Pharmacological Interventions Including Medical Injections for Neck Pain: An Overview as Part of the ICON§ Project
Paul M Peloso1, Mahweesh Khan2, Anita R Gross*, 2, Lisa Carlesso2, Lina Santaguida2, Janet Lowcock2, Joy C MacDermid2, Dave Walton3, Charlie H Goldsmith4, Pierre Langevin5, Qiyun Shi3
Identifiers and Pagination:Year: 2013
Issue: Suppl 4
First Page: 473
Last Page: 493
Publisher Id: TOORTHJ-7-473
Article History:Received Date: 18/12/2012
Revision Received Date: 25/3/2013
Acceptance Date: 4/4/2013
Electronic publication date: 20/9/2013
Collection year: 2013
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/) which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.
To conduct an overview (review-of-reviews) on pharmacological interventions for neck pain.
Computerized databases and grey literature were searched from 2006 to 2012.
Systematic reviews of randomized controlled trials (RCT) in adults with acute to chronic neck pain reporting effects of pharmacological interventions including injections on pain, function/disability, global perceived effect, quality of life and patient satisfaction.
Data Collection & Analysis:
Two independent authors selected articles, assessed risk of bias and extracted data The GRADE tool was used to evaluate the body of evidence and an external panel provided critical review.
We found 26 reviews reporting on 47 RCTs. Most pharmacological interventions had low to very low quality methodologic evidence with three exceptions. For chronic neck pain, there was evidence of:
- a small immediate benefit for eperison hydrochloride (moderate GRADE, 1 trial, 157 participants);
- no short-term pain relieving benefit for botulinum toxin-A compared to saline (strong GRADE; 5 trial meta-analysis, 258 participants) nor for subacute/chronic whiplash (moderate GRADE; 4 trial meta-analysis, 183 participants) including reduced pain, disability or global perceived effect; and
- no long-term benefit for medial branch block of facet joints with steroids (moderate GRADE; 1 trial, 120 participants) over placebo to reduce pain or disability;
While in general there is a lack of evidence for most pharmacological interventions, current evidence is against botulinum toxin-A for chronic neck pain or subacute/chronic whiplash; against medial branch block with steroids for chronic facet joint pain; but in favour of the muscle relaxant eperison hydrochloride for chronic neck pain.