Conservative Treatment

Conservative Treatment for Neck Pain

Non-Surgical Therapy for Neck Pain - An Overview

With so many forms of non-surgical therapy available to patients with neck pain, whether acute or chronic, deciding which method to try can be stressful in itself. Most frequently patients self-medicate using analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs), often whilst waiting for a referral from their physician to a physical therapist or spine specialist. Other patients, often tired of waiting for treatment, turn to alternative therapies for neck pain using chiropractors, massage therapists, and non-surgical spinal decompression to relieve their pain.

For all patients it is important to understand the source of neck pain as fully as possible before utilizing any particular treatment modality. This is because there are risks associated with almost all forms of therapy, however innocuous they may appear. Levels of evidence vary substantially for each treatment, and commonalities between treatments often confound the little evidence that there is. Trends in mainstream medicine’s attitude towards specific treatments affects both research, patients’ awareness of therapies, and availability.

There appears to be a trend in the research that is published showing that any intervention achieves more success than no treatment at all when dealing with patients’ pain. Often it appears that a reassuring, professional consultation can significantly affect patients’ responses to therapy, particularly if they are coupled with a psychological intervention to help with attitudes to neck pain and offering hope for cure or significant neck pain reduction (Malone and Strube, 1988). Ensuring that patients are fully versed in available therapies and are given the actual details of their condition by their physician in a way they can comprehend makes choosing a therapeutic strategy much easier for both the sufferer and their doctor. Approaching patients on an individual basis rather than relying on outmoded fashions in diagnosis and referral make a successful outcome all the more likely, although patients should understand that some treatments are decidedly off-limits if they have specific conditions that could be exacerbated by treatment.

NSAIDs, Oral Steroids, and Epidural Steroid Injections

More than 60 million Americans use NSAIDs on a regular basis, many remaining unaware of their dangerous side-effects, especially when used long-term to manage chronic neck pain. In addition, these medications may not be as effective as patients believe, and other remedies, which are considerably less dangerous, such as fish oil, may be more appropriate for both long- and short-term use.

If patients are unresponsive to NSAIDs then a physician may, usually reluctantly, prescribe oral steroids, or use epidural steroid injections to manage the patients’ pain. There are some serious dangers associated with oral steroid use, and some patients such as those with a compromised immune system, or diabetes may be advised against the use of oral steroids. Some patients, however, may find that oral steroids significantly relieve their pain and inflammation, specifically in conditions such as polymyalgia rheumatica where low levels of adrenal hormones are being investigated as a possible mechanism behind the pathology (Cutolo, 2006).

Epidural steroid injections may be particularly effective at relieving radicular pain associated with the compression of a nerve root in the cervical spine, they may even present an opportunity for a break in the cycle of inflammation, allowing a herniated cervical disc to start the healing process. The long-term effects of repeated epidural steroid injections remains unknown, however, making physicians wary of giving more than three injections to a patient in most cases, and ensuring that these are spread over a long period of time. There are dangers associated with epidural steroid injections, such as risk of infection, and dural tear. Risks are minimized through the use of a fluoroscope during the procedure, but patients should apply caution when seeking this treatment as it usually does little to address the underlying condition causing the nerve pain.

Massage, Thermotherapy, and Cryotherapy

Therapies such as massage, chiropractic treatment, and physical therapy go in and out of favor with the orthodox medical establishment. This affects their accessibility for patients with chronic or acute neck pain, and the attention paid to them in the medical literature in terms of new research and clinical advances. Massage was, particularly before WWII, a popular treatment in many major hospitals and was conducted by specially trained nurses. With the advent of recent research into the cognitive effects of massage on stress levels, pain perception, and overall health, it may be simply a matter of time before the practice enjoys some of its former admiration and esteem. Massage may also be effective for conditioning and strengthening muscles after periods of disuse due to injury, and may form part of an adjunct treatment to physical therapy modalities.

Similarly, simple home remedies such as heat/cold therapy are becoming more systematically medicalized and understood at a biochemical and neurological level. Cryotherapy for acute, painful, inflammatory neck injuries may be particularly beneficial when applied appropriately. Thermotherapy, both localized and systemic can have profound effects on a patient’s sense of well-being, leading to significant reductions in the tension that can cause neck pain and the sensation of pain itself. There remain some worries over risks of cryotherapy and thermotherapy, particularly as they are contraindicated in some patients, such as diabetics, and those with multiples sclerosis or nerve system disorders.

Chiropractic Treatment, and Physical Therapy

Chiropractic treatment has also been subjected to some serious attacks in terms of its safety record in recent years, with researchers scrambling to acquire funding for trials to show its relative safety. Ironically, the record for safety of these non-surgical treatment methods is often significantly better than for orthodox spinal surgery, with many also having a better body of evidence to support their use. Chiropractic treatment can offer benefits in terms of pain relief for some patients, whilst others are advised against the treatment due to underlying pathology such as fractures, tumors, or circulatory disorders.

For those who are referred by their physician to a physical therapist, or who attend one privately, there may be great gains to be had in treating both acute neck pain and chronic neck pain. Although evidence for the efficacy of physical therapy as a whole is scarce, the component treatments that are included under the heading of physical therapy have substantial evidence to support their claims. Unfortunately, the dilemma for the patient is that the effect of treatment depends largely on which of these therapies are actually applied during treatment, with acute neck pain responding better to manipulation and mobilization and chronic pain having a better outcome when treated with exercise and mobilization techniques.

Non-Surgical Spinal Decompression

For many patients attending a chiropractic clinic or receiving alternative therapy for relief of their neck pain they may be invited to undergo non-surgical spinal decompression. The research substantiating the claims of those using this technique is far from conclusive, with worries over research bias when funded by major non-surgical spinal decompression table manufacturers and those who have purchased such products, at great expense, for their clinic. Some patients will experience significant relief from these tables, but the manufacturers claims of 85% plus having excellent pain relief remain unsubstantiated by quality, peer-reviewed clinical research data.

Additionally, the success of some non-surgical spinal decompression may be attributed to the other therapeutic strategies that are applied in conjunction with the treatment such as massage, physical therapy, education, and relaxation techniques. Serious, large-scale trials into non-surgical spinal decompression are yet to be conducted, and the relative cost of treatment compared to perceived cost of NSAIDs, for instance, may be a deciding factor for some patients, despite the differences in potential danger profiles. If a patient is considering non-surgical spinal decompression then they are advised to locate an experienced clinician who has been using the table for a number of years and can advise as to the appropriateness of treatment. A reputable practitioner will often make use of diagnostic imaging methods, such as MRI, or x-ray before commencing any non-surgical spinal decompression.





Last Updated: 11/20/2010