I've been using this for about a week and my straight neck has improved slightly, so I've changed pillows since then. I've only washed the cover. Everything in the photos is included. - Brand: RAKUNA - Product Name: NEW Seitaimakura (Chiropractic Pillow) - Adjustment: Includes a 2cm adjustment pad - Design Features: Shape that supports the neck and shoulders - How to Use: Simply sleep to care for the S-curve Thank you for looking.