Combination treatment provides better improvement for neck pain than stand-alone treatment

People seeking relief from neck pain recover similarly with pain medication and physical therapy, epidural steroid injections, or combination of all of these, suggests a randomized study published in the November issue of Anesthesiology, the official medical journal of the American Society of Anesthesiologists® (ASA®).

The study, which is the largest to date comparing these treatments, found that pain one month after starting treatment was similar in patients who had epidural steroid injections, conservative treatment (pain medication and physical therapy) or a combination.

“Our research shows epidural steroid injections as a stand-alone treatment are not more effective than using medications and doing physical therapy.  Although our primary test for effectiveness did not differ between conservative treatment, epidural steroid injections, or their combination, there were some hints that perhaps the combination treatment resulted in better improvement,” said Steven P. Cohen, M.D., lead author of the study and professor of Anesthesiology and Critical Care Medicine at Johns Hopkins School of Medicine, Baltimore.  “It’s possible that epidural steroid injections can provide short or intermediate relief and if a patient uses this window to participate in a physical therapy program to improve function, that relief can be maintained.”

People in the study suffered from cervical radiculopathy, meaning pain in the neck that often radiates through the shoulders and down the arms. In the study, 59 patients had conservative treatment (pain medication and physical therapy), 55 had an epidural steroid injection and 55 had both therapies. Researchers measured arm pain one month after beginning treatment as their primary outcome, and pain scores at this time did not differ between conservative treatment (a score of 4.3 out of 10), epidural steroid injections (4.2) or a combination (3.5). However, in exploring other outcomes, they noted that after three months, 26.8 percent of patients who had conservative treatment, 36.7 percent who had steroid injections and 56.9 percent who had a combination of those treatments benefitted from a decrease in arm pain.

About two-thirds of people will suffer from significant neck pain at some point during life. Treatment is difficult and while epidural steroid injections are commonly prescribed, there is a concern that they are overused.

“This research suggests that epidural steroid injections should not be a first-line, stand-alone treatment for neck pain,” said Dr. Cohen. “A combination of epidural steroid injections and conservative therapy might provide some people better and longer relief than the treatments individually.”