THOUSAND OAKS, Calif., and HAMILTON, Ontario –  Neck pain afflicts about 10% of the population at any given time and may cause as much absenteeism as low back pain but surprisingly is seldom studied in randomized clinical trials, McMaster University researchers report in the Journal of Rheumatology.1

The Cochrane systematic review research team, led by Paul M. Peloso, MD, of Amgen, Inc, conclude from an exhaustive review of the literature that:

  • IM lidocaine is effective for chronic mechanical neck disorders (MND)
  • IV methylprednisolone is effective for acute whiplash
  • There is limited evidence supporting the efficacy of epidural methylprednisolone and of lidocaine for chronic MND with radicular involvement
  • Data for the efficacy of oral psychotropic agents such as diazepam (Valium® ) and cyclobenzaprine (Flexeril®) are too contradictory to permit firm conclusions
  • Botulinum toxin (Botox®) is probably no better than saline injection for chronic neck disorders with or without radicular findings or headache

"We found no high-quality randomized trials that were replicated, showing benefit for any medications or injections." —Paul M. Peloso, MD
The systematic review identified 32 selected trials of neck pain treatment, but none that met prespecified criteria for strong evidence of benefit. "[W]e found no high-quality randomized trials that were replicated showing benefit for any medications or injections. Therefore, we were unable to calculate [the] number needed to treat and treatment advantage for any high quality intervention," the authors write.

Dr. Peloso told CIAOMed that he was both surprised and concerned at the dearth of data. "We first reviewed the literature on neck pain in 1996 and found few good studies. I was surprised that 10 years later, neck pain has still gotten so little attention," he said. "Neck pain is common. The medications used are common. Our assumption had been that their use would have been widely studied."

Dr. Peloso also said that the conclusion about botulinum toxin, which was based on "moderate evidence" from five trials that included 141 patients, was unexpected. "We went in expecting to find evidence of benefit," he said.

The small amount of research on neck pain is in notable contrast to the relatively large number of high-quality, randomized, controlled trials on treatment of low back pain. "It may be that physicians assume that if something works on another type of pain, such as low back pain, it will be effective for neck pain. They might be right, but we don't know. The studies just have not been done. We also don't know whether the size of the treatment effect with any particular treatment is the same in neck pain as in low back pain.

"There is a strong need for good studies of all the currently used medicinal and injection therapies for mechanical neck pain, since none of them are supported by high-quality, consistent evidence, and we need to be certain that more good than harm is being done," Dr. Peloso said.

Reference

Peloso PM, Gross AR, Haines TA, et al. Medicinal and injection therapies for mechanical neck disorders: a Cochrane Systematic Review. J Rheumatol. 2006;33:957-967.