Neck Pain: Treatment for Cervical Disc Herniation

Neck pain can be a disabling condition which may severely affect our daily lives and could also result in sleeplessness, chronic pain and depression.

Patients with neck pain often present with arm pain in a specific dermatomal, and/or myotomal, pattern resulting in weakness of specific muscles and altered sensation, paresthesia. This is typically known as radiculopathy, where one or more nerve root is/are affected; the general term for such condition is neuropathy.

In May 2013, the European Chiropractic Union (ECU) convention took place in Spain and amongst the many scientific topics, the ECU Research Council and the European Academy of Chiropractic (EAC), awarded the best research project presented by doctors of chiropractic with the aim to promote the effectiveness and safety of the chiropractic profession.

The first prize went to a Dutch research team who investigated the efficacy of cervical spinal manipulation on patients with MRI confirmed cervical disc herniation.

This prestigious award, also known as the EAC Jean Robert Research Prize, narrows the gap between various treatment options for patients suffering from cervical disc herniation which usually present with radiculopathy, neck and arm pain following the distribution of the involved nerve root.

Undoubtedly, this is a giant step forward concerning the management of patients with neck pain caused by cervical disc herniation.

A well deserved first price. Congratulations!

Article Abstract

OBJECTIVE:   The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation (CDH) who are treated with spinal manipulative therapy.

METHODS:   Adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included. Magnetic resonance imaging-confirmed CDH linked with symptoms was required. Baseline data included 2 pain numeric rating scales (NRSs), for neck and arm, and the Neck Disability Index (NDI). At 2 weeks, 1 month, and 3 months after initial consultation, patients were contacted by telephone, and the NDI, NRSs, and patient’s global impression of change data were collected. High-velocity, low-amplitude spinal manipulations were administered by experienced doctors of chiropractic. The proportion of patients responding “better” or “much better” on the patient’s global impression of change scale was calculated. Pretreatment and posttreatment NRSs and NDIs were compared using the Wilcoxon test. Acute vs subacute/chronic patients’ NRSs and NDIs were compared using the Mann-Whitney U test.

RESULTS:   Fifty patients were included. At 2 weeks, 55.3% were “improved,” 68.9% at 1 month and 85.7% at 3 months. Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores (P < .0001). Of the subacute/chronic patients, 76.2% were improved at 3 months.

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