Medicine for neck pain
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Effective Treatments for Neck Pain: A Comprehensive Review
Introduction to Neck Pain Management
Neck pain is a prevalent condition that affects a significant portion of the population, leading to substantial personal and societal costs. Various treatments are available, ranging from pharmacological interventions to alternative therapies. This article synthesizes the latest research on the efficacy of different treatments for neck pain, including chiropractic spinal manipulative therapy (CSMT), traditional Chinese medicine (TCM), home exercises, acupuncture, and herbal medicine.
Chiropractic Spinal Manipulative Therapy (CSMT) and Medication
Efficacy of CSMT and Ibuprofen
A multicenter randomized controlled trial (RCT) compared the efficacy of CSMT, sham CSMT, ibuprofen, and placebo in treating acute neck pain. The study found that CSMT and ibuprofen were more effective than placebo in reducing pain intensity over a 14-day period. The CSMT group showed a 60% reduction in pain, while the ibuprofen and sham CSMT groups showed a 40% reduction, and the placebo group showed a 20% reduction1.
Spinal Manipulation vs. Medication
Another RCT evaluated spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain. SMT was found to be more effective than medication in both the short and long term, with significant pain reduction observed at 8, 12, 26, and 52 weeks. HEA also showed similar efficacy to SMT at most time points, suggesting that non-pharmacological interventions can be as effective as medication3.
Traditional Chinese Medicine (TCM)
Acupuncture and Cupping
A systematic review and meta-analysis of TCM treatments, including acupuncture and cupping, found moderate evidence supporting their efficacy in reducing chronic neck pain (CNP). Acupuncture was more effective than sham acupuncture in reducing pain immediately post-treatment, while cupping showed significant pain reduction compared to waitlist controls and NSAIDs2.
Baduanjin Qigong
Baduanjin, a traditional Qigong exercise, was also found to be effective in reducing neck pain in middle-aged and elderly individuals. A meta-analysis of 13 RCTs showed that Baduanjin significantly reduced pain intensity and improved functional movement, making it a viable non-pharmacological option for managing neck pain in older adults4.
Herbal Medicine
Oral and Topical Herbal Treatments
Herbal medicine has shown promise as both a sole intervention and an add-on treatment for neck pain. A systematic review found that herbal medicine as an add-on to standard care significantly reduced pain compared to standard care alone. Specific herbal formulations, such as Compound Qishe Tablets and Compound Extractum Nucis Vomicae, were found to be more effective than placebo and certain conventional medications6 9.
Acupuncture
Limited Efficacy for Chronic Mechanical Neck Pain
Despite its popularity, acupuncture did not show a clinically significant benefit over placebo in treating chronic mechanical neck pain. A rigorous RCT found no significant differences in pain relief, function, or analgesic use between acupuncture and sham transcutaneous electrical stimulation5.
Conclusion
The management of neck pain can benefit from a variety of treatments, each with varying degrees of efficacy. Chiropractic spinal manipulative therapy and ibuprofen have shown effectiveness for acute neck pain, while traditional Chinese medicine, including acupuncture and Baduanjin, offers promising results for chronic conditions. Herbal medicine, particularly as an add-on treatment, also shows potential. However, the efficacy of acupuncture for chronic mechanical neck pain remains inconclusive. Future research should continue to explore these treatments to provide more definitive guidance for clinical practice.
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Most relevant research papers on this topic
Chiropractic spinal manipulative therapy for acute neck pain: A 4-arm clinical placebo randomized controlled trial. A prospective study protocol
This study aims to determine the effectiveness of chiropractic spinal manipulative therapy (CSMT) and ibuprofen for acute neck pain, providing evidence-based support for these treatments.
RCT
Large Human TrialTraditional Chinese Medicine for Neck Pain and Low Back Pain: A Systematic Review and Meta-Analysis
Acupuncture, acupressure, and cupping may be effective in reducing pain and disability associated with chronic neck and low back pain, while gua sha, tai chi, qigong, and Chinese manipulation show fair effects.
Meta-Analysis
Rigorous Journal
Highly CitedSpinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain
Spinal manipulation therapy (SMT) is more effective than medication for acute and subacute neck pain in both short and long term, but a few instructional sessions of home exercise with advice can also provide similar outcomes.
RCTHighly CitedBaduanjin improves neck pain and functional movement in middle-aged and elderly people: A systematic review and meta-analysis of randomized controlled trials
Baduanjin is a safe and potentially effective treatment for neck pain in middle-aged and elderly people, but more studies are needed to confirm this.
Meta-AnalysisAcupuncture versus Placebo for the Treatment of Chronic Mechanical Neck Pain
Acupuncture showed no significant improvement in pain, function, or analgesic use for chronic mechanical neck pain compared to placebo.
RCTHighly CitedEffectiveness of orally administered herbal medicine for neck pain with active controls: A systematic review and meta-analysis
Herbal medicine as an add-on treatment significantly improves pain and function in neck pain patients compared to standard care alone, but the level of evidence is low.
Meta-AnalysisWITHDRAWN: Botulinum toxin for subacute/chronic neck pain.
Botulinum toxin injections show no significant clinically important or statistically significant benefits for chronic neck pain, disability, or quality of life at four week and six months.
Meta-Analysis
Very Rigorous JournalEast or West-Manual Therapy As a Viable Nonpharmacologic Option for Chronic Neck Pain.
Chuna manual therapy is a safe and effective nonpharmacologic treatment for chronic neck pain, with greater reductions in pain and disability compared to usual care.
Systematic ReviewRigorous JournalChinese Herbal Medicine for Chronic Neck Pain due to Cervical Degenerative Disc Disease
Chinese herbal medicines, such as Compound Qishe Tablets and Compound Extractum Nucis Vomicae, show low quality evidence in reducing chronic neck pain due to cervical degenerative disc disease.
Systematic ReviewAdvances in the diagnosis and management of neck pain
Neck pain is a significant chronic condition with strong evidence supporting exercise, while weak evidence supports epidural steroid injections and radiofrequency denervation for cervical radiculopathy and facet arthropathy.
Very Rigorous JournalHighly Cited