Tuesday, September 30, 2008

EVIDENCES ON MECHNICAL NECK DISORDER- REVIEW OF REVIEWS



Neck pain is a frequently reported complaint of the musculoskeletal system which can be disabling and costly to society. Mechanical traction, Exercise therapy, Electrotherapy, Manipulation and mobilization and Medicinal therapies and injections is often used as therapies in outpatient rehabilitation.

The effectiveness of above said commonly recommended treatments for neck pain are yet controversial and question persists over their effectiveness.

Having this in mind, I tried to Cochrane Data base to find out the evidence of their effectiveness. I went through a series of reviews. The conclusion of their reviews I have presented in article. The reviews are in the following order:

1. Mechanical traction on MND
2. Exercises on MND
3. Electrotherapy on MND
4. Manipulation & Mobilization on MND
5. Medicinal & injection therapies on MND

1. Mechanical traction for neck pain with or without radiculopathy.
Graham N et al reviewed the effects of mechanical traction for neck disorders.

They found:

1. The current literature does not support or refute the efficacy or effectiveness of continuous or intermittent traction for pain reduction, improved function or global perceived effect when compared to placebo traction, tablet or heat or other conservative treatments in patients with chronic neck disorders.

2. They suggested; large, well conducted RCTs are needed to first determine the efficacy of traction, then the effectiveness, for individuals with neck disorders with radicular symptoms.

2. Exercises for mechanical neck disorders.
Kay TM et al reviewed the effectiveness of exercise therapy to relieve pain, or improve function, disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders (MND).

They found:

1. Specific exercises may be effective for the treatment of acute and chronic MND, with or without headache.

2. To be of benefit, a stretching and strengthening exercise program should concentrate on the musculature of the cervical, shoulder-thoracic area, or both.

3. A multimodal care approach of exercise, combined with mobilisation or manipulation for subacute and chronic MND with or without headache, reduced pain, improved function, and global perceived effect in the short and long term.

4. They suggested; relative benefit of other treatments (such as physical modalities) compared with exercise or between different exercise programs needs to be explored.

5. They also suggested, quality of future trials should improve through more effective 'blinding' procedures and better control of compliance and co-intervention. Furthermore, Phase II trials would help identify the most effective treatment characteristics and dosages.

3. Electrotherapy for neck disorders.
Kroeling P et al assessed whether electrotherapy, either alone or in combination with other treatments, relieves pain, or improves function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders (MND).
They found:
1. Basing on current literature no there is no definitive statements on electrotherapy for MND.

2. The current evidence on Galvanic current (direct or pulsed), iontophoresis, TENS, EMS, PEMF and permanent magnets is either lacking, limited, or conflicting.

3. They suggested, Possible new trials on these interventions should have larger patient samples and include more precise standardization and description of all treatment characteristics.

4. Manipulation and mobilisation for mechanical neck disorders.
Gross AR et al assessed whether manipulation and mobilisation, either alone or in combination with other treatments, relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders (MND).

They found:
1. Multimodal care has short-term and long-term maintained benefits for subacute/chronic MND with or without headache.

2. The common elements in this care strategy were mobilisation and/or manipulation plus exercise.

3. The evidence did not favour manipulation and/or mobilisation done alone or in combination with various other physical medicine agents; when compared to one another, neither was superior.

4. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings.

5. The added benefit of exercise needs to be further explored.

6. They suggested, factorial design would help determine the active treatment agent(s) within a treatment mix and further phase II trials would help identify the most effective treatment characteristics and dosages. Greater attention to methodological quality is needed.

5. Medicinal and injection therapies for mechanical neck disorders.

Peloso P et al determined the effect of medicines and injections on pain, function/disability, patient satisfaction and range of motion in participants with mechanical neck disorders (MND).

They found:
1. Intra-muscular injection of lidocaine for chronic MND and intravenous injection of methylprednisolone for acute whiplash were effective treatments.

2. There was limited evidence of effectiveness of epidural injection of methylprednisolone and lidocaine for chronic MND with radicular findings.

3. Oral psychotropic agents had mixed results.

4. There was moderate evidence that Botox A intramuscular injections for chronic MND were no better than saline.

5. Other medications, including NSAIDs, had contradictory or limited evidence of effectiveness.

The above said article is based on review works of
Graham N et al (1), Kay TM et al (2), Kroeling P et al (3), Gross AR et al (4), Gross AR et al (5), Peloso P et al (6)

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