Physician-Delivered Injection Therapies for Mechanical Neck Disorders: A Systematic Review Update (Non-Oral, Non-Intravenous Pharmacological Interventions for Neck Pain)

Anita R. Gross*, 1, Paul M. Peloso2, Erin Galway1, Neenah Navasero1, Karis Van Essen1, Nadine Graham1, Charlie H Goldsmith3, Wisam Gzeer1, Qiyun Shi4, Ted and COG Haines1 , §
1 McMaster University, Hamilton, Canada
2 Merck, Kenilworth, NJ, USA
3 Simon Fraser University, Burnaby, Canada
4 Western University, London, Canada

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Creative Commons License
© Gross 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:
§ COG, Cervical Overview Group is an international research group that conducts and maintains systematic reviews for neck pain.



Controversy persists regarding medicinal injections for mechanical neck disorders (MNDs).


To determine the effectiveness of physician-delivered injections on pain, function/disability, quality of life, global perceived effect and patient satisfaction for adults with MNDs.

Search Methods:

We updated our previous searches of CENTRAL, MEDLINE and EMBASE from December 2006 through to March 2012.

Selection Criteria:

We included randomized controlled trials of adults with neck disorders treated by physician-delivered injection therapies.

Data Collection and Analysis:

Two authors independently selected articles, abstracted data and assessed methodological quality. When clinical heterogeneity was absent, we combined studies using random-effects models.


We included 12 trials (667 participants). No high or moderate quality studies were found with evidence of benefit over control. Moderate quality evidence suggests little or no difference in pain or function/disability between nerve block injection of steroid and bupivacaine vs bupivacaine alone at short, intermediate and long-term for chronic neck pain. We found limited very low quality evidence of an effect on pain with intramuscular lidocaine vs control for chronic myofascial neck pain. Two low quality studies showed an effect on pain with anaesthetic nerve block vs saline immediately post treatment and in the short-term. All other studies were of low or very low quality with no evidence of benefit over controls.

Authors' Conclusions:

Current evidence does not confirm the effectiveness of IM-lidocaine injection for chronic mechanical neck pain nor anaesthetic nerve block for cervicogenic headache. There is moderate evidence of no benefit for steroid blocks vs controls for mechanical neck pain.

Keywords: Injections, neck, pain, systematic review, meta-analysis.