Effectiveness of median nerve neural mobilization versus oral ibuprofen treatment in subjects who suffer from cervicobrachial pain: a randomized clinical trial

Abstract

IntroductionOral ibuprofen (OI) and median nerve neural mobilization (MNNM) are first line treatments for patients who suffer cervicobrachial pain (CP). OI may produce side effects which are not tolerated by all subjects who suffer CP, whereas MNNM has no known side effects. Therefore, the aim of this study was to assess the effectiveness of both treatments (OI vs. MNNM) in CP.Material and methodsThis investigation was a blinded parallel randomized clinical trial (NCT02593721). Sixty-two participants diagnosed with CP were recruited and randomly assigned to 2 groups (n = 31), which received MNNM or 1200 mg/day OI treatment for 6 weeks. The numeric rating scale for pain intensity was the primary outcome. The cervical rotation range of motion (CROM) and the upper limb function were the secondary outcomes.ResultsThe results showed that OI treatment (η2 = 0.612–0.755) was clearly superior to MNNM (η2 = 0.816–0.821) in all assessments (p < 0.05) except for the CROM device results, which were equivalent to those of the MNNM group (p > 0.05). Three subjects were discharged because of OI side effects.ConclusionsOral ibuprofen may be superior to MNNM for pain reduction and upper limb function increase of subjects with CP. Nevertheless, both treatments were effective. Median nerve neural mobilization may be considered an effective non-pharmaceutical treatment option in subjects with CP. Regarding OI adverse effects, our findings challenge the role of pharmacologic versus manual therapy as possible treatments that may improve pain intensity and upper limb functionality in subjects with CP.

Median Nerve Neural Mobilization Adds No Additional Benefit When Combined with Cervical Lateral Glide in the Treatment of Neck Pain: A Randomized Clinical Trial

“…This outcome was assessed with NDI. NDI is the preferred tool for the evaluation of disability levels [ 49 , 69 ] in patients suffering from non-specific NP, with [ 19 , 20 , 21 , 22 ] or without irradiation symptoms [ 50 , 51 , 70 ].…”

“…Regarding neural mobilization approaches for musculoskeletal conditions in patients with CBP [ 15 , 16 ], median nerve neural mobilization (MNNM) and cervical lateral glide (CLG) were shown to be more effective in short-term for improving pain intensity, range of motion (ROM) during upper limb neurodynamic test (ULNT1), and functionality than therapeutic ultrasound [ 17 ], manual cervical traction [ 18 ] or no treatment [ 19 , 20 ]. Although pharmacologic treatment, such as oral ibuprofen, can decrease pain intensity and disability more than MNNM or CLG, the non-existence of ROM differences between these interventions, as well as adverse effects associated with the pharmacological agents, suggest neural mobilization as a possible treatment option in patients with CBP [ 21 , 22 ]. Indeed, neural mobilization techniques for upper quadrant pain syndromes might modulate central sensitization and mechanosensitivity in patients with NP [ 23 ].…”

Mitigating the environmental impact of NSAIDs - physiotherapy as a contribution to One Health and the SDGs

“…Though further research is needed in this regard, growing evidence is suggesting that physiotherapy is better tolerated and at least as effective as NSAIDs in the treatment of mild to moderate musculoskeletal pain for a variety of conditions [24][25][26]. For example, in a comparison of the efficacy of oral ibuprofen against neural mobilisation in the treatment of cervicobrachial pain, it was indicated that neural mobilisation was less effective in the short term but came without the side effects of its pharmacological alternative [27]. Studies comparing NSAIDs against taping as adjuncts to exercise further indicate that non-pharmacological combinations are equally effective in the treatment of subacromial impingement and knee osteoarthritis while being tolerated better and reducing or delaying the need for pharmacological supplementation [28,29].…”

Effects of neural mobilization on individuals with chronic low back pain

“…One of the available treatments is neural mobilization (NM), which is characterized by a set of techniques that aim to impose greater tension in the peripheric nervous system through certain postures; slow and rhythmic movements are applied to the peripheral nerves and spinal cord, improving nerve impulse conduction [8][9][10][11][12] . Studies have demonstrated the beneficial effects of NM, including improved joint pain in patients with rheumatoid arthritis 13 and improved cervicobrachial pain 14 . NM has demonstrated an excellent prognosis in patients with neuropathic pain, in addition to presenting other advantages such as low operational cost, easy application and no adverse effects.…”