title: Pharmacological Interventions Including Medical Injections for Neck Pain: An Overview as Part of the ICON Project.
abstract: OBJECTIVE
  To conduct an overview (review-of-reviews) on pharmacological interventions for neck pain.
  
  
  METHODS
  Computerized databases and grey literature were searched from 2006 to 2012.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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: 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; andno 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;
  
  
  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.
authors.affiliation: Merck & Co., Rahway, NJ, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Peloso
authors.forename: Mahweesh
authors.initials: M
authors.lastname: Khan
authors.forename: Anita R
authors.initials: AR
authors.lastname: Gross
authors.forename: Lisa
authors.initials: L
authors.lastname: Carlesso
authors.forename: Lina
authors.initials: L
authors.lastname: Santaguida
authors.forename: Janet
authors.initials: J
authors.lastname: Lowcock
authors.forename: Joy C
authors.initials: JC
authors.lastname: Macdermid
authors.forename: Dave
authors.initials: D
authors.lastname: Walton
authors.forename: Charlie H
authors.initials: CH
authors.lastname: Goldsmith
authors.forename: Pierre
authors.initials: P
authors.lastname: Langevin
authors.forename: Qiyun
authors.initials: Q
authors.lastname: Shi
keywords: Neck pain; medical injections; pharmacological interventions; review of reviews.