Effectiveness and Safety of Nerve Block Therapy for Neck Pain: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

XU Jing , JIA Gongwei , TAN Botao ,  YU Lehua

Rehabilitation Medicine Department, The Second Hospital Affiliated to Chongqing Medical University, Chongqing 400010, China;

Corresponding author：

YU Lehua, Email: yulehuadoc@yahoo.com.cn

Keywords：

Nerve block therapy; Neck pain; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20120230

Video：

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Objective 　To systematically evaluate effectiveness and safety of nerve block therapy for neck pain.
Methods 　Databases including CENTRAL, PubMed, Ovid, ISI, EBSCO, CBM and CNKI were searched from the date of their establishment to November 2011, and relevant references were also retrieved manually to collect both domestic and abroad randomized controlled trials (RCTs) about nerve block therapy for neck pain. According to the inclusion and exclusion criteria, two researchers independently screened literature, extracted data, and assessed the quality of the included studies. Then the meta-analysis was conducted using RevMan 5.0 software.
Results 　A total of 10 studies involving 625 participants were included. The results of qualitative analysis showed that: a) The short-term effectiveness of the nerve block therapy group was markedly superior to the placebo group, the cognitive therapy group and the transcutaneous electric nerve stimulation (TENS) group; and b) The short-term effectiveness of the combined nerve block therapy was markedly superior to the single nerve block therapy. The results of meta-analysis demonstrated that: a) There was no significant difference between the greater occipital nerve (GON) block group and the C2/3 nerve block group in neither short-term (SMD=−0.13, 95%CI −0.58 to 0.32, P=0.58) nor medium-term effectiveness (SMD=−0.01, 95%CI −0.46 to 0.44, P=0.98); and b): There was no significant difference between the injection with steroids group and the injection without steroids group in both short-term (SMD=0.16, 95%CI −0.13 to 0.44, P=0.28) and long-term effectiveness (SMD=0.27, 95%CI −0.02 to 0.55, P=0.07).
Conclusion 　Current evidence shows nerve block therapy for neck pain is safe and especially good in short-term effectiveness. The combined nerve block therapy is probably more effective, but the effectiveness is not obviously improved by injection with or without steroids, and by different block methods. Due to the limitation of quality, quantity and total sample size of the included studies, this conclusion still needs to be proved by conducting more high quality and large scale studies.

Citation： XU Jing,JIA Gongwei,TAN Botao,YU Lehua. Effectiveness and Safety of Nerve Block Therapy for Neck Pain: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(12): 1497-1502. doi: 10.7507/1672-2531.20120230 Copy

1.	Cté P, Cassidy D, Carroll L. The Saskatchewan health and back pain survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine, 1998, 23(15): 1689-1698.
2.	Binder AI. Cervical spondylosis and neck pain. BMJ, 2007, 334: 527–531.
3.	Jette AM, Smith K, Haley SM, et al. Physical therapy episodes of care for patients with low back pain. Phys Ther, 1994, 74: 101-110.
4.	John DC, Joshua AC, James ME, et al. Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther, 2008, 38(9): A1-A34.
5.	Gross A, Miller J, Sylva JD, et al. Manipulation or Mobilisation for neck pain: A Cochrane Review. Manual Therapy, 2010, 15(4): 315-333.
6.	Langevin P, Lowcock J, Nolan M, et al. Botulinum toxin for subacute/chronic neck pain(Review). Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD008626. DOI: 10.1002/14651858.CD008626.pub2.
7.	刘兵, 梁新梅. 颈源性头痛及其神经阻滞疗法. 中国疼痛医学杂志, 2009, 15(6): 363-365.
8.	谭冠先. 神经阻滞疗法. 见: 谭冠先, 主编. 疼痛诊疗学. 第2版. 人民卫生出版社, 2010. 44-44.
9.	Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache, 1990, 30(11): 725-726.
10.	Inan N, Ceyhan A, Inan L, et al. C2/C3 nerve blocks and greater occipital nerve block in cervicogenic headache treatment. Funct Neurol, 2002, 16(3): 239-243.
11.	Gale G, Nussbaum D, Rothbart P, et al. A randomized treatment study to compare the efficacy of repeated nerve blocks with cognitive therapy for control of chronic head and neck pain. Pain Res Manag, 2003, 7(4): 185-189.
12.	Naja ZM, El-Rajab M, Al-Tannir MA, et al. Occipital nerve blockade for cervicogenic headache: a double-blind randomized controlled clinical trial. Pain Practice, 2006, 6(2): 89-95.
13.	Manchikanti L, Singh V, Falco F J, et al. Cervical medial branch blocks for chronic cervical facet joint pain: a randomized, double-blind, controlled trial with one-year follow-up. Spine, 2008, 33(17): 1813-1820.
14.	Manchikanti L, Cash KA, Pampati V, et al. Cervical epidural injections in chronic discogenic neck pain without disc herniation or radiculitis: preliminary results of a randomized, double-blind, controlled trial. Pain Physician, 2010, 13(4): E265-278.
15.	Manchikanti L, Singh V, Falco FJ, et al. Comparative outcomes of a 2-year follow-up of cervical medial branch blocks in management of chronic neck pain: a randomized, double-blind controlled trial. Pain Physician, 2010, 13(5): 437-450.
16.	郑宝森, 史可梅, 邓迺封, 等. 神经阻滞与经皮电刺激治疗颈源性头痛的对照研究. 天津医科大学学报, 2002, 8(3): 344-346.
17.	王威, 王保国, 刘延青, 等. 不同神经阻滞方法治疗颈源性头痛的疗效观察. 中国康复医学杂志, 2005, 20(8): 585-588.
18.	申颖, 白莺, 金旭, 等. 甘油果糖复合神经阻滞治疗颈源性头痛的临床观察. 中国康复理论与实践, 2008, 14(6): 506-507.
19.	庄志刚, 王秀岩. 椎旁神经阻滞治疗颈源性头痛对比观察. 中国实用神经疾病杂志, 2011, 14(4): 12-13.

1. Cté P, Cassidy D, Carroll L. The Saskatchewan health and back pain survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine, 1998, 23(15): 1689-1698.
2. Binder AI. Cervical spondylosis and neck pain. BMJ, 2007, 334: 527–531.
3. Jette AM, Smith K, Haley SM, et al. Physical therapy episodes of care for patients with low back pain. Phys Ther, 1994, 74: 101-110.
4. John DC, Joshua AC, James ME, et al. Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther, 2008, 38(9): A1-A34.
5. Gross A, Miller J, Sylva JD, et al. Manipulation or Mobilisation for neck pain: A Cochrane Review. Manual Therapy, 2010, 15(4): 315-333.
6. Langevin P, Lowcock J, Nolan M, et al. Botulinum toxin for subacute/chronic neck pain(Review). Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD008626. DOI: 10.1002/14651858.CD008626.pub2.
7. 刘兵, 梁新梅. 颈源性头痛及其神经阻滞疗法. 中国疼痛医学杂志, 2009, 15(6): 363-365.
8. 谭冠先. 神经阻滞疗法. 见: 谭冠先, 主编. 疼痛诊疗学. 第2版. 人民卫生出版社, 2010. 44-44.
9. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache, 1990, 30(11): 725-726.
10. Inan N, Ceyhan A, Inan L, et al. C2/C3 nerve blocks and greater occipital nerve block in cervicogenic headache treatment. Funct Neurol, 2002, 16(3): 239-243.
11. Gale G, Nussbaum D, Rothbart P, et al. A randomized treatment study to compare the efficacy of repeated nerve blocks with cognitive therapy for control of chronic head and neck pain. Pain Res Manag, 2003, 7(4): 185-189.
12. Naja ZM, El-Rajab M, Al-Tannir MA, et al. Occipital nerve blockade for cervicogenic headache: a double-blind randomized controlled clinical trial. Pain Practice, 2006, 6(2): 89-95.
13. Manchikanti L, Singh V, Falco F J, et al. Cervical medial branch blocks for chronic cervical facet joint pain: a randomized, double-blind, controlled trial with one-year follow-up. Spine, 2008, 33(17): 1813-1820.
14. Manchikanti L, Cash KA, Pampati V, et al. Cervical epidural injections in chronic discogenic neck pain without disc herniation or radiculitis: preliminary results of a randomized, double-blind, controlled trial. Pain Physician, 2010, 13(4): E265-278.
15. Manchikanti L, Singh V, Falco FJ, et al. Comparative outcomes of a 2-year follow-up of cervical medial branch blocks in management of chronic neck pain: a randomized, double-blind controlled trial. Pain Physician, 2010, 13(5): 437-450.
16. 郑宝森, 史可梅, 邓迺封, 等. 神经阻滞与经皮电刺激治疗颈源性头痛的对照研究. 天津医科大学学报, 2002, 8(3): 344-346.
17. 王威, 王保国, 刘延青, 等. 不同神经阻滞方法治疗颈源性头痛的疗效观察. 中国康复医学杂志, 2005, 20(8): 585-588.
18. 申颖, 白莺, 金旭, 等. 甘油果糖复合神经阻滞治疗颈源性头痛的临床观察. 中国康复理论与实践, 2008, 14(6): 506-507.
19. 庄志刚, 王秀岩. 椎旁神经阻滞治疗颈源性头痛对比观察. 中国实用神经疾病杂志, 2011, 14(4): 12-13.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Nerve Block Therapy for Neck Pain: A Systematic Review

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