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Neck pain interventions from the Cochrane Library

One of the most important functions of the Cochrane Library is to demonstrate what we do not know. Good quality reviews that find no trials, no good trials, or good trials with no effect, are really important in delimiting the extent of our knowledge (or ignorance). This survey briefly examines a number of reviews on neck pain.


Conservative treatments for whiplash


AP Verhagen et al. Conservative treatments for whiplash. Cochrane Database of Systematic Reviews 2004 issue 1.


Clinical bottom line

There were 15 trials, including those of low quality, and only three satisfied the authors' definition of high quality. There is no evidence of benefit from conservative treatment, other than possibly a trend that active interventions are better than passive ones.


Medicinal and injection therapies


P Peloso et al. Medicinal and injection therapies for mechanical neck disorders. Cochrane Database of Systematic Reviews 2004 issue 2.


Clinical bottom line

There were 32 trials, looking at different interventions in mechanical neck disorder, headache of cervical origin, neck disorder with radicular signs and symptoms, whiplash, and various degenerative changes. No high quality studies showing evidence of benefit were replicated.


Manipulation and mobilisation


AR Gross et al. Manipulation and mobilisation for mechanical neck disorders. Cochrane Database of Systematic Reviews 2004 issue 1.


Clinical bottom line

There were 33 trials, including those of low quality. Single or multiple sessions of mobilisation or manipulation were compared with various controls. There was no evidence of any benefit.


Radiofrequency denervation


L Niemisto et al. Radiofrequency denervation for neck and back pain. Cochrane Database of Systematic Reviews 2003 issue 1.


Clinical bottom line

There were six high quality trials including 275 patients of whom 141 received active treatment. Studies were small, follow up times were short, and there were methodological problems. There is no evidence of benefit.