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
1 Merck & Co., Rahway, NJ, USA
2 McMaster University, Hamilton, Canada
3 Western University, London, Canada
4 Simon Fraser University, Vancouver, Canada
5 Laval University, Quebec City, Canada

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Creative Commons License
© Peloso et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the McMaster University, School of Rehabilitation Science, IAHS, 1400 Main Street West, 4th floor, Hamilton, ON, L8S 1C7, Canada; Tel: 905-577-0098; Fax: 905-577-0603; E-mail:
§ ICON (International Collaboration on Neck)Expert Panel: Helge Kasch, MD - Neurology, Aarhus University Hospital, Aarhus, Denmark; Jan Hartvigsen, DC, PhD, University of Southern Denmark; Odense M, Denmark; Marc White, MD, PhD - Family Medicine, Massage Therapy, Canadian Institute for the Relief of Pain and Disability, Vancouver, Canada; Margareta Nordin, DMedSci, New York University Hospital for Joint Diseases, New York, USA; Justin Kenardy, Clinical Health Psychologist, PhD, The University of Queensland, Royal Brisbane and Women’s Hospital, QLD, Australia; Norm Buckley, MD - Anesthesia, McMaster University, Hamilton, Canada



To conduct an overview (review-of-reviews) on pharmacological interventions for neck pain.

Search Strategy:

Computerized databases and grey literature were searched from 2006 to 2012.

Selection Criteria:

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.

Main Results:

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:

  1. a small immediate benefit for eperison hydrochloride (moderate GRADE, 1 trial, 157 participants);
  2. 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
  3. 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;

Reviewers' Conclusions:

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.

Keywords: Neck pain, pharmacological interventions, medical injections, review of reviews.