For the treatment of chronic neck pain, the evidence is even more sparse than that for acute neck pain, and even less supportive of traditional approaches. There is no published evidence supporting the effectiveness of a collar, TENS, traction, trigger point therapy, or multimodal therapy for chronic neck pain.112 There is no published evidence of any drugs being effective.
For acupuncture, the evidence is conflicting. While some studies have reported an effect greater than that of placebo,113[II] others have found no difference from placebo,114,115116112 118 119[II] and one study found placebo to be more effective.120[II] Injections of Botulinum toxin are not effective for chronic neck pain.121 [II] One study found trigger point injections to be as effective as ultrasound treatment122[II] but another found ultrasound to be no more effective than placebo treatment.123[II] Intra-articular injections of cortico-steroids are not effective for cervical zygapophysial joint pain.124[II]
A systematic review110[I] found no evidence of benefit from manipulative therapy or cervical mobilization for chronic neck pain. Physiotherapy provides only small improvements in pain, and is not more effective than a brief session of advice.125[II] No controlled trials have determined if multidisciplinary or behavioral therapy is effective for chronic neck pain.112
Of the conventional, conservative therapies, exercises are the mainstay of treatment for chronic neck pain. Exercises of various types can reduce pain by anywhere between 25 and 75 percent, but they are not demonstrably more effective than treatments with which they have been compared, which include manual therapy and ordinary activity (Table 36.5). In the most recent study, exercises were barely more effective than three sessions of advice.134[II]
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