This issue of the Scandinavian Journal of Pain publishes a randomized controlled trial by Nystrom and co-workers on cervical fusion for chronic neck pain after whiplash injury . Patients were randomized to either cervical fusion or multimodal rehabilitation. In the surgical group, a diagnostic provocation test was performed that consisted in an open and direct mechanical stimulation of the suspected discs, followed by fusion of the symptomatic segments. The patients in the rehabilitation group received a six weeks multimodal outpatient treatment involving physiotherapists, occupational therapist, psychologist, social workers and nurses. In the intention-to-treat analysis, improvement at follow- up was observed in 65% and 23% of patients in the surgery and rehabilitation group, respectively. In the per-protocol analysis, the improvement was observed in 83% and 12% of patients in the two groups, respectively.The study has several merits. The enormous difficulties in planning and completing a randomized controlled trial of a surgical treatment are obvious and the authors have to be commended for their undertaking. The average follow-up period was approximately 2 years. The treatment for the rehabilitation group was an extensive multidisciplinary programme that seems to meet all criteria of an optimized and intensive conservative care.There are however several limitations
Scandinavian Journal of Pain – de Gruyter
Published: Dec 29, 2017
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