Neck Pain
Neck Pain
Neck Pain
References
Hagen KB et al. The updated Cochrane review of bedrest for low back pain and sciatica. Spine 2005; 30: 542-6.
Luijsterburg PAJ et al. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic
review. Eur Spine J 2007 Apr 6;(Epub ahead of print).
Trinh K et al, Cervical Overview Group. Acupuncture for neck disorders. Cochrane Database of Systematic Reviews
2006, Issue 3. Art. No.: CD004870. DOI: 10.1002/14651858.CD004870.pub3.
Of those randomised controlled trials published since the Cochrane review (Trinh
2006: see above) five compared acupuncture to various types of sham treatment:
acupuncture was superior in three (Liang 2009, 2010; Vas 2006) equivalent in one
(Sahin 2010), and the results are unclear in one (Fu 2009). Given that sham
The evidence
Research Conclusion
Systematic reviews
Fu L-M et al. Randomized controlled A systematic review that pooled data from 14 randomised
trials of acupuncture for neck pain: controlled trials assessing acupuncture for neck pain. Nine
Systematic review and meta-analysis. meta-analyses addressing different clinical issues were carried
Journal of Alternative and out, seven of which yielded positive results. When the primary
Complementary Medicine 2009; 15; outcome was short-term pain reduction, acupuncture was
133-45. found to be more effective than the control in the treatment of
neck pain. Acupuncture was also found to be significantly more
effective than sham acupuncture for pain relief. The reviewers
concluded that their review confirmed the short-term
effectiveness and efficacy of acupuncture in the treatment of
neck pain.
Trinh K et al. Cervical Overview Group. A systematic review that summarised the most current
Acupuncture for neck disorders. scientific evidence on the effectiveness of acupuncture for
Cochrane Database of Systematic acute, subacute and chronic neck pain. A total of 10 trials of
Reviews 2006, Issue 3. Art. No.: acupuncture treatments for chronic neck pain were included,
CD004870. DOI: but no trials were found of acupuncture for acute or subacute
10.1002/14651858.CD004870.pub3. pain. For chronic mechanical neck disorders, there was
moderate evidence that acupuncture was more effective for
pain relief than some types of sham controls, measured
immediately post-treatment. There was moderate evidence
that acupuncture was more effective than inactive, sham
treatments measured immediately post-treatment and at short-
term follow-up. There was limited evidence that acupuncture
was more effective than massage at short-term follow-up. For
chronic neck disorders with radicular symptoms, there was
moderate evidence that acupuncture was more effective than a
wait-list control at short-term follow-up. The reviewers
concluded that there is moderate evidence that acupuncture
relieves pain better than some sham treatments, measured at
the end of the treatment, and that those who receive
acupuncture report less pain at short term follow-up than those
on a waiting list. They also concluded that there is also
moderate evidence that acupuncture is more effective than
inactive treatments for relieving pain post-treatment and this is
maintained at short-term follow-up.
Sahin N et al. Efficacy of acupuncture A randomised controlled trial that compared the efficacy of
in patients with chronic neck pain--a electroacupuncture and sham acupuncture in the treatment of
randomised, sham controlled trial. 31 patients with chronic neck pain. Patients were evaluated
Acupuncture & electro-therapeutics before and after therapy and 3 months later by Visual
research 2010; 35: 17-27. Analogue Scale (VAS) and the bodily pain subscale of the
Short Form Health Survey-36 scale. VAS scores in both
groups significantly reduced after therapy and at 3 months
post-therapy, but the difference between groups was not
significant. In respect of bodily pain, there was a significant
improvement in the acupuncture group after therapy (p<0.01).
The researchers concluded that their results suggested that
stimulation of conventional acupuncture points was not
generally superior to needling of nonspecific points on the
neck, and both treatments were associated with improvement
of symptoms. However, they stated that needles inserted into
the neck are likely to be an inappropriate sham control for
acupuncture.
Fu W-B et al. Analysis on the effect of A randomised controlled trial that observed the clinical effect of
acupuncture in treating cervical real and sham acupuncture for cervical spondylosis with
spondylosis with different syndrome different syndrome types in 117 patients. The efficacy of
types. Chinese Journal of Integrative treatment was evaluated with the Northwick Park Neck Pain
Medicine 2009; 15: 426-30. Questionnaire (NPQ) and Visual Analogue Scale (VAS). The
NPQ and VAS scores had significantly reduced in both groups
at the end of treatment and for the 1st month of follow-up
(p<0.05), but it did not last into the 3rd month of follow-up. The
researchers concluded that acupuncture had a good
immediate effect in treating cervical spondylosis, but its long-
term effect is not satisfactory.
Liang ZH et al. [Logistic regression A randomised sham-controlled trial that explored the main
analysis on therapeutic effect of factors influencing the therapeutic effects of acupuncture on
acupuncture on neck pain caused by neck pain caused by cervical spondylosis in 106 patients.
Witt CM et al. Acupuncture for patients A randomised controlled trial that investigated the
with chronic neck pain. Pain 2006; 125: effectiveness of acupuncture in addition to routine care in
98-106. 14,161 patients with chronic neck pain (duration >6 months)
compared to treatment with routine care alone. Patients were
randomly allocated to an acupuncture group or a control group
receiving no acupuncture. All the patients were allowed to
receive usual medical care in addition to study treatment. Neck
pain and disability (NPAD Scale by Wheeler) were assessed
after 3 months. Of the 14,161 patients, 1,880 were randomised
to acupuncture and 1,886 to control, and 10,395 were included
into a non-randomised acupuncture group. At 3 months, neck
pain and disability improved by 16.2 to 38.3 and by 3.9 to 50.5
(difference 12.3; p<0.001) in the acupuncture and control
group, respectively. Treatment effects were maintained for 6
months. Non-randomised patients had more severe symptoms
at baseline and showed higher neck pain and disability
improvement compared to randomised patients. The
researchers concluded that treatment with acupuncture added
to routine care in patients with chronic neck pain was
associated with improvements in neck pain and disability
compared to treatment with routine care alone.
Vas J et al. Efficacy and safety of A randomised controlled trial that compared the efficacy and
acupuncture for chronic uncomplicated safety of acupuncture with transcutaneous nerve stimulation-
neck pain: A randomised controlled placebo (TENS-placebo) in the treatment of 123 patients with
study. Pain 2006; 126: 245-55. chronic uncomplicated neck pain. All the patients experienced
neck motion-related pain intensity equal to or exceeding 30 on
a visual analogue scale (VAS) of 0 to 100 mm. The primary
outcome measure was the change in maximum pain intensity
related to motion of the neck, 1 week after the final treatment.
The change in the pain-VAS variable was greater in the
acupuncture group, with improvements in quality of life
(physical aspect), active neck mobility and reduced rescue
medication were clinically and statistically significant. The
researchers concluded that acupuncture is more effective than
placebo treatment for routine treatment of chronic neck pain in
clinical practice.
Willich SN et al. Cost-effectiveness of A randomised controlled study that assessed costs and cost-
acupuncture treatment in patients with effectiveness of additional acupuncture treatment in 3,451
chronic neck pain. Pain 2006; 125: patients with chronic neck pain compared to patients receiving
107-13. routine care alone. Resource use and health related quality of
life (SF-36) at baseline and after 3 months were assessed. The
main outcome parameters were direct and indirect cost
differences during the 3 months study period and the
incremental cost-effectiveness ratio (ICER) of acupuncture
treatment. Acupuncture treatment was associated with
significantly higher costs over the 3-month study duration
Zhou JW et al. [Multicenter randomized A randomised controlled trial that looked at the clinical value of
controlled study on acupuncture- acupuncture compared to or used with massage in 180
massage comprehensive program for patients with cervical spondylosis of the arterial type (CSA).
treatment of cervical spondylosis of Multiple-dimensional indexes were used to evaluate the
arterial type]. Zhongguo Zhen Jiu 2005; therapeutic effect and safety. The cured-markedly effective
25: 227-31. and the effective rate were 68.3% and 88.3% in the
acupuncture-massage group, 51.7% and 75.0% in the
acupuncture group, and 50.0% and 76.7% in the massage
group, respectively, the acupuncture-massage group being
better than the other two groups (p<0.05). The total cumulative
scores for symptoms in the three groups decreased
significantly (all p<0.01), the acupuncture-massage group
being superior to the other two groups (p<0.05). The physical
signs in the three groups improved significantly (p<0.01), with
no significant differences among the groups (p>0.05). The time
to clinical effect in the acupuncture-massage group was
shorter than that in the other two groups (p<0.05 or p<0.01);
and no adverse effects were found in the 3 groups. The
researchers concluded that acupuncture plus massage has a
definite therapeutic effect on cervical spondylosis of arterial
type, is safe, and is more effective than simple acupuncture or
the simple massage.
Zhao ZQ. Neural mechanism Review article that discusses the various peripheral and
underlying acupuncture analgesia. central nervous system components of acupuncture
Prog Neurobiol 2008; 85: 355-75. anaesthesia in detail.
Kavoussi B, Ross BE. The Review article that suggests the anti-inflammatory actions of
neuroimmune basis of anti- traditional and electro-acupuncture are mediated by efferent
inflammatory acupuncture. Integr vagus nerve activation and inflammatory macrophage
Cancer Ther 2007; 6: 251-7. deactivation.
Pomeranz B. Scientific basis of Needle activation of A delta and C afferent nerve fibres in
acupuncture. In: Stux G, Pomeranz B, muscle sends signals to the spinal cord, where dynorphin and
eds. Acupuncture Textbook and Atlas. enkephalins are released. Afferent pathways continue to the
Heidelberg: Springer-Verlag; 1987:1- the midbrain, triggering excitatory and inhibitory mediators in
18. spinal cord. Ensuing release of serotonin and norepinephrine
onto the spinal cord leads to pain transmission being inhibited
both pre- and postsynaptically in the spinothalamic tract.
Finally, these signals reach the hypothalamus and pituitary,
triggering release of adrenocorticotropic hormones and beta-
endorphin.