Hypoalgesic Effect of Neural Mobilization Versus Ibuprofen Pharmacologic Treatment

Universidad Europea de Madrid50 enrolled

Overview

The purpose of this study is to compare the effectivity of Median Nerve Neural Mobilization and oral Ibuprofen in treating patients who suffer cervicobrachial pain

Median Nerve Neural Mobilization and Ibuprofen both relieve cervicobrachial pain, but this happens through different mechanisms and with a different onset of side effects. Median Nerve Neural Mobilization is a physical therapy technique that achieves pain relief through mechanical stimulation of the median nerve and the brachial plexus. The proper mechanical stimulation of the nerve and its surrounding neural tissue induces a wide variety of physiologic responses that may reduce cervicobrachial pain including the activation of descending nervous system pain modulation mechanisms, all though the entire set of underlying reasons for this pain reduction is not completely understood. Among the effects caused by the Neural Tissue Mobilization that produce pain relief are: intraneural edema reduction, changes on the intraneural nerve pressure,dispersion of pro-inflammatory substances and an increase in nerve mobility Ibuprofen is a nonsteroidal anti-inflammatory drug used worldwide to control pain, fever and inflammation.Oral intake of Ibuprofen produces a hypoalgesic effect due to biochemical inhibition of the COX enzymes, which convert arachidonic acid to prostaglandin H2 (PGH2). PGH2, which in turn, is converted by other enzymes to several types of prostaglandins and thromboxanes (which are mediators of pain and inflammation). Side effects derived from the oral intake of Ibuprofen are related to its systemic action and can be severe in some patients. This fact suggests that oral Ibuprofen may not be suitable to use in all types of patients suffering from cervicobrachial pain, meanwhile the Median Nerve Neural Mobilization has little to no side effects known. This reveals a point of interest in determining comparative effectiveness between this two therapeutic options in the treatment of cervicobrachial pain.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Cervicobrachial Neuralgia

Interventions

Median Nerve Neural MobilizationPROCEDURE

Non-surgical non-invasive Median Nerve neural mobilization procedure was applied by a physical therapist continuously during 2 minutes in 5 different occasions with 1 minute of rest between each 2 minute application of the Neural Mobilization technique. The intervention was applied during a period of 6 weeks. The maximum level of elbow extension movement degree without the reproduction of symptoms during the application of the Median Nerve Neural mobilization treatment was determined through the baseline use of a Universal Goniometer Device.

IbuprofenDRUG

The active comparator group received an oral Ibuprofen treatment. The starting dose was of 400 mg/day and it was increased to a maximum of 1200 mg/day divided in 3 oral intakes every 8 hours depending on patient tolerance.The intervention was applied during a period of 6 weeks.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 45 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Clinical diagnosis of cervicobrachial pain confirmed by magnetic resonance imaging * Presence of unilateral symptoms of arm pain, paresthesia or numbness in the upper extremity during at least 3 continuous months previous to the application of treatment. * Positive results in all of the following tests: Spurling, Distraction, and Upper Limb Exclusion Criteria: * Contraindication in the use of nonsteroidal anti inflammatory drugs (NSAIDs) * The use of any type of treatment, therapy, procedure or drug to relieve pain * Patients who are under anticonvulsant, antidepressant or psychotropic medication * Vertebral instability * Vertebral osteoporosis * Vertebral or spine infection. * Neurologic diseases of genetic, infectious or neoplastic origin * Cervical stenosis myelopathy * Pregnancy * Kinesiophobia * Endocrine disorders and menopause * History of spine surgery * Intellectual disability, severe mental illness, intoxication, severe sleep deprivation, Alzheimer's disease.

Locations (1)

Centro de Medicina Fisica y de Rehabilitacion FISIOREH

Valencia, Carabobo, Venezuela

Outcomes

Primary Outcomes

Change from baseline using the Numeric Rating Scale for Pain at 1 hour

The Numeric Rating Scale (NRS) is an 11 point scale for patient self-reporting of pain, it was employed to evaluate the presence and relieve of cervicobrachial pain symptoms

Time frame: at baseline and 1 hour after the application of treatment, corresponding to intervention sessions 1, 15 and 30

Secondary Outcomes

Change from baseline of the Physical function involving the affected upper limb using the Quik DASH Scale

The Disabilities of the Arm, Shoulder and Hand ( QuickDASH) Test is a self-report short questionnaire designed to measure physical function and symptoms in people with any of several musculoskeletal disorders of the upper limb.

Time frame: at baseline, corresponding to intervention session 1 and 30 of treatment.

Change from baseline cervical rotation range of motion at 1 hour

Cervical rotation was assessed in units of rotation degrees, using the cervical range-of-motion device (CROM).

Time frame: at baseline and 1 hour after the application of treatment, corresponding to intervention sessions 1 and 30

Data from ClinicalTrials.gov

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