How much rational the doctors treatment are for mechanical neck disorders- review of evidence.

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To address the persisting controversy regarding medicinal therapies and injections use on primary outcomes (e.g. pain) for adults with mechanical neck disorders and whiplash; Peloso P et al did a review of current articles on the subject which was published in 2007.
The treatments subjected to analysis are: oral NSAIDs, psychotropic agents, steroid injections, and anaesthetic agents.
1. For acute whiplash, administering intravenous methylprednisolone within eight hours of injury reduced pain at one week, and sick leave but not pain at six months compared to placebo in one trial.
2. For chronic neck disorders at short-term follow-up, intramuscular injection of lidocaine was superior to placebo, treatment advantage 45% and dry needling, but similar to ultrasound in one trial each.
3. In chronic neck disorders with radicular findings, epidural methylprednisolone and lidocaine reduced neck pain and improved function more than when given by intramuscular route at one-year follow-up, in one trial.
4. In subacute and chronic neck disorders, muscle relaxants, analgesics and NSAIDs had limited evidence and unclear benefits.
5. In participants with chronic neck disorders with or without radicular findings or headache, there was moderate evidence from five high quality trials that Botulinum toxin A intramuscular injections had similar effects to saline in improving pain, disability or global perceived effect.

The conclusions are as follows:
1. Moderate evidence for the benefit of intravenous methylprednisolone given within eight hours of acute whiplash, from a single trial.
2. Lidocaine injection into myofascial trigger points appears effective in two trials.
3. There is moderate evidence that Botulinum toxin A is not superior to saline injection for chronic MND.
4. Muscle relaxants, analgesics and NSAIDs had limited evidence and unclear benefits.

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