Physician-Delivered Injection Therapies for Mechanical Neck Disorders: A Systematic Review Update (Non-Oral, Non-Intravenous Pharmacological Interventions for Neck Pain)

Abstract

Background: Controversy persists regarding medicinal injections for mechanical neck disorders (MNDs).Objectives: To determine the effectiveness of physician-delivered injections on pain, function/disability, quality of life, global perceived effect and patient satisfaction for adults with MNDs.Search Methods: We updated our previous searches of CENTRAL, MEDLINE and EMBASE from December 2006 through to March 2012.Selection Criteria: We included randomized controlled trials of adults with neck disorders treated by physician-delivered injection therapies.Data Collection and Analysis: Two authors independently selected articles, abstracted data and assessed methodological quality. When clinical heterogeneity was absent, we combined studies using random-effects models.Results: We included 12 trials (667 participants). No high or moderate quality studies were found with evidence of benefit over control. Moderate quality evidence suggests little or no difference in pain or function/disability between nerve block injection of steroid and bupivacaine vs bupivacaine alone at short, intermediate and long-term for chronic neck pain. We found limited very low quality evidence of an effect on pain with intramuscular lidocaine vs control for chronic myofascial neck pain. Two low quality studies showed an effect on pain with anaesthetic nerve block vs saline immediately post treatment and in the short-term. All other studies were of low or very low quality with no evidence of benefit over controls.Authors' Conclusions: Current evidence does not confirm the effectiveness of IM-lidocaine injection for chronic mechanical neck pain nor anaesthetic nerve block for cervicogenic headache. There is moderate evidence of no benefit for steroid blocks vs controls for mechanical neck pain.

Increased mechanosensivity of the greater occipital nerve in subjects with side-dominant head and neck pain – a diagnostic case-control study

“…It has been shown that findings in imaging methods such as x-ray [97], MRI [98,99] or discrimitative, laboratory-based evidence [89] are not related to CGH. Likewise, in subjects with CGH, effectiveness of anesthetic blocks can neither be verified nor dismissed [19,21,22,100,101].. The remaining criteria of the ICHD-3 and the corresponding comments are comparable to the criteria of the CHISG.…”

“…Systematic reviews show that an anesthetic infiltration of the GON can be an effective treatment method for various types of headaches [17][18][19][20][21][22]. Recent randomizedcontrolled trials show a marked effect of GON blocks in chronic migraine [23][24][25][26].…”

Correlation between Neck Muscle Endurance Tests, Ultrasonography, and Self-Reported Outcomes in Women with Low Cervical Disability and Neck Pain

“…The prevalence of neck pain is higher in women than in men [7]. Additionally, the occurrence of neck pain tends to increase with age, reaching a peak between the ages of 30 and 45 [8]. Moreover, women tend to experience a greater number of years lived with disability attributed to neck pain when compared to men [5].…”