Medline Articles on Neck Pain
- Chronic spinal pain syndromes:
a clinical pilot trial comparing acupuncture, a nonsteroidal
anti-inflammatory drug, and spinal manipulation.
Giles LG, Muller R. National Unit for Multidisciplinary Studies of Spinal
Pain, Townsville General Hospital, Queensland, Australia.
J Manipulative Physiol Ther
OBJECTIVE: To compare needle acupuncture, medication (tenoxicam
with ranitidine), and spinal manipulation for managing chronic (>13
weeks duration) spinal pain syndromes. DESIGN: Prospective, randomized,
independently assessed preintervention and postintervention clinical pilot trial. SETTING:
Specialized spinal pain syndrome out-patient unit at Townsville General Hospital, Queensland, Australia. SUBJECTS: Seventy-seven
patients (without contraindication to manipulation or medication) were
recruited. INTERVENTIONS: One of three separate, clearly defined
intervention protocols: needle acupuncture, nonsteroidal
anti-inflammatory medication, or chiropractic spinal manipulation. MAIN
OUTCOME MEASURES: Main outcome measures were changes (4 weeks vs. initial
visit) in the scores of the (1) Oswestry Back
Pain Disability Index, (2) Neck Disability Index, and (3) three visual
analogue scales of local pain intensity. RESULTS: Randomization was successful.
After a median intervention period of 30 days, spinal manipulation was the
only intervention that achieved statistically significant improvements
(all expressed as percentages of the original scores) with (1) a reduction
of 30.7% on the Oswestry scale, (2) an
improvement of 25% on the neck disability index, and (3) reductions on the
visual analogue scale of 50% for low back pain, 46% for upper back pain,
and 33% for neck pain (all P<.001). Neither of the other interventions showed any significant improvement on any of the outcome measures. >CONCLUSIONS:
The consistency of the results provides, in spite of several discussed
shortcomings of this pilot study, evidence that in patients with chronic
spinal pain syndromes spinal manipulation, if not contraindicated, results
in greater improvement than acupuncture and medicine.
- A symptomatic classification of
whiplash injury and the implications for treatment
Khan S, Cook J, Gargan M, Bannister G.
University Department of Orthopaedic Surgery,
Journal of Orthopaedic Medicine 1999 21 22-25
Objective: To determine which patients with chronic whiplash will benefit
from chiropractic treatment. Design: Retrospective review by structured
telephone interviews of 93 consecutive patients seen in chiropractic
clinic. Setting: Independent chiropractic clinic in a large city.
Subjects: 93 patients, 68 female. Main outcome measure: Gargan and Bannister grading pre and post treatment.
Results: Three groups of patients were recognised.
Group 1 consisted of patients with isolated neck pain associated with a
restricted range of neck movement. Group 2 consisted of patients with
neurological symptoms or signs associated with a restricted range of
movement. Group 3 comprised patients who described severe neck pain but
all of whom had a full range of neck movement. Patients in this group
often described an unusual group of symptoms, with a bizarre, non-dermatomal pain distribution. There was a significant
difference in outcome between the three groups (p<0.001) with only groups 1 and 2 improving following chiropractic manipulation. >Conclusion:
Whiplash injuries are common. Chiropractic is the only proven effective
treatment in chronic cases. Our study enables patients to be classified at
initial assessment in order to target those patients who will benefit from