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PAUL M. PELOSO, ANITA R. GROSS, TED A. HAINES, KIEN TRINH, CHARLES H. GOLDSMITH, PETER AKER, and the Cervical Overview Group
ABSTRACT. Methods. We searched CENTRAL (Issue 4, 2002), and MEDLINE, EMBASE, MANTIS, CINHAL from their start to March 2003. Two authors independently selected articles, abstracted data, and assessed methodological quality using the Jadad criteria. When clinical heterogeneity was absent, we combined studies using random-effects metaanalysis models. Results. Thirty-two selected trials had an overall methodological quality of mean 3.2/5. For acute whiplash, administering intravenous methylprednisolone within 8 hours reduced pain at one week [SMD –0.90 (95% CI –1.57 to –0.24)], and sick leave but not pain at 6 months compared to placebo. For chronic MND at short-term followup, intramuscular injection of lidocaine was superior to placebo [SMD 1.36 (95% CI –1.93 to –0.80)]. In chronic MND with radicular findings, epidural methylprednisolone and lidocaine reduced neck pain [SMD –1.46 (95% CI –2.16 to –0.76)] and improved function at one-year followup compared to the intramuscular route. In subacute/chronic MND, we found conflicting evidence for oral psychotropic agents. In chronic MND with or without radicular findings or headache, there was moderate evidence from 5 high quality trials showing that botulinum toxin (Botox A) intramuscular injections were not better than saline in improving pain [SMD pooled –0.39 (95% CI –1.25 to 0.47)], disability, or global perceived effect. Conclusion. Intramuscular injection of lidocaine for chronic MND and intravenous injection of methylprednisolone for acute whiplash were effective treatments. There was limited evidence of effectiveness of epidural injection of methylprednisolone and lidocaine for chronic MND with radicular findings. Muscle relaxants and nonsteroidal antiinflammatory drugs have unclear benefits. There was moderate evidence that Botox-A intramuscular injections for chronic MND were not better than saline. (J Rheumatol 2006;33:957-67) Key Indexing Terms:
METAANALYSIS From Amgen Inc., Thousand Oaks, California, USA; and the Departments of Epidemiology and Biostatistics and Occupational Health and Safety, Schools of Rehabilitation Sciences and Medicine, McMaster University, Hamilton, Ontario, Canada. Supported by the Consortial Center of Chiropractic Research, National Institute of Health, Bethesda, MD, USA; and Problem-Based Research Award, Sunnybrook and Women's College Foundation, Toronto, Canada. Dr. Peloso is currently a clinical research director for Amgen Inc. No drugs or related components discussed in this review are manufactured by this company. P.M. Peloso, MD, MSc, Amgen Inc.; A.R. Gross, MSc; T.A. Haines, MSc; K. Trinh, PhD (Candidate); C.H. Goldsmith, PhD, Departments of Epidemiology and Biostatistics and Occupational Health and Safety, Schools of Rehabilitation Sciences and Medicine, McMaster University; P. Aker, MSc, private practice, Belleville, Canada. Cervical Overview Group*: T. Kay, MSc; N. Graham, BScPT; P. Kroeling, MD; G. Bronfort, PhD; P. Santaguida, PhD; B. Haraldsson, RMT; C. Myers, PhD; J. Hoving, PhD; J. Ezzo, PhD; A. Morien, PhD; A.M. Eady, MLS. *An interdisciplinary and international working group interested in conducting and maintaining system reviews on conservative management for mechanical neck disorders. Address reprint requests to Dr. P.M. Peloso, Global Development Leader, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320. E-mail: ppeloso@adelphia.net Accepted for publication October 18, 2005.
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