| Let's suppose that you have been diagnosed as | | | | surgery, physical therapy or a cervical collar. The |
| having a pinched nerve in your neck, also known | | | | patients ranged from 28 to 64 years old and |
| as cervical radiculopathy. If so, you probably have | | | | 54% of them were male. The surgeons used the |
| pain in the neck and one shoulder. The pain might | | | | so-called Cloward procedure, removing fragments |
| radiate into your arm and you might have | | | | of protruding discs and spurs through an incision in |
| weakness or numbness in the arm as well. Moving | | | | the front of the neck, and then fusing two |
| your neck in certain positions probably worsens | | | | neck-bones together by means of a bone-graft. |
| the pain. | | | | Physical therapy involved 15 sessions over a span |
| If you're a younger adult, the pinch could be due | | | | of three months and consisted of whatever the |
| to a herniated (slipped) disc. Discs are the soft | | | | physical therapist considered appropriate, variously |
| spacers that separate each pair of stacked | | | | including any of the following: heat application, cold |
| neck-bones (vertebrae). If you're an older adult, | | | | application, electrical stimulation, ultrasound, |
| the pinch is more likely due to a bony spur | | | | massage, manipulation, exercise and education. In |
| (spondylosis). In either case, you're in good | | | | the cervical collar group, patients wore rigid, |
| company. A survey in Sicily showed 3.5 active | | | | shoulder-resting collars every day for three |
| cases at any one time of cervical radiculopathy | | | | months. Additionally, some of the subjects wore |
| per population of 100,000. In Rochester, | | | | soft collars overnight. |
| Minnesota, another survey showed 85 new cases | | | | How did the study turn out? Three of the |
| each year of cervical radiculopathy per population | | | | subjects who were assigned to surgery refused |
| of 100,000. | | | | the procedure because they had already |
| Let's say that your doctor has evaluated you | | | | improved on their own. For statistical purposes |
| thoroughly by taking a history of your symptoms | | | | their outcomes were included with those who |
| and performing a physical examination. Perhaps | | | | actually received the operation. After three |
| with the additional help of an MRI of your cervical | | | | months the surgery and physical therapy groups |
| spine (neck) and electrical tests of nerve and | | | | reported, on average, less pain. After an additional |
| muscle function (nerve conduction studies and | | | | 12 months patients in all three groups had less |
| electromyography) the diagnosis of cervical | | | | pain than at the beginning of the study and the |
| radiculopathy is deemed definite. Furthermore, | | | | outcomes of each treatment were statistically |
| there is no sign that the spinal cord itself is | | | | alike. Measurements of mood and overall function |
| pinched. Now what? | | | | following treatment were likewise equal among |
| Get 1000s of TIPS On How To Treat | | | | the groups. |
| A---------->pinched nerve Right NOW! | | | | So, over the long haul, no treatment was better |
| Now what, indeed. Choosing a treatment for this | | | | than the others. Of course, within each group |
| condition is far from straightforward. Out of | | | | some patients did better or worse than others |
| hundreds of published medical reports concerning | | | | and this spread of outcomes was not reflected in |
| treatment of cervical radiculopathy, most are | | | | the overall averages. In fact, five patients in the |
| case reports or case series. A "case series" | | | | collar group and one patient in the physical |
| translates roughly as: "We gave six patients in a | | | | therapy group went on to receive surgery owing |
| row the same treatment and five of them got | | | | to lack of satisfactory improvement. In addition, |
| better." What can be concluded from a study of | | | | eight patients in the surgery group underwent a |
| this kind? Did the treatment make the patients | | | | second operation that in one case was due to a |
| better or would they have improved anyway? | | | | complication of the first operation. |
| We don't know. | | | | With this Swedish study representing the only |
| The missing ingredient here is a comparison group | | | | rigorous investigation of treatment outcomes in |
| of untreated or differently treated individuals | | | | cervical radiculopathy, there are a number of |
| known as a control group. The other mark of a | | | | unanswered questions. For example, what are the |
| quality study is that the chosen treatment is | | | | effects on cervical radiculopathy of painkillers, |
| randomized, meaning that the research subjects | | | | anti-inflammatory drugs, local injections, |
| agreed in advance to be assigned to one | | | | systematic traction or other forms of surgery? |
| treatment group or another based on the | | | | We don't know. What happens if there is no |
| equivalent of a coin-toss. So out of the hundreds | | | | treatment whatsoever? We don't know the |
| of published studies involving treatment of this | | | | answer to that question either. |
| common condition, how many were randomized | | | | Thus, in the care of individual patients there is a |
| controlled trials? Unfortunately, the answer is just | | | | yin-yang balancing act between the medical edict |
| one. | | | | of "Above all, do no harm" and the practical |
| Liselott Persson, Carl-Axel Carlsson and Jane | | | | dictum of "Do what you have to do." This |
| Carlsson at the University Hospital of Lund, | | | | balancing act usually means starting with less |
| Sweden, randomly allocated 81 patients who had | | | | intrusive treatments like drugs and physical |
| symptoms of cervical radiculopathy present for at | | | | therapy. If symptoms fail to improve or become |
| least three months to any of three treatments -- | | | | unbearable, an operation may be helpful. |