 55 persons found the pillows positively affected sleep and 27 of 42 found that they positively affected neck pain. The ideal pillow should be soft and not too high, should provide neck support and should be allergy-tested and washable. The pillow that included two firmer supporting cores for neck lordosis received the best rating.
CONCLUSION:
A neck pillow with good shape and consistency and with firm support for cervical lordosis can be recommended as a part of treatment for neck pain.

Neck pain and pillows – A blinded study of the effect of pillows on non-specific neck pain, headache and sleep
Liselott Persson
2006, Vol. 8, No. 3 , Pages 122-127 (doi:10.1080/14038190600780239)

Neck support pillows are widely used in patients with neck pain to reduce pain and get better quality of sleep. To test whether specific neck pillows have any effect on neck pain, headache and quality of sleep in people with chronic non-specific neck pain and to find the optimal characteristics of such a pillow, 52 patients with chronic neck pain tested four different pillows (three specially designed neck pillows and one normal pillow) with different shapes and consistency randomly over 4–10 weeks. The patients graded them according to comfort and described the characteristics of an ideal pillow. The effects of the pillows on neck pain, sleep quality and headache were stated on a questionnaire. Forty of the 52 patients found a positive effect on the neck pain, 24 of 31 (77%) reported a positive effect on night’s sleep and 19 of 31 (61%) a positive effect on headache. There were no differences in graded comfort between two of the specially designed neck pillows and the “normal pillow” in the test. The opinion was that an ideal pillow should be soft and with good support for the neck lordosis. A specially selected and individually tested pillow with good shape, comfort and support to the neck lordosis can reduce neck pain and headache and give a better sleep quality.

2 thoughts on “Choosing a Pillow? Which is best?

  1. Remaining stationary for too long can harm your back. Buy cushions designed specifically to ease back pain. Look at a local pharmacy, large department store, or on the internet to find a good back cushion. There are a lot of different kinds of pads for support, so you will surely be able to find one that works for you.

    Try a good old-fashioned heating pad to alleviate pain in your back. Heat also increases blood circulation to the area for added pain relief. Heating pads are great, because you can use them either lying down or sitting.

  2. Your blog is very informative and makes great suggestions for the comfortable pillows for neck pain. I hope that my sore neck would finally be put to rest.

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