Vernon Howard T, Humphreys B Kim, Hagino Carol A
Center for Studies of the Cervical Spine, Graduate Education and Research, Canadian Memorial Chiropractic College, Graduate Education and Research, Toronto, Ontario, Canada M2H 3J1.
J Manipulative Physiol Ther. 2005 Jul-Aug;28(6):443-8. doi: 10.1016/j.jmpt.2005.06.011.
To identify the evidence base of clinical trials of conservative treatments for acute neck pain not due to whiplash injury.
A comprehensive literature search was performed in MEDLINE, CINHAHL, AMED, MANTIS, Index to Chiropractic Literature, Alt HealthWatch, the Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Registry, and several EBSCO Information Services databases. Systematic retrieval and evaluation procedures were used.
The search generated 1980 citations. Four trials (5 publications) were accepted according to the inclusion/exclusion criteria. Three trials used a form of spinal manual therapy. One of these trials used only one manipulation and reported immediate effects on pain, with real manipulation producing significantly greater pain reduction than control procedure. The other 2 of these trials reported on outcomes over 1 to 3 weeks. In 1 trial, the group receiving manipulation showed significantly greater pain reduction at 1 week than did the group receiving only medication. In the other trial, the group receiving transcutaneous electrical nerve stimulation had a significantly greater level of pain reduction at 3 weeks. In the fourth trial, exercise was compared to passive physiotherapy; however, outcomes were not reported until 6 and 12 months, so the results cannot be compared to the natural history of acute neck pain not due to whiplash.
There is limited evidence of the benefit of spinal manipulation and transcutaneous electrical nerve stimulation in the treatment of acute neck pain not due to whiplash injury. There is a dearth of high-quality clinical trials of conservative treatments for this condition.
确定非挥鞭伤所致急性颈部疼痛保守治疗临床试验的证据基础。
在MEDLINE、CINHAHL、AMED、MANTIS、脊椎按摩疗法文献索引、另类健康观察、Cochrane系统评价数据库、Cochrane对照试验注册库以及几个EBSCO信息服务数据库中进行了全面的文献检索。采用了系统检索和评估程序。
检索产生了1980条引文。根据纳入/排除标准，四项试验（五篇出版物）被纳入。三项试验采用了某种形式的脊柱手法治疗。其中一项试验仅使用了一次手法操作，并报告了对疼痛的即时影响，实际手法操作比对照程序能显著减轻疼痛。这些试验中的另外两项报告了1至3周的结果。在一项试验中，接受手法治疗的组在1周时的疼痛减轻程度明显大于仅接受药物治疗的组。在另一项试验中，接受经皮电刺激神经疗法的组在3周时的疼痛减轻程度明显更大。在第四项试验中，将运动与被动物理治疗进行了比较；然而，直到6个月和12个月才报告结果，因此无法将结果与非挥鞭伤所致急性颈部疼痛的自然病程进行比较。
在治疗非挥鞭伤所致急性颈部疼痛方面，脊柱手法治疗和经皮电刺激神经疗法有益的证据有限。针对这种情况的保守治疗缺乏高质量的临床试验。
