Medicinal and injection therapies for mechanical neck disorders

Paul Michael J Peloso, Anita Gross, Ted Haines, Kien Trinh, Charles H Goldsmith, Stephen J Burnie, Cervical Overview Group

Controversy persists regarding medicinal injection therapies for mechanical neck disorders. To determine the effects of medicinal injections on primary outcomes of pain, function and disability, and quality of life for adults with mechanical neck disorders. We searched bibliographic databases in the medical, chiropractic, and allied health literature, through CENTRAL, MEDLINE and EMBASE from their start through to March 2012. We scrutinised reference lists for other trials. We included randomised controlled trials with adults with neck disorders, with or without associated headache or radicular findings. We considered medicinal injection therapies. 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). Only medicinal injections were used in these studies. We found limited very low quality evidence that there was an effect in pain for intramuscular local anaesthetic injection versus control (four trials; 201 participants; pooled effect) for chronic myofascial neck pain.  Two low quality studies showed that there was an effect in pain for nerve block with anaesthetic over saline in the immediate post (one trial; 20 participants) and the short term (one trial; 47 participants). No high or moderate quality studies were found with evidence of benefit over control. Moderate quality evidence suggests that there was little or no difference in pain or function and disability between nerve block injection of steroid and bupivicaine versus bupivicaine alone at short, intermediate and long term (one trial; 120 participants) for chronic neck pain.  All other studies found had low or very low quality and showed no evidence of effect of the intervention over control. ???