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

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.

Median Nerve Neural Mobilization Adds No Additional Benefit When Combined with Cervical Lateral Glide in the Treatment of Neck Pain: A Randomized Clinical Trial

“…The improvement in rotation in the CLG group only reached improvements of 8.57% (4.96 degrees) and 5.57% (3.32 degrees) in the contralateral rotation. These data are contradictory to those found in several previous studies [ 19 , 20 , 22 ], achieving a 12.1% improvement in the cervical range of motion in patients with cervicobrachial neuralgia after application of median nerve neural mobilization [ 19 ], and an 18% (10 degrees) improvement when lateral cervical slippage was applied [ 20 , 22 ]. This difference could be explained by the fact that, in those three previous studies, 30 sessions were applied as opposed to the two sessions we have applied in our study.…”

“…Another study [ 20 ] in which the authors applied 30 sessions of the lateral cervical sliding technique also found effects on pain intensity superior to our study, with an improvement that reached 35.5% (2.16 points). Finally, in another study [ 22 ] that compared 30 sessions of neural mobilization of the median nerve against lateral cervical glide in patients with cervicobrachial neuralgia, the authors found an improvement superior to that of our study, reaching 36.06% (2.2 points) in the group subjected to lateral cervical glide and 46.15% (3 points) in the group of neural mobilization of the median nerve. Again, we believe that the number of sessions is the main cause of this difference.…”

“…Regarding neural mobilization approaches for musculoskeletal conditions in patients with CBP [ 15 , 16 ], median nerve neural mobilization (MNNM) and cervical lateral glide (CLG) were shown to be more effective in short-term for improving pain intensity, range of motion (ROM) during upper limb neurodynamic test (ULNT1), and functionality than therapeutic ultrasound [ 17 ], manual cervical traction [ 18 ] or no treatment [ 19 , 20 ]. Although pharmacologic treatment, such as oral ibuprofen, can decrease pain intensity and disability more than MNNM or CLG, the non-existence of ROM differences between these interventions, as well as adverse effects associated with the pharmacological agents, suggest neural mobilization as a possible treatment option in patients with CBP [ 21 , 22 ]. Indeed, neural mobilization techniques for upper quadrant pain syndromes might modulate central sensitization and mechanosensitivity in patients with NP [ 23 ].…”

Physiotherapy for people with painful peripheral neuropathies: a narrative review of its efficacy and safety

“…Second, a small trial by Plaza-Manzanno et al 64 (n = 32) did not find evidence for a clinically meaningful difference in pain between a group of patients with lumbar disk herniation who received 8 sessions of manual neurodynamic mobilisation plus motor control exercises, compared to a group who received motor control exercises alone. Finally, a three-arm trial by Calvo-Lobo et al 12 (n = 105) found that 2 types of manual neural mobilization were inferior to oral ibuprofen in patients with cervical radicular pain.…”

“…Although there is some evidence that physiotherapy treatments provide meaningful improvements in pain, QoL, and disability for people with peripheral neuropathies and neuropathic pain, there are also high-quality studies in which this does not happen. In fact, some of the available studies found that physiotherapy interventions did not improve pain to a greater extent than more simple and less time-intensive treatments such as ibuprofen, 12 a neck collar, 48 or general practitioner care alone. 53 Where improvements do occur, they are often modest.…”