Doctor… I Have a Pain in the Neck - What can I Do?
Saturday, May 10th, 2008 Subscribe To Our Feed
Tip! The problem is that many front line health care practitioners do not know how to properly diagnose or treat this condition. In fact, the subluxation complex, which simply means a spinal bone or vertebrae has fallen out of alignment, is almost always overlooked when a patient is first examined by their physician for neck pain.
Neck pain is a common and costly medical ailment. Few studies of really effective medical treatments exist compared with those, say, for low back pain.
Many drugs used in clinical practice have been tried. Among those are nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants, neuroleptic agents, and opioid analgesics.
While uncontrolled studies show benefit, controlled studies are lacking. So what has been shown to work so far? According to a recent study, there are only two medicines that have been proven to be effective. The first is intravenous methylprednisolone for acute whiplash used within eight hours for whiplash and the second is intramuscular lidocaine for chronic mechanical neck disorders. (Peloso PM, Gross AR, Haines TA, et al. Medicinal and injection therapies for mechanical neck disorders: a Cochrane systemic Review. J Rheum 2006; 33:957-967).
What is disheartening is that the usual treatments such as anti-inflammatory drugs and acetaminophen have been largely ineffective- at least according to this one large study.
Even epidural injections were classified as showing “limited evidence of benefit.”
A number of interventions in this large study were ineffective. These include:
Oral psychotropic agents
Oral anti-inflammatory agents and oral analgesics
Intramuscular injections of multivitamins.
Nerve-block injections
Tip! For severe acute neck pain resulting from an accident or injury, doctors recommend bed rest, a neck brace or collar, and cold treatment (such as an ice pack) for neck pain relief. Heat (such as that from a heating pad) and physical therapy are usually recommended for treating chronic neck pain.
In addition, several interventions were judged to have shown “moderate evidence of no benefit.” These included intramuscular injections of botulinum toxin (Botox A), intracutaneous injections of sterile water, subcutaneous injection of carbon dioxide and melatonin.
So what can you do if you’re a patient?
First of all, remember that these studies that are published in the literature have flaws. They do not report the data from private practices. Also, many of the studies that are reported as being “negative” are done in large medical centers where there is already a built in bias that these treatments don’t work. It’s sad but true. A lot of academic doctors really don’t believe in treatment. They’d rather write negative papers.
Second, make sure you see a skilled rheumatologist… one who is skilled in the management of osteoarthritis and neck problems.
The things that might afford some relief in addition to the two described above are also- at least in my 25 years of experience are:
Physical therapy for chronic problems
Chiropractic for acute problems
A neck support pillow
Ice/ moist heat
Gentle traction
Exercises done under the supervision of a skilled therapist
A soft cervical collar worn temporarily
Epidural, nerve block, and soft tissue injections (despite what they say, I think they work)
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Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions, go to: http://www.arthritis-treatment-and-relief.com Tip! More recently some TENs machines are now available with an electrical probe which can be used to stimulate acupuncture points to bring pain relief. While almost all TENs machines have cautions about placing the electrode pads on the head and neck these accu TENs machines will permit users to stimulate the accu points or channels elsewhere on the body to bring relief to head or neck pain. |
