Ultrasound as an adjuvant treatment for non-specific neck pain

Abstract

Rationale: The use of ultrasound as an adjuvant to conservative treatment for neck pain is common, but the evidence of its benefit remains unclear. Objective: To determine the effectiveness of ultrasound as an adjuvant to exercise or/and manual therapy for the improvement of patient-centered outcomes in adults with non-specific neck pain. Methods: Electronic databases including MEDLINE, EMBASE, AMED, CINAHL, CENTRAL, PEDro and PubMed were searched from date of inception to March 2019 for controlled trials involving ultrasound or phonophoresis as an adjuvant to exercise or/and manual therapy in adults with non-specific neck pain. Review Manager 5.3 was used to calculate mean group differences. Main results: Six studies (361 participants) examining ultrasound or phonophoresis as an adjuvant to exercise or/and manual therapy for sub-acute and chronic non-specific neck pain were included. The quality of evidence was of very low GRADE. Phonophoresis with capsaicin plus exercise improved pain immediately post-treatment (MD -3.30, 95% CI: -4.05 to -2.55) but not with diclofenac sodium plus exercise as compared to exercise alone. Continuous ultrasound plus exercise improved pain and Pressure Pain Threshold (PPT) at immediate post-treatment (pain: MD -3.42, 95% CI: -4.08 to -2.7; PPT: MD 0.91, 95% CI: 0.68 to 1.14 ) and at intermediate - term (pain: MD -2.70 95% CI: -3.62 to -1.78; PPT: MD 0.27 95% CI: 0.03 to 0.51) as compared to exercise alone. Continuous ultrasound or High Power Pain Threshold (HPPT) ultrasound plus manual therapy and exercise showed no benefit for pain reduction (MD -0.75, 95% CI: -2.08 to 0.58), increase in PPT (MD -1.15, 95% CI: -2.55 to 0.25) or improved function/disability (MD -1.05, 95% CI: -4.27 to 2.17) at immediate or short-term as compared to manual therapy and exercise. Conclusion: Based on very low quality evidence, there is insufficient data to support ultrasound or phonophoresis as an adjuvant treatment for non-specific neck pain.