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versão impressa ISSN 1806-0013
Rev. dor vol.13 no.1 São Paulo jan./mar. 2012
Effects of chiropractic care in patients with cervical pain: a systematic review*
Rodrigo Marcel Valentim da SilvaI; Márcio Souza de LimaII; Fernando Henrique CostaII; Ana Carolina da SilvaIII
IGraduated in Physical Therapy, Potiguar University (UnP). Master Student in Physical Therapy, Federal University of Rio Grande do Norte (UFRN). Natal, RN, Brazil
IIGraduated in Physical Therapy, Potiguar University, Natal/RN. Specialist in Clinical and Sports Chiropractic Care, Integrated Universities of Patos. Natal, RN, Brazil
IIIGraduated in Physical Education, Potiguar University (UnP). Natal, RN, Brazil
BACKGROUND AND OBJECTIVES: Cervical pain is mostly caused by mechanical-postural changes. Among different therapeutic techniques used by physical therapists, chiropractic care is becoming common in Brazil. This study aimed at reviewing the literature, with secondary and tertiary sources, using Pubmed, Medline and PEdro databases.
CONTENTS: Just 6 controlled randomized clinical trials investigating the effects of chiropractic care on cervical pain were found. In most studies, manipulation techniques have promoted pain relief in a faster and more prolonged way and pain was evaluated by Oswestry's Functional Index, by McGill Pain Questionnaire and by Pain Visual Analog Scale.
CONCLUSION: A larger number of controlled randomized clinical trials involving chiropractic care is needed, as well as the use of more dependable evaluation methods, to prove its real effects in the treatment of cervical pain.
Keywords: Cervical pain, Chiropractic care, Controlled randomized clinical trial, Orthopedic manipulation, Physical therapy modalities.
Cervical pain is an acute or chronic painful syndrome affecting the cervical spine, which may have different etiologies, such as mechanical-postural changes, arthroses, hernias and disk protrusions, arthritis, spondylitis or muscle spasms, causing orthopedic, rheumatologic or even neurological repercussions1.
Cervical pain is common in different age groups and both genders, with high predominance among body pain syndromes, being the second major cause of spinal pain, after low back pain. Cervical pain affects an average of 12% to 34% of the adult population in some phase of their lives, with higher incidence among females and impairing their daily activities. Its onset is seldom sudden and in general may be related to jolt, long standing in forced position, effort or trauma. Cervical pain may be acute or chronic and is related to biomechanical and muscular disorders, with resulting pain, inflammation and loss of movement amplitude2.
Chiropractic care is based on chiropractic adjustment techniques which return arthrokinematic movements, normal micromovements to the spine, decreasing neural compression responsible for pain symptoms of that specific dermatome3.
Although a lot has been researched, there is no consensus in the literature about the best treatment alternative for cervical pain, with strong disagreement about resources to be used. Recently, a practice based on manipulative techniques such as chiropractic care has been proposed. Medline/Pubmed and PEdro databases were queried. Keywords were: Randomized controlled trial of chiropractic in neck pain, chiropractic treatment of pain and Manual Therapies. Only controlled and randomized clinical trials published between 2002 and 2010 were included.
This study aimed at analyzing, by literature review, the action of chiropractic care to treat cervical pain.
Thirty-five articles were identified, however only 6 controlled randomized clinical trials to evaluate the effects of chiropractic care techniques to treat cervical pain met the criteria of this study.
A study has evaluated 366 patients with cervical pain, the origin of which was not arthritis, discal hernia or vertebral fracture. Patients were randomly distributed in 3 groups where cervical manipulation, joint mobilization and conventional physical therapy were applied. Pain was evaluated by Adapted Oswestry and McGill Pain questionnaires. There has been significant difference between groups receiving cervical mobilization and manipulation3.
A different study has observed the dose-response of cervical manipulation by evaluating the effects of chiropractic care with 8 and 16 weeks, as compared to the group receiving massage alone. Manipulative treatment had better results as compared to massage after evaluation with a specific questionnaire. It has been observed that the time window of 8 to 16 weeks was effective for the treatment of cervical pain disorders4.
A study comparing cervical manipulation effects to manipulation treatment during the acute and sub-acute phases, including 182 patients divided in two groups receiving 4 sessions during two weeks, has observed that individuals receiving manipulation presented more significant clinical improvement5.
According to a study including 80 patients divided in two groups of 40, being the former submitted to conservative cervical pain treatment and the latter to chiropractic treatment, there has been clinical pain improvement of these patients in addition to less functional incapacity6.
A different study has shown clinical improvement of sub-acute cervical pain with the use of manipulation and other chiropractic and osteopathic techniques. However, due to the small sample size (47 patients), results need confirmation by studies with larger sample sizes7.
A controlled clinical trial was carried out with 182 patients divided in two groups: manipulation and mobilization. Cervical manipulation was effective to treat cervical pain; however, there has been no significant difference as compared to the group submitted to mobilization8.
Most analyzed studies have used the Oswestry's Functional Index adapted to cervical pain, however McGill pain questionnaire and visual analog scales were also used.
This review shows the need for new controlled randomized clinical trials with different types of patients to better justify the use of chiropractic techniques to treat cervical pain and to give further subsidies to the clinical practice, thus favoring population's health promotion.
A larger number of controlled randomized clinical trials involving chiropractic care is needed, as well as the use of more dependable evaluation methods, to prove its real effects in the treatment of cervical pain.
1. Tosato JP, Cesar GM, Caria PHF, et al. Avaliação da dor em pacientes com lombalgia e cervicalgia. Coluna 2006;6(2):73-7. [ Links ]
2. Sobral MKM, Da Silva PG, Vieira RAG, et al. A efetividade da terapia de liberação posicional (TLP) em pacientes com cervicalgia. Fisioter Mov 2010;23;(4):513-21. [ Links ]
3. Hurwitz EL, Morgenstern H, Harber P, et al. A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study. Am J Public Health 2002;92(10):1634-41. [ Links ]
4. Haas M, Spegman A, Peterson D, et al. Dose-response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Spine J 2010;10(2):117-28. [ Links ]
5. Leaver AM, Refshauge KM, Maher CG, et al. Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomised controlled trial. BMC Musculoskel Disord 2007;8:18. [ Links ]
6. Vavrek D, Haas M, Peterson D. Physical examination and self-reported pain outcomes from a randomized trial on chronic cervicogenic headache. J Manipulative Physiol Ther 2010;33(5):338-48. [ Links ]
7. Gemmell H, Miller P. Relative effectiveness and adverse effects of cervical manipulation, mobilisation and the activator instrument in patients with sub-acute non-specific neck pain: results from a stopped randomised trial. Chiropr Osteopat 2010;9(1):18:20. [ Links ]
8. Leaver AM, Maher CG, Herbert RD, et al. A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain. Arch Phys Med Rehabil 2010;91(9):1313-8. [ Links ]
Correspondence to: Submitted in November 01, 2012. * Received from the Federal University of Rio Grande do Norte. Natal, RN.
Rodrigo Marcel Valentim da Silva
Rua Major Newton Leite 151Âª Cidade Alta
59025-180 Natal, RN.
Phone: (84) 9164-5644
Accepted for publication in February 24, 2012.
Submitted in November 01, 2012.
* Received from the Federal University of Rio Grande do Norte. Natal, RN.