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Chinese herbal medicine for chronic neck pain due to cervical degenerative disc disease

  • Review
  • Intervention

Authors

  • Xuejun Cui,

    Corresponding author
    1. Shanghai University of Traditional Chinese Medicine, Research Institute of Spine Diseases, Shanghai Research Institute of Acupuncture and Meridian, Longhua Hospital, Shanghai, Shanghai, China
    • Xuejun Cui, Research Institute of Spine Diseases, Shanghai Research Institute of Acupuncture and Meridian, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No 725, South Wanping Rd, Shanghai, Shanghai, 200032, China. diyicuixj@sohu.com. diyicuixj@163.com.

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  • Kien Trinh,

    1. McMaster University, DeGroote School of Medicine, Office of MD Admissions, Hamilton, Ontario, Canada
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  • Yong-Jun Wang

    1. Research Institute of Spine Diseases, Longhua Hospital, Shanghai, China
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Abstract

Background

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.

Objectives

To assess the efficacy of Chinese herbal medicines in treating chronic neck pain with radicular signs or symptoms.

Search methods

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.

Selection criteria

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.

Data collection and analysis

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.

Main results

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.

Authors' conclusions

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.

Résumé scientifique

Contexte

La cervicalgie chronique avec signes ou symptômes radiculaires est une condition commune. Plusieurs patients utilisent des approches de médecine non conventionnelle, incluant la médecine traditionnelle chinoise pour soulager leurs symptômes.

Objectif

Évaluer l’efficacité de la phytothérapie traditionnelle chinoise dans le traitement des cervicalgies chroniques avec signes ou symptômes radiculaires.

Stratégie de recherche

Nous avons fouillé les bases de données CENTRAL (The Cochrane Library 2009, numéro 3), MEDLINE, EMBASE, CINAHL et AMED (à partir du début jusqu’au 1er octobre 2009), la base de données biomédicales chinoise et les bases de données apparentées au Japon et en Corée du Sud (de 1979 à 2007). Nous avons contacté des experts du domaine et nous avons aussi consulté certains périodiques publiés en Chine.

Critères de sélection

Nous avons inclus les essais cliniques randomisés réalisés auprès d’adultes avec un diagnostic de discopathie dégénérative cervicale, de radiculopathie cervicale ou de myélopathie documentée radiologiquement. Les interventions étaient des produits de phytothérapie chinoise dérivés de plantes ou de parties de plantes, de minéraux ou d’animaux qui sont utilisés à des fins médicinales. Le critère principal d’évaluation était le soulagement de la douleur, mesuré à partir d’une échelle visuelle analogique ou numérique ou d’un autre outil validé.

Collecte de données et analyse

Les données ont été extraites et saisies indépendamment par deux auteurs sur un formulaire développé à cette fin. Les risques de biais et la pertinence clinique ont été évalués séparément par deux auteurs qui ont utilisé les cinq questions et les douze critères recommandés par le Groupe Cochrane sur le rachis. Les désaccords étaient réglés par consensus.

Principaux résultats

Les quatre études incluses étaient chinoises dont deux non publiées. L’amplitude de l’effet mesuré n’était pas cliniquement significative et la qualité de la preuve a été qualifiée de faible sur tous les résultats à cause des limites des études et de la faible disponibilité des données (une seule étude pour chaque comparaison). Deux essais (680 participants) ont conclu que les comprimés Qishe soulageaient mieux la douleur à court terme que le placébo ou le Jingfukang. Un troisième essai (60 participants) a observé que les préparations à base de plantes pour voie orale de Huangqi ((Radix Astragali)18 g, de Dangshen (Radix Codonopsis) 9 g, de Sanqi (Radix Notoginseng) 9 g, de Chuanxiong (Rhizoma Chuanxiong)12 g, de Lujiao (Cornu Cervi Pantotrichum) 12 g, et de Zhimu (Rhizoma Anemarrhenae)12 g) soulageaient mieux la douleur que le Mobicox ou le Méthycobal. Un quatrième essai (360 participants) a montré qu’un médicament topique de phytothérapie, le composé « Extractum Nucis Vomicae », soulageait mieux la douleur que le « Diclofenac Diethylamine Emulgel ».

Conclusions des auteurs

Il y a une faible qualité de preuves que le comprimé de phytothérapie Qishe pour voie orale réduise plus la douleur que le placébo ou le Jingfukang; il y a également une faible qualité de preuve que le composé «Extractum Nucis Vomicae » réduise plus la douleur que le « Diclofenac Diethylamine Emulgel ». Des recherches ultérieures pourraient vraisemblablement montrer une plus grande amplitude de l’effet mesuré et modifier notre confiance dans les résultats.

Traduction

La traduction française de cet examen Cochrane a été financée par le groupe Cochrane sur les maux de dos et a été effectuée par Arlette Missiha et Bernard Soucy.

Plain language summary

Herbal medicine for cervical degenerative disc disease

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.

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