Neck pain medicine
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Advances in Neck Pain Medicine: A Comprehensive Overview
Prevalence and Impact of Neck Pain
Neck pain is a prevalent condition that significantly impacts individuals' quality of life and imposes a substantial socioeconomic burden. It ranks among the top five chronic pain conditions in terms of prevalence and years lost to disability1. Despite its high prevalence, neck pain research receives less funding compared to other chronic pain conditions like low back pain1.
Pharmacological Treatments for Neck Pain
Muscle Relaxants and NSAIDs
For acute neck pain, muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed and have been shown to be effective1. These medications help alleviate pain and reduce inflammation, providing short-term relief for patients.
Botulinum Toxin
Botulinum toxin (BoNT) injections have been explored for treating subacute and chronic neck pain. However, high-quality evidence suggests that BoNT-A injections do not significantly differ from saline injections in reducing pain or improving disability and quality of life8. Therefore, BoNT-A is not recommended as a primary treatment for chronic neck pain.
Non-Pharmacological Treatments
Spinal Manipulation Therapy (SMT)
Spinal manipulation therapy (SMT) has been found to be more effective than medication for both short-term and long-term relief of acute and subacute neck pain2. SMT and home exercise with advice (HEA) showed similar outcomes, indicating that a few instructional sessions of HEA can be as beneficial as SMT2.
Traditional Chinese Medicine (TCM)
Traditional Chinese medicine, including acupuncture, acupressure, and cupping, has shown moderate evidence of efficacy in treating chronic neck pain. Acupuncture, in particular, was more effective than sham acupuncture in reducing pain immediately post-treatment3. However, the evidence for other TCM modalities like gua sha, tai chi, and qigong remains inconclusive and requires further research3.
Manipulation and Mobilization
Manipulation and mobilization therapies are widely used for chronic nonspecific neck pain. Studies indicate that these therapies can reduce pain and improve function, especially when combined with exercise4 7. Thoracic manipulation, in particular, has shown benefits for both acute and chronic neck pain7.
Chiropractic Spinal Manipulative Therapy (CSMT)
A clinical trial protocol aims to compare the efficacy of chiropractic spinal manipulative therapy (CSMT) against sham CSMT, ibuprofen, and placebo medicine for acute neck pain. This study will provide more robust evidence on the effectiveness of CSMT and ibuprofen5.
Transcutaneous Electrical Nerve Stimulation (TENS)
TENS is a non-invasive, low-cost intervention used for chronic neck pain. However, current evidence is insufficient to confirm its effectiveness, and further well-designed studies are needed10.
Complementary and Alternative Treatments
Exercise and Physical Therapy
Exercise is one of the most supported complementary treatments for neck pain, with strong evidence backing its efficacy1. Other treatments like massage, acupuncture, yoga, and spinal manipulation have weaker evidence but are still considered beneficial in various contexts1.
Acupuncture
While acupuncture is a popular alternative therapy, a randomized controlled trial found no significant benefit of acupuncture over placebo for chronic mechanical neck pain6. This suggests that while some patients may find relief, the overall efficacy of acupuncture remains debatable.
Conclusion
Neck pain management involves a combination of pharmacological and non-pharmacological treatments. Muscle relaxants and NSAIDs are effective for acute pain, while SMT, exercise, and certain TCM practices offer relief for chronic conditions. However, the efficacy of treatments like BoNT-A and TENS remains uncertain, highlighting the need for further research. Integrating multiple treatment approaches may provide the best outcomes for patients suffering from chronic neck pain.
Sources and full results
Most relevant research papers on this topic
Advances 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 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 CitedTraditional 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 JournalHighly CitedManipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel.
Manipulation and mobilization therapies can reduce pain and improve function for chronic nonspecific neck pain, with multimodal approaches showing the greatest potential impact.
Meta-AnalysisHighly CitedChiropractic 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 TrialAcupuncture 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 CitedManipulation or mobilisation for neck pain.
Cervical manipulation and mobilization both show similar short-term effects on pain and function, while thoracic manipulation may improve pain and function, but optimal techniques and dose remain unresolved.
Meta-AnalysisVery Rigorous JournalHighly CitedWITHDRAWN: 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-AnalysisVery 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 JournalTranscutaneous electrical nerve stimulation (TENS) for chronic neck pain.
TENS may have very low-certainty effects compared to sham TENS in short-term follow-up for chronic neck pain.
Systematic ReviewVery Rigorous Journal