Only two interventions effective for neck pain

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Only two interventions effective for neck pain



May 11, 2006



Zosia Chustecka

Hamilton, ON - Neck pain is common and costly, but there are few

studies of medicinal interventions, in contrast to the large body of

data that exists for low back pain, for example. Many of the drugs

used in clinical practice have limited data on benefit, including

nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic

antidepressants, neuroleptic agents, and opioid analgesics. The most

promising therapies appear to be intravenous methylprednisolone for

acute whiplash and intramuscular lidocaine for chronic mechanical

neck disorders. So concludes the latest Cochrane systematic review on

the subject in the May 2006 issue of the Journal of Rheumatology [1].



Surprisingly, we found no evidence for acetaminophen (paracetamol)

and largely negative data for anti-inflammatory drugs in neck pain,

either acute or chronic.





" In general, the systemic evaluation of medicines and injections for

neck pain yielded disappointing results, " the authors comment.

" Surprisingly, we found no evidence for acetaminophen (paracetamol)

and largely negative data for anti-inflammatory drugs in neck pain,

either acute or chronic. "

The authors are researchers from McMaster University, Hamilton,ON,

working together with the Cervical Overview Group; first author Dr

Peloso is now at Amgen. Funding for the review came from the US

National Institutes of Health (NIH) and a Problem-based Research

Award from Sunnybrook and Women's College Foundation, Toronto, ON.

Moderate benefit shown for two interventions

The review included 32 medication trials, conducted (variously) in

patients with mechanical neck disorder, headache of cervical origin,

neck disorder with radicular signs and symptoms, whiplash-associated

disorders, or degenerative changes. None of the studies met the

authors' criteria for " strong evidence of benefit. "











High-quality studies are needed to ensure that more good than harm is

being done for patients with neck pain.













Two interventions were considered to have shown " moderate evidence of

benefit. " One was intravenous methylprednisolone, used within eight

hours of injury, for acute whiplash. The other was intramuscular

lidocaine for chronic mechanical neck disorders. In one of the two

studies showing this benefit, intramuscular lidocaine plus neck

stretches were superior to intramuscular injections of saline plus

neck stretches, but they were not superior to ultrasound and neck

stretches, the authors point out. Epidural injections were classified

as showing " limited evidence of benefit. "

A number of interventions showed " unclear evidence of benefit, "

including:

Oral psychotropic agents (the studies reviewed tested

cyclobenzaprine, diazepam, tetrazepam, eperisone hydrochloride,

phenobarbital, meprobamate, fluoxetine, and amitriptyline).

Oral anti-inflammatory agents and oral analgesics (tenoxicam plus

ranitidine, ibuprofen, oral glafenine, and acetaminophen

[paracetamol]).

Intramuscular injections of multivitamins.

Nerve-block injections (prilocaine, bupivacaine).

In addition, several interventions were judged to have shown

" moderate evidence of no benefit. " These included intramuscular

injections of botulinum toxin (Botox A), intracutaneous injections of

sterile water, subcutaneous injection of carbon dioxide, and melatonin.

Many of the drugs that are currently being used in clinical practice

have insufficient data to suggest that they are effective, and yet

they all have side effects, the authors comment. " High-quality

studies are needed to ensure that more good than harm is being done

for patients with neck pain. "







Source



Peloso PM, Gross AR, Haines TA, et al. Medicinal and injection

therapies for mechanical neck disorders: a Cochrane systemic review.

J Rheum 2006; 33:957-967. 

http://www.jointandbone.org/viewArticle.do?primaryKey=697693