A Cochrane review [Abstract] 1 [withdrawn from publication] included 36 studies that examined the effects of oral NSAIDs, psychotropic agents, injections of steroids, and anaesthetic agents. For acute whiplash, administering intravenous methylprednisolone within eight hours reduced pain at one week (SMD -0.90, 95% CI -1.57 to -0.24), and sick leave but not pain at six months compared to placebo. For chronic MND at short-term follow-up, intramuscular injection of lidocaine was superior to placebo (SMD -1.36, 95% CI -1.93 to -0.80); NNT 3 or dry needling, but similar to ultrasound. In chronic MND with radicular findings, epidural methylprednisolone and lidocaine reduced neck pain and improved function at one-year follow-up compared to the intramuscular route. In subacute/chronic MND, conflicting evidence of pain reduction for oral psychotropic agents compared to placebo or control was found. Single trials of eperison hydrochloride and tetrazepam showed positive results. Results for cyclobenzaprine were mixed. Diazepam did not show benefit. Other treatments including NSAIDS and nerve blocks had unclear or limited evidence of benefit. In participants with chronic MND with or without radicular findings or headache, there was moderate evidence from six high quality trials with 273 patients showing that Botox A intramuscular injections were not better than saline in improving pain (pooled SMD: -0.39 (95%CI: -1.25 to 0.47), disability or global perceived effect.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).
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