Wednesday, October 21, 2009

Cochrane review: Electrotherapy for neck pain

Neck pain is common, disabling and costly. Electrotherapy is an umbrella term that covers a number of therapies that aim to reduce pain and improve muscle tension and function.

This updated review included 18 small trials (1043 people). The results of the trials could not be pooled because they examined different populations, types and doses of electrotherapy, and comparison treatments and measured slightly different outcomes.  

We cannot make any definitive statements about the efficacy of electrotherapy for neck pain because of the low or very low quality of the evidence for each outcome, which in most cases, was based on the results of only one trial. 

For patients with acute neck pain, TENS possibly relieved pain better than electrical muscle stimulation, not as well as exercise and infrared and as well as manual therapy and ultrasound. There was no additional benefit when added to infrared, hot packs and exercise, physiotherapy or a combination of a neck collar, exercise and pain medication.

For patients with acute whiplash, iontophoresis was no more effective than no treatment, interferential current or a combination of traction, exercise and massage for relieving neck pain with headache; pulsed electro-magnetic field was more effective than 'standard care'.

For patients with chronic neck pain, TENS possibly relieved pain better than placebo and electrical muscle stimulation, not as well as exercise and infrared and possibly as well as manual therapy and ultrasound; pulsed electro-magnetic field was possibly better than placebo, galvanic current, and electrical muscle stimulation. Magnetic necklaces were no more effective than placebo for relieving pain; there was no additional benefit when electrical muscle stimulation was added to either mobilisation or manipulation.

For patients with myofascial neck pain, TENS, FREMS (variation of TENS) and repetitive magnetic stimulation seemed to relieve pain better than placebo.

While over half of the trials were assessed as having a low risk of bias, seven of them did not describe how their participants were randomised, eight did not conceal the treatment assignment, and 12 did not control co-interventions. The trials were very small, with a range of 16 to 336 participants. Sparse and imprecise data mean the results cannot be generalized to the broader population and contributes to the reduction in the quality of the evidence, which was low or very low for all results. Therefore, further research is very likely to change the results and our confidence in them.

Kroeling P, Gross A, Goldsmith CH, Burnie SJ, Haines T, Graham N, Brant A. Electrotherapy for neck pain. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD004251. DOI: 10.1002/14651858.CD004251.pub4

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