Is pharmacologic treatment better than neural mobilization for cervicobrachial pain? A randomized clinical trial

César Calvo-Lobo, Francisco Unda-Solano, Daniel López-López, Irene Sanz-Corbalán, Carlos Romero-Morales, Patricia Palomo-López, Jesús Seco-Calvo, David Rodríguez-Sanz, César Calvo-Lobo, Francisco Unda-Solano, Daniel López-López, Irene Sanz-Corbalán, Carlos Romero-Morales, Patricia Palomo-López, Jesús Seco-Calvo, David Rodríguez-Sanz

Abstract

Purpose: This study aim was to compare the effectiveness of the median nerve neural mobilization (MNNM) and cervical lateral glide (CLG) intervention versus oral ibuprofen (OI) in subjects who suffer cervicobrachial pain (CP). Methods: This investigation was a, multicenter, blinded, randomized controlled clinical trial (NCT02595294; NCT02593721). A number of 105 individuals diagnosed with CP were enrolled in the study and treated in 2 different medical facilities from July to November 2015. Participants were recruited and randomly assigned into 3 groups of 35 subjects. Intervention groups received MNNM or CLG neurodynamic treatments, and the (active treatment) control group received an OI treatment for 6 weeks. Primary outcome was pain intensity reported through the Numeric Rating Scale for Pain (NRSP). Secondary outcomes were physical function involving the affected upper limb using the Quick DASH scale, and ipsilateral cervical rotation (ICR) using a cervical range of motion (CROM) device. Assessments were performed before and 1 hour after treatment for NRSP (baseline, 3 and 6 weeks) and CROM (baseline and 6 weeks), as well as only 1 assessment for Quick DASH (baseline and 6 weeks). Results: Repeated-measures ANOVA intergroup statistically significant differences were shown for CP intensity (F(2,72) = 22.343; P < .001; Eta2 = 0.383) and Quick DASH (F(2,72) = 15.338; P < .001; Eta2 = 0.299), although not for CROM (F(2,72) = 1.434; P = .245; Eta2 = 0.038). Indeed, Bonferroni´s correction showed statistically significant differences for CP intensity (P < .01; 95% CI = 0.22 - 3.26) and Quick DASH reduction (P < .01; 95% CI = 8.48 - 24.67) in favor of the OI treatment at all measurement moments after baseline. Conclusions: OI pharmacologic treatment may reduce pain intensity and disability with respect to neural mobilization (MNNM and CLG) in patients with CP during six weeks. Nevertheless, the non-existence of between-groups ROM differences and possible OI adverse effects should be considered.

Keywords: Musculoskeletal manipulations; Neck; Non-steroidal anti-inflammatory agents; Rehabilitation; Upper extremity..

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Fig 1
Fig 1
Initial and final positions of the MNNM slide maneuver. (A) Initial position. (B) Final position. Abbreviation: MNNM, median nerve neural mobilization.
Fig 2
Fig 2
Initial and final positions of the CLG neural slide maneuver. (A) Initial position. (B) Final position. Abbreviation: CLG, cervical lateral glide.
Fig 3
Fig 3
Participant flow through the trial. Abbreviations: CLG, cervical lateral glide; NSAIDs, non-steroidal antiinflammatory drugs; MNNM, median nerve neural mobilization; OI, oral ibuprofen.
Fig 4
Fig 4
CP intensity intergroup comparison during follow-up. Abbreviations: CLG, cervical lateral glide; CI, confidence interval; h, hour; MNNM, median nerve neural mobilization; NRSP, numeric rating scale for pain intensity; OI, oral ibuprofen. *According to the P-values obtained by the Bonferroni correction (P < .05/3; significance < .017).
Fig 5
Fig 5
Range of motion intergroup comparison during follow-up. Abbreviations: CLG, cervical lateral glide; CI, confidence interval; CROM, cervical range of motion; h, hour; MNNM, median nerve neural mobilization; OI, oral ibuprofen. *According to the P-values obtained by the Bonferroni correction (P < .05/3; significance < .017).
Fig 6
Fig 6
Physical function intergroup comparison during follow-up. Abbreviations: CLG, cervical lateral glide; CI, confidence interval; h, hour; MNNM, median nerve neural mobilization; OI, oral ibuprofen; Quick DASH, Quick Disabilities of the Arm, Shoulder and Hand. *According to the P-values obtained by the Bonferroni correction (P < .05/3; significance < .017).

References

    1. Cleland JA, Whitman JM, Fritz JM, Palmer JA. Manual Physical Therapy, Cervical Traction, and Strengthening Exercises in Patients With Cervical Radiculopathy: A Case Series. J Orthop Sport Phys Ther. 2005;35:802–11.
    1. Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117:325–35.
    1. Gangavelli R, Nair NS, Bhat AK, Solomon JM. Cervicobrachial pain - How Often is it Neurogenic? J Clin Diagn Res. 2016;10:YC14–6.
    1. Fisher RFG, Shaw PLF. Papiro quirúrgico de Edwin Smith. Historia y Filosofía de la Medicina. A Méd. 2005;50:43–8.
    1. Wagner SC, Van Blarcum GS, Kang DG, Lehman RA. Operative treatment of new onset radiculopathy secondary to combat injury. Mil Med. 2015;180:137–40.
    1. Eubanks JD. Cervical radiculopathy: nonoperative management of neck pain and radicular symptoms. Am Fam Physician. 2010;81:33–40.
    1. Peolsson A, Söderlund A, Engquist M, Lind B, Löfgren H, Vavruch L. et al. Physical Function Outcome in Cervical Radiculopathy Patients After Physiotherapy Alone Compared With Anterior Surgery Followed by Physiotherapy. Spine (Phila Pa 1976) 2013;38:300–7.
    1. Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS J. 2011;7:265–72.
    1. Dillingham TR. Evaluating the Patient With Suspected Radiculopathy. PM&R. 2013;5:S41–9.
    1. Boyles R, Toy P, Mellon J, Hayes M, Hammer B. Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review. J Man Manip Ther. 2011;19:135–42. A.
    1. Young IA, Michener LA, Cleland JA, Aguilera AJ, Snyder AR. Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther. 2009;89:632–42.
    1. Dabbs V, Lauretti WJ. A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther. 1995;18:530–6.
    1. van der Velde G, Hogg-Johnson S, Bayoumi AM, Cassidy JD, Côté P, Boyle E. et al. Identifying the Best Treatment Among Common Nonsurgical Neck Pain Treatments. J Manipulative Physiol Ther. 2009;32:S209–18.
    1. Sheather-Reid RB, Cohen M. Efficacy of analgesics in chronic pain: a series of N-of-1 studies. J Pain Symptom Manage. 1998;15:244–52.
    1. Day RO. Variability in response to NSAIDs: what progress? Agents Actions Suppl. 1993;44:3–6.
    1. Isabel de-la-Llave-Rincón A, Puentedura EJ, Fernández-de-Las-Peñas C. Clinical presentation and manual therapy for upper quadrant musculoskeletal conditions. J Man Manip Ther. 2011;19:201–11.
    1. Allison GT, Nagy BM, Hall T. A randomized clinical trial of manual therapy for cervico-brachial pain syndrome - a pilot study. Man Ther. 2002;7:95–102.
    1. Clark BD, Barr AE, Safadi FF, Beitman L, Al-Shatti T, Amin M. et al. Median nerve trauma in a rat model of work-related musculoskeletal disorder. J Neurotrauma. 2003;20:681–95.
    1. Bove GM. Epi-perineurial anatomy, innervation, and axonal nociceptive mechanisms. J Bodyw Mov Ther. 2008;12:185–90.
    1. Elvey R. Brachial plexus tension test and the pathoanatomical origin of arm pain. In: Glasgow E TL, editor. Aspects of manipulative therapy. Lincoln In. Melbourne; 1979. p. 105-110.
    1. Elliott MB, Barr AE, Kietrys DM, Al-Shatti T, Amin M, Barbe MF. Peripheral neuritis and increased spinal cord neurochemicals are induced in a model of repetitive motion injury with low force and repetition exposure. Brain Res. 2008;1218:103–13.
    1. Chu J, Allen DD, Pawlowsky S, Smoot B. Peripheral response to cervical or thoracic spinal manual therapy: an evidence-based review with meta analysis. J Man Manip Ther. 2014;22:220–9.
    1. Kietrys DM, Palombaro KM, Azzaretto E, Hubler R, Schaller B, Schlussel JM. et al. Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2013;43:620–34.
    1. Butler DS, Coppieters MW. Neurodynamics in a broader perspective. Man Ther. 2007;12:e7–8.
    1. Coppieters MW, Butler DS. Do “sliders” slide and “tensioners” tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther. 2008;13:213–21. A.
    1. Elvery R, Hall T. Neural tissue evaluation and treatment. 3rd ed. Donatelli R, editor. New York: Churchill Livingstone; 1997. pp. 131–152. p.
    1. Beneciuk JM, Bishop MD, George SZ. Effects of upper extremity neural mobilization on thermal pain sensitivity: a sham-controlled study in asymptomatic participants. J Orthop Sports Phys Ther. 2009;39:428–38.
    1. Coppieters MW, Stappaerts KH, Wouters LL, Janssens K. The Immediate Effects of a Cervical Lateral Glide Treatment Technique in Patients With Neurogenic Cervicobrachial Pain. J Orthop Sport Phys Ther. 2003;33:369–78.
    1. Nee RJ, Vicenzino B, Jull GA, Cleland JA, Coppieters MW. Neural tissue management provides immediate clinically relevant benefits without harmful effects for patients with nerve-related neck and arm pain: a randomised trial. J Physiother. 2012;58:23–31.
    1. Rainsford KD. Ibuprofen: pharmacology, efficacy and safety. Inflammopharmacology. 2009;17:275–342.
    1. Rainsford KD. Ibuprofen: pharmacology, efficacy and safety. Inflammopharmacology. 2009;17:275–342.
    1. Carlesso LC, Macdermid JC, Gross AR, Walton DM, Santaguida PL. Treatment preferences amongst physical therapists and chiropractors for the management of neck pain: results of an international survey. Chiropr Man Therap. 2014;22:11.
    1. Boutron I, Dutton S, Ravaud P, Altman DG. Reporting and Interpretation of Randomized Controlled Trials With Statistically Nonsignificant Results for Primary Outcomes. JAMA. 2010;303:2058.
    1. Bono CM, Ghiselli G, Gilbert TJ, Kreiner DS, Reitman C, Summers JT. et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 2011;11:64–72.
    1. Weiner DK, Ernst E. Complementary and alternative approaches to the treatment of persistent musculoskeletal pain. Clin J Pain. 2004;20:244–55.
    1. Rodríguez-Sanz D, Calvo-Lobo C, Unda-Solano F, Sanz-Corbalán I, Romero-Morales C, López-López D. Cervical Lateral Glide Neural Mobilization Is Effective in Treating Cervicobrachial Pain: A Randomized Waiting List Controlled Clinical Trial. Pain Med. 2017;18:2492–2503.
    1. Gómez-Pérez L, López-Martínez AE, Ruiz-Párraga GT. Psychometric Properties of the Spanish Version of the Tampa Scale for Kinesiophobia (TSK) J Pain. 2011;12:425–35.
    1. Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976) 2005;30:1331–4.
    1. MacDermid JC, Walton DM, Côté P, Santaguida PL, Gross A, Carlesso L. et al. Use of Outcome Measures in Managing Neck Pain: An International Multidisciplinary Survey. Open Orthop J [Internet] 2013;7:506–20.
    1. Kendrick DB, Strout TD. The minimum clinically significant difference in patient-assigned numeric scores for pain. Am J Emerg Med. 2005;23:828–32.
    1. Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH. et al. Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41:1073–93.
    1. Basson CA, Stewart A, Mudzi W. The effect of neural mobilisation on cervico-brachial pain: design of a randomised controlled trial. BMC Musculoskelet Disord. 2014;15:419.
    1. Angst F, Schwyzer H-K, Aeschlimann A, Simmen BR, Goldhahn J. Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and Its Short Version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society Standardized Shoulder. Arthritis Care Res (Hoboken) 2011;63(S11):S174–88.
    1. van Kampen DA, Willems WJ, van Beers LWAH, Castelein RM, Scholtes VAB, Terwee CB. Determination and comparison of the smallest detectable change (SDC) and the minimal important change (MIC) of four-shoulder patient-reported outcome measures (PROMs) J Orthop Surg Res; 2013. N; 8: 40.
    1. Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7:44.
    1. Audette I, Dumas J-P, Côté JN, De Serres SJ. Validity and between-day reliability of the cervical range of motion (CROM) device. J Orthop Sports Phys Ther. 2010;40:318–23.
    1. Youdas JW, Carey JR, Garrett TR. Reliability of measurements of cervical spine range of motion-comparison of three methods. Phys Ther. 1991;71:98–104. -6.
    1. Fletcher JP, Bandy WD. Intrarater reliability of CROM measurement of cervical spine active range of motion in persons with and without neck pain. J Orthop Sports Phys Ther. 2008;38:640–5.
    1. Salt E, Kelly S, Soundy A. Randomised Controlled Trial for the Efficacy of Cervical Lateral Glide Mobilisation in the Management of Cervicobrachial Pain. Open J Ther Rehabil. Scientific Research Publishing. 2016;4(3):132–45.
    1. McQuay HJ, Moore RA. Dose-response in direct comparisons of different doses of aspirin, ibuprofen and paracetamol (acetaminophen) in analgesic studies. Br J Clin Pharmacol. 2007;63:271–8.
    1. Max MB, Schafer SC, Culnane M, Dubner R, Gracely RH. Association of pain relief with drug side effects in postherpetic neuralgia: A single-dose study of clonidine, codeine, ibuprofen, and placebo. Clin Pharmacol Ther. 1988;43:363–71.
    1. Moloney N, Hall T, Doody C. An investigation of somatosensory profiles in work related upper limb disorders: a case-control observational study protocol. BMC Musculoskelet Disord. 2010;11:22.
    1. Lopez-de-Uralde-Villanueva I, Beltran-Alacreu H, Fernandez-Carnero J, Kindelan-Calvo P, La Touche R. Widespread Pressure Pain Hyperalgesia in Chronic Nonspecific Neck Pain with Neuropathic Features: A Descriptive Cross-Sectional Study. Pain Physician. 2016;19:77–88.
    1. Beltran-Alacreu H, López-de-Uralde-Villanueva I, Fernández-Carnero J, La Touche R. Manual Therapy, Therapeutic Patient Education, and Therapeutic Exercise, an Effective Multimodal Treatment of Nonspecific Chronic Neck Pain. Am J Phys Med Rehabil. 2015;94:887–97.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit