Narcotics may be overused for the treatment of chronic neck pain

Clinicians may overuse diagnostics and prescribe narcotics more often than necessary for patients with chronic neck pain and perhaps overlook more effective modalities for this condition, such as therapeutic exercises, according to a recent study in Arthritis Care & Research.

For their study, researchers from Duke University and University of North Carolina reviewed data from a 2006 telephone survey of 5,357 households in North Carolina. Of the respondents, 135 non-institutionalized adults older than 21 years had chronic neck pain. When weighted to the North Carolina population, this was a 2.2% rate of chronic, impairing neck pain.

“Our sample population had a high degree of disability, despite using a number of diagnostics and treatments,” Adam Goode, PT. DPT, a lead researcher for the study stated in a press release. “Based on current evidence, several treatments were over-used, and some effective treatments were under-used.”

Chronic pain patterns

Goode and colleagues defined chronic neck pain as almost daily pain and activity limitations for the prior 3 months or greater than 24 episodes of pain the previous year that limited an individual’s activity for 1 day or more, according to the press release.

The study participants reported chronic pain for an average of 6.9 years and, during that time, saw about five different types of health care providers during 21 ambulatory care visits. They received 1.6 diagnostic tests, including spine radiographs (45%), MRIs (30%) and spine CT (24%).

“For patients with such a long disease duration, the likelihood that imaging techniques would offer clinically important inferences may decrease,” Goode stated in the release.

Patients who had a spine radiograph in the year prior to the survey reported having two different sets of radiographs taken, which Goode and his colleagues noted was inconsistent with clinical decision-making guidelines for diagnostic testing.

Pain management efforts

Concerning the medications used to manage the subjects’ chronic neck pain, more than 50% used over-the-counter NSAIDs, 29% reported taking stronger narcotics, and 23% used weaker than over-the-counter drugs. In their study, the researchers reported that there is limited evidence regarding the effectiveness of medications for chronic neck.

“Rehabilitation conditioning and acupuncture studies have shown to be effective treatments that were less frequently used by patients with chronic neck pain,” Goode stated in the release.

The most commonly used treatments among the study participants were superficial heat (57%), prescribed exercise (53%), cold therapy (47%), spinal manipulation (36%) and therapeutic massage (28%).

Reference:
Goode AP, Freburger J, Carey TS. Prevalence, practice patterns and evidence for chronic neck pain. Arthritis Care & Research. Published Online: August 4, 2010. DOI: 10.1002/acr.20270.

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