Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Twenty-six to 71% of the adult population can recall experiencing an episode of neck pain or stiffness in their lifetime. Neck pain is usually a benign and self-limited condition, but can be disabling to varying degrees. As such, it has a large impact on healthcare expenditure, due to visits to healthcare professionals, and sick leave, disability and the related loss of productivity.(Trinh 2010)
Neck pain can be associated with symptoms that radiate to the arms or head, and may involve one or several neurovascular and musculoskeletal structures such as nerves, nerve roots, intervertebral joints, discs, bones, muscle and ligaments.
Conventional management includes advice to stay active and continue daily activities; exercise therapy; analgesics (e.g. paracetamol, NSAIDs, an opioid); muscle relaxants; corticosteroid spinal injections; and referral for consideration of surgery. However, there is a lack of strong evidence of effectiveness for most of these interventions (Hagen 2007, Luijsterburg 2007).
How acupuncture can help
One systematic review found that acupuncture was effective in the short-term for the treatment of neck pain.(Fu 2009) Another review found moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the course of treatment, For inactive shams (e.g. TENS or electroacupuncture apparatus with the electrical supply disconnected) and waiting list controls acupuncture was superior also at short-term follow-up. (Trinh 2006)
Of those randomised controlled trials published since the Cochrane review (Trinh 2006: see above) five compared acupuncture to various types of sham treatment: acupuncture was superior in three (Liang 2009, 2010; Vas 2006) equivalent in one (Sahin 2010), and the results are unclear in one (Fu 2009). Given that sham acupuncture is usually to some extent an active treatment in its own right, not an inert placebo, these are encouraging results. In two other trials, acupuncture plus routine care was found to be better than routine care alone (Witt 2006; Chan 2009). In another, acupuncture plus massage produced better effects for cervical spondylosis patients than either therapy alone (Zhou 2005). Finally, one trial found that, according to international cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic neck pain.(Willich 2006).
Acupuncture can help relieve neck pain by:
- Stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008);
- Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);
- Improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling.
- Hagen KB et al. The updated Cochrane review of bedrest for low back pain and sciatica. Spine 2005; 30: 542-6.
- Luijsterburg PAJ et al. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J 2007 Apr 6;(Epub ahead of print).
- Trinh K et al, Cervical Overview Group. Acupuncture for neck disorders. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004870. DOI: 10.1002/14651858.CD004870.pub3.