Aspecifieke nekpijn: diagnose en behandeling - KCE
Aspecifieke nekpijn: diagnose en behandeling - KCE
Aspecifieke nekpijn: diagnose en behandeling - KCE
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24 Non-Specific Neck Pain: diagnosis and treatm<strong>en</strong>t <strong>KCE</strong> Reports 119<br />
3.5.6.3 Pillows<br />
Key messages regarding pillows<br />
• Pillows used in a multimodal approach in combination with exercises have<br />
shown positive results in reducing neck pain. (Grade C) There is not <strong>en</strong>ough<br />
evid<strong>en</strong>ce for the use of pillows as isolated treatm<strong>en</strong>t for pati<strong>en</strong>ts with<br />
chronic neck pain.<br />
Evid<strong>en</strong>ce from the literature<br />
Only one systematic review is found on this topic 64 and one other systematic review<br />
m<strong>en</strong>tions pillows within various techniques 45 . One RCT studied the effect of sleeping<br />
neck support combined or not with exercise 65 . The combination of exercise with a<br />
neck pillow showed a significant effect. Although some studies showed positive effects<br />
on pain reduction, there is not <strong>en</strong>ough evid<strong>en</strong>ce for the use of pillows alone to reduce<br />
chronic neck pain. (Grade C)<br />
3.5.6.4 Soft collars<br />
3.5.6.5 Oral splint<br />
From one systematic review there is moderate evid<strong>en</strong>ce of no b<strong>en</strong>efit for the use soft<br />
collars for pati<strong>en</strong>t with non-specific neck pain 45 . (Grade B)<br />
One systematic review studied the effect of oral splints and found moderate evid<strong>en</strong>ce of<br />
no b<strong>en</strong>efit 45 (Grade B) .<br />
3.5.6.6 Acupuncture<br />
Acupuncture is the insertion of needles into the body to reduce pain or induce<br />
anaesthesia. There are a number of differ<strong>en</strong>t approaches that incorporate medical<br />
traditions from China, Japan, Korea, and other countries. The most thoroughly studied<br />
mechanism of stimulation of acupuncture points employs p<strong>en</strong>etration of the skin by thin,<br />
solid, metallic needles, which are manipulated manually or by electrical stimulation 66 .<br />
Key messages regarding acupuncture<br />
• Based on the literature there is moderate evid<strong>en</strong>ce that acupuncture, and<br />
more specifically trigger point acupuncture can improve pain relief for nonspecific<br />
chronic neck pain in the short term only without any significant<br />
change in function. (Grade B)<br />
Evid<strong>en</strong>ce from the literature<br />
One systematic review 67 analysed the effect of acupuncture and one systematic review<br />
45<br />
on conservative treatm<strong>en</strong>ts and acupuncture was also included. Three additional<br />
rec<strong>en</strong>t RCT’s on the effects of acupuncture, including its cost-effectiv<strong>en</strong>ess , were also<br />
included 68-70<br />
• There is strong to moderate evid<strong>en</strong>ce that acupuncture is effective for<br />
pain relief compared to inactive treatm<strong>en</strong>ts either immediately posttreatm<strong>en</strong>t<br />
or in short - and intermediate follow-up for chronic mechanical<br />
neck disorders 45, 67, 69 . (Grade A) A rec<strong>en</strong>t cost-effectiv<strong>en</strong>ess study among<br />
3451 pati<strong>en</strong>ts with chronic neck pain, showed that treating pati<strong>en</strong>ts with<br />
acupuncture resulted in a marked clinical relevant b<strong>en</strong>efit and was<br />
relatively cost-effective in Japan, Spain and Germany (€ 12.469 per QALY<br />
gained) 70 .<br />
• There is heterog<strong>en</strong>eity in acupuncture interv<strong>en</strong>tions (trigger point<br />
acupuncture, classical, and others). Trigger point acupuncture seems more<br />
effective than some other types of acupuncture for pain relief, measured<br />
at the <strong>en</strong>d of the treatm<strong>en</strong>t and at short-term follow-up 68 . (Grade C)