Medicinal and injection therapies for mechanical neck disorders: a Cochrane systematic review.
OBJECTIVE
To systematically review randomized trials on medicines and injections used to improve pain, function/disability, and patient satisfaction in adults with mechanical neck disorders (MND) with or without associated headache or radicular findings.


METHODS
We searched CENTRAL (Issue 4, 2002), and MEDLINE, EMBASE, MANTIS, CINHAL from their start to March 2003. Two authors independently selected articles, abstracted data, and assessed methodological quality using the Jadad criteria. When clinical heterogeneity was absent, we combined studies using random-effects metaanalysis models.


RESULTS
Thirty-two selected trials had an overall methodological quality of mean 3.2/5. For acute whiplash, administering intravenous methylprednisolone within 8 hours reduced pain at one week [SMD -0.90 (95% CI -1.57 to -0.24)], and sick leave but not pain at 6 months compared to placebo. For chronic MND at short-term followup, intramuscular injection of lidocaine was superior to placebo [SMD 1.36 (95% CI -1.93 to -0.80)]. In chronic MND with radicular findings, epidural methylprednisolone and lidocaine reduced neck pain [SMD -1.46 (95% CI -2.16 to -0.76)] and improved function at one-year followup compared to the intramuscular route. In subacute/chronic MND, we found conflicting evidence for oral psychotropic agents. In chronic MND with or without radicular findings or headache, there was moderate evidence from 5 high quality trials showing that botulinum toxin (Botox A) intramuscular injections were not better than saline in improving pain [SMD pooled -0.39 (95% CI -1.25 to 0.47)], disability, or global perceived effect.


CONCLUSIONS
Intramuscular injection of lidocaine for chronic MND and intravenous injection of methylprednisolone for acute whiplash were effective treatments. There was limited evidence of effectiveness of epidural injection of methylprednisolone and lidocaine for chronic MND with radicular findings. Muscle relaxants and nonsteroidal antiinflammatory drugs have unclear benefits. There was moderate evidence that Botox-A intramuscular injections for chronic MND were not better than saline.
Peloso
Paul M
PM
Amgen Inc., Thousand Oaks, California, USA. ppeloso@adelphia.net
Gross
Anita R
AR
Haines
Ted A
TA
Trinh
Kien
K
Goldsmith
Charles H
CH
Aker
Peter
P
D000284:Administration, Oral; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007268:Injections, Epidural; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008775:Methylprednisolone / Q000627:therapeutic use*; D019547:Neck Pain / Q000188:drug therapy* / Q000503:physiopathology; D017060:Patient Satisfaction; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000188:drug therapy* / Q000503:physiopathology
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D011619:Psychotropic Drugs; D008012:Lidocaine; D001905:Botulinum Toxins; D008775:Methylprednisolone