Significance of the review
Degenerative changes of the cervical spine are quite common and can cause severe neck pain, impairment and decreased quality of life. Degenerative disc disease of the cervical spine can result in severe pain, instability and radiculopathy (pain spreading down the arms and into the head), myelopathy (spasticity and weakness of arms or hands, which may include "numb and clumsy" hands) or both. Chinese oral and topical herbal medicines are being used to treat many neck disorders. Some have been tested in clinical trials.
Description of the trials
Two Chinese oral herbal medications were tested in three randomized controlled trials that included 701 adults with chronic neck pain with radicular signs or symptoms or myelopathy. One oral herbal medication was compared with Mobicox (non-steroidal anti-inflammatory medication) and Methycobal (drug to reduce numbness, tingling in the arms), and the other (Compound Qishe Tablet) with placebo and Jingfukang. A topical herbal medicine (Compound Extractum Nucis Vomicae) was compared with Diclofenac Diethylamine Emulgel (non-steroidal anti-inflammatory medication).
Findings
Oral herbal medications may reduce neck pain more than placebo and Jingfukang. A topical herbal medicine (Compound Extractum Nucis Vomicae) also relieved neck pain in the short term (four weeks), but the trail had a high risk of bias.
Limitations
All four included studies were in Chinese and two of these studies were unpublished. Half of the trials had a low risk of bias, but they only tested the effects of short term use (up to eight weeks). The size of the studies was small. There is a need for trials with adequate numbers of participants that address the long-term efficacy or effectiveness of Chinese herbal medicine compared to placebo.
Conclusion
For chronic neck pain with or without radicular symptoms, there is low quality evidence that Compound Qishe Tablet is more effective than placebo for pain relief, measured at the end of the treatment. However, the size of the studies was small and the effect was measured in the short-term. Further research is very likely to change both the effect size and our confidence in the results. There is a need for trials with adequate numbers of participants that address long-term efficacy or effectiveness of herbal medicine compared to placebo.
There is low quality evidence that an oral herbal medication, Compound Qishe Tablet, reduced pain more than placebo or Jingfukang and a topical herbal medicine, Compound Extractum Nucis Vomicae, reduced pain more than Diclofenac Diethylamine Emulgel. Further research is very likely to change both the effect size and our confidence in the results.
Chronic neck pain with radicular signs or symptoms is a common condition. Many patients use complementary and alternative medicine, including traditional Chinese medicine, to address their symptoms.
To assess the efficacy of Chinese herbal medicines in treating chronic neck pain with radicular signs or symptoms.
We electronically searched CENTRAL (The Cochrane Library 2009, issue 3), MEDLINE, EMBASE, CINAHL and AMED (beginning to October 1, 2009), the Chinese Biomedical Database and related herbal medicine databases in Japan and South Korea (1979 to 2007). We also contacted content experts and handsearched a number of journals published in China.
We included randomized controlled trials with adults with a clinical diagnosis of cervical degenerative disc disease, cervical radiculopathy or myelopathy supported by appropriate radiological findings. The interventions were Chinese herbal medicines, defined as products derived from raw or refined plants or parts of plants, minerals and animals that are used for medicinal purposes in any form. The primary outcome was pain relief, measured with a visual analogue scale, numeric scale or other validated tool.
The data were independently extracted and recorded by two review authors on a pre-developed form. Risk of bias and clinical relevance were assessed separately by two review authors using the twelve criteria and the five questions recommended by the Cochrane Back Review Group. Disagreements were resolved by consensus.
All four included studies were in Chinese; two of which were unpublished. Effect sizes were not clinically relevant and there was low quality evidence for all outcomes due to study limitations and sparse data (single studies). Two trials (680 participants) found that Compound Qishe Tablets relieved pain better in the short-term than either placebo or Jingfukang; one trial (60 participants) found than an oral herbal formula of Huangqi ((Radix Astragali)18 g, Dangshen (Radix Codonopsis) 9 g, Sanqi (Radix Notoginseng) 9 g, Chuanxiong (Rhizoma Chuanxiong)12 g, Lujiao (Cornu Cervi Pantotrichum) 12 g, and Zhimu (Rhizoma Anemarrhenae)12 g) relieved pain better than Mobicox or Methycobal and one trial (360 participants) showed that a topical herbal medicine, Compound Extractum Nucis Vomicae, relieved pain better than Diclofenac Diethylamine Emulgel.