Graham Nadine, Gross Anita R, Carlesso Lisa C, Santaguida P Lina, Macdermid Joy C, Walton Dave, Ho Enoch
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
Open Orthop J. 2013 Sep 20;7:440-60. doi: 10.2174/1874325001307010440. eCollection 2013.
Neck pain is common, can be disabling and is costly to society. Physical modalities are often included in neck rehabilitation programs. Interventions may include thermal, electrotherapy, ultrasound, mechanical traction, laser and acupuncture. Definitive knowledge regarding optimal modalities and dosage for neck pain management is limited.
To systematically review existing literature to establish the evidence-base for recommendations on physical modalities for acute to chronic neck pain.
A comprehensive computerized and manual search strategy from January 2000 to July 2012, systematic review methodological quality assessment using AMSTAR, qualitative assessment using a GRADE approach and recommendation presentation was included. Systematic or meta-analyses of studies evaluating physical modalities were eligible. Independent assessment by at least two review team members was conducted. Data extraction was performed by one reviewer and checked by a second. Disagreements were resolved by consensus.
Of 103 reviews eligible, 20 were included and 83 were excluded. Short term pain relief - Moderate evidence of benefit: acupuncture, intermittent traction and laser were shown to be better than placebo for chronic neck pain. Moderate evidence of no benefit: pulsed ultrasound, infrared light or continuous traction was no better than placebo for acute whiplash associated disorder, chronic myofascial neck pain or subacute to chronic neck pain. There was no added benefit when hot packs were combined with mobilization, manipulation or electrical muscle stimulation for chronic neck pain, function or patient satisfaction at six month follow-up.
The current state of the evidence favours acupuncture, laser and intermittent traction for chronic neck pain. Some electrotherapies show little benefit for chronic neck pain. Consistent dosage, improved design and long term follow-up continue to be the recommendations for future research.
颈部疼痛很常见，可能会使人致残，且给社会带来高昂成本。物理治疗方法通常包含在颈部康复计划中。干预措施可能包括热疗、电疗法、超声、机械牵引、激光和针灸。关于颈部疼痛管理的最佳治疗方法和剂量的确切知识有限。
系统回顾现有文献，为急性至慢性颈部疼痛的物理治疗方法建议建立证据基础。
纳入2000年1月至2012年7月全面的计算机和手工检索策略、使用AMSTAR进行的系统评价方法学质量评估、使用GRADE方法进行的定性评估以及推荐意见呈现。对评估物理治疗方法的研究进行系统评价或荟萃分析符合要求。由至少两名综述团队成员进行独立评估。数据提取由一名综述员进行，另一名进行核对。分歧通过协商解决。
在103篇符合条件的综述中，20篇被纳入，83篇被排除。短期疼痛缓解——有中等获益证据：针灸、间歇牵引和激光对慢性颈部疼痛的疗效优于安慰剂。无获益的中等证据：脉冲超声、红外光或持续牵引对急性挥鞭样损伤相关疾病、慢性肌筋膜性颈部疼痛或亚急性至慢性颈部疼痛并不比安慰剂更好。对于慢性颈部疼痛、功能或六个月随访时的患者满意度，热敷与活动、手法治疗或电刺激肌肉疗法联合使用并无额外益处。
现有证据支持针灸、激光和间歇牵引治疗慢性颈部疼痛。一些电疗法对慢性颈部疼痛几乎没有益处。持续的剂量、改进的设计和长期随访仍是未来研究的建议。
