Neck Pain Treatment Today: Ample Techniques, Abundant Theories, None Useful in Echo Chambers
There are various non-drug treatments for chronic neck pain. How much do they work? Is one better than the other? In 2019, Barreto TW et al published an article in American Family Physicians, which provided evidence-based answers to these questions.
Combination exercise
Combination of muscle performance, mobility, muscle reeducation, and aerobic slightly improves function and pain in the short term, based on inconsistent or limited-quality patient-oriented evidence.
Low-level laser therapy
It moderately improves function and pain in the short term, based on inconsistent or limited-quality patient-oriented evidence.
Acupuncture
It slightly improves function in the short and intermediate term (less than 12 months) but is not more effective than sham acupuncture for pain, based on inconsistent or limited-quality evidence.
The Alexander technique (mind-body practice)
It slightly improves function in the short and intermediate term, based on inconsistent or limited-quality evidence.
Massage
It does not improve function in the short or intermediate term, based on inconsistent or limited-quality evidence.
Physical therapist–led relaxation techniques
They do not improve pain or function when compared with no treatment or advice alone, based on inconsistent or limited-quality evidence.
In summary, we do have abundant tricks for neck pain. But either they do not work at all, or work merely slightly. None is there that we are strongly confident they truly work.
Abundant Theories, None Helpful
In the last over 100 years history of non-drug pain management, we have established a plethora of anatomically or metaphysically "plausible" theories or rationales to guide our practice in treating neck pain (and many other myofascial pains). The famous ones include:
领英推荐
But unfortunately, none of these charmingly-looking doctrines have been proved to be useful for dealing with a pain at neck (nor for pains at other body parts, for example, back, shoulder, knee, elbow...).
Miserable Failure of Pain Medicine
The advance of pain medicine has been in a halt at least in the last century. In physical science, we can send a man to the moon. In molecular biology and biochemistry, we are almost able to clone a human. But in musculoskeletal medical science, we are still unable to reduce a patient's muscle or joint pain more than a placebo does, even when the pain is merely a penny-sized spot (for example, at lateral elbow), not to speak pain at the neck, back or shoulder ....
Dead End Theories
The reason is pretty much clear: Too many dead end theories flooded our closed minds. Few of us, if any, tried to widen their mind to the human body tissues beyond muscle or spinal cord or meridians. They totally ignored the fact that without a neural network covering the entire body, all tissues in the body are nothing but chunks of dead flesh, incapable to sense anything including pain or to perform any normal biological functions.
The biological knowledge of a high school student about nerves and brain is enough to let us clinicians understand a simple fact: the thing called neck pain does not exist, except a signal (a flip of action potential) originated from the nociceptive free nerve endings in the neck which are perceived by brain as pain. It follows that any technique guided by any theory for pain relief is doomed not going anywhere, if it does not target the modification of neural action potentials transmitted via the neural network to the brain.
One common thing of these dead-end theories is that they restricted our attention to the hundreds of tiny spots (600ish trigger points, or 360ish spinal joints, or 360ish meridian-based acupoints) on the body, but completely ignored the fact that only on the surface of human body, there are at least 1,700, 000 free sensory nerve terminals which cover the entire body, not to speak of the additional millions and millions sensory nerve terminals which cover the internal organs, bones, ligaments, joints,... All these terminals, through communicating with brain, formed the neural network of human body.
The above mentioned dead-end theories enclosed us into small cages or echo chambers which in turn isolated us from the vast outside world - the neural network of the human body which exists in all tissues or structures beyond muscles, spinal cord and meridians.
Particularly note: there are no sensory nerve terminals in spinal cord, and no nociceptive nerve terminals in muscles (Krassioukov AV, 2002). That is, spinal cord and muscles can not produce any action potential change which the brain will sense as pain. Furthermore, of course, no sensory nerve terminals exist in imaginary meridians either.
Science Does not Advance in Echo Chambers
Science does not advance in echo chambers which rejects critical thinking and intensifies only yes-sayers’ opinions without questioning. Science does not move forward if we blindly accept everything of what we see, hear or read (including this post). Science does not believe experts.
Many echo chambers were from the very beginning created by brilliant minds, intelligent big names or gurus who eventually became Gods in the echo chamber universes they invented. But psychological researches showed again and again that many delusions or stupid ideas prey not on dim minds but on bright ones.
Now the question is: For the God followers, do we dare to question, criticize, even smash the small cages which “protects” us and makes us feel safe, comfort even pride?
References
Barreto TW et al, Chronic Neck Pain: Nonpharmacologic Treatment. Am Fam Physician. 2019 Aug 1;100(3):180-182.
Krassioukov AV, Peripheral Nervous System. Encyclopedia of the Human Brain, 2002
#neckpain #pettheories #painrelief #painscience #echochambers #falsebeliefs #scientificthinking #criticalthinking #skepticism