Neck pain is a common and costly medical ailment. Few studies of really effective medical treatments exist compared with those, say, for low back pain.

Many drugs used in clinical practice have been tried. Among those are nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants, neuroleptic agents, and opioid analgesics.

While uncontrolled studies show benefit, controlled studies are lacking. So what has been shown to work so far? According to a recent study, there are only two medicines that have been proven to be effective. The first is intravenous methylprednisolone for acute whiplash used within eight hours for whiplash and the second is intramuscular lidocaine for chronic mechanical neck disorders. (Peloso PM, Gross AR, Haines TA, et al. Medicinal and injection therapies for mechanical neck disorders: a Cochrane systemic Review. J Rheum 2006; 33:957-967).

What is disheartening is that the usual treatments such as anti-inflammatory drugs and acetaminophen have been largely ineffective- at least according to this one large study.

Even epidural injections were classified as showing "limited evidence of benefit."

A number of interventions in this large study were ineffective. These include:

" Oral psychotropic agents
" Oral anti-inflammatory agents and oral analgesics
" Intramuscular injections of multivitamins.
" Nerve-block injections

In addition, several interventions were judged to have shown "moderate evidence of no benefit." These included intramuscular injections of botulinum toxin (Botox A), intracutaneous injections of sterile water, subcutaneous injection of carbon dioxide and melatonin.

So what can you do if you're a patient?

First of all, remember that these studies that are published in the literature have flaws. They do not report the data from private practices. Also, many of the studies that are reported as being "negative" are done in large medical centers where there is already a built in bias that these treatments don't work. It's sad but true. A lot of academic doctors really don't believe in treatment. They'd rather write negative papers.

Second, make sure you see a skilled rheumatologist... one who is skilled in the management of osteoarthritis and neck problems.

The things that might afford some relief in addition to the two described above are also- at least in my 25 years of experience are:

" Physical therapy for chronic problems
" Chiropractic for acute problems
" A neck support pillow
" Ice/ moist heat
" Gentle traction
" Exercises done under the supervision of a skilled therapist
" A soft cervical collar worn temporarily
" Epidural, nerve block, and soft tissue injections (despite what they say, I think they work)