From the Guidelines
Neither chiropractic adjustment nor steroid injection is universally suitable for all cases of chronic neuropathic and musculoskeletal pain, as treatment should be tailored to the specific diagnosis and patient factors. For musculoskeletal pain, chiropractic adjustments may provide temporary relief in certain conditions like mechanical back pain, but evidence for long-term effectiveness is limited, as noted in studies such as 1. Steroid injections (such as methylprednisolone 40-80mg or triamcinolone 40mg, often mixed with lidocaine) can be beneficial for inflammatory conditions like arthritis or radiculopathy, typically administered every 3-6 months with a maximum of 3-4 injections yearly to minimize side effects, as suggested by 1. For neuropathic pain, however, neither treatment addresses the underlying nerve dysfunction, and first-line treatments typically include medications like gabapentin (300-3600mg daily), pregabalin (150-600mg daily), duloxetine (60-120mg daily), or amitriptyline (10-75mg daily), as recommended by 1 and 1. Before pursuing either treatment, patients should undergo proper diagnostic evaluation to identify the pain source, discuss potential risks (including rare but serious complications like stroke with cervical manipulation or infection with injections), and consider a comprehensive approach that might include physical therapy, appropriate medications, and lifestyle modifications. Many patients benefit most from multimodal treatment rather than relying on a single intervention, as supported by guidelines such as 1. Key considerations include:
- Proper diagnosis to guide treatment
- Discussion of potential risks and benefits
- Consideration of comprehensive, multimodal treatment approaches
- Tailoring treatment to the specific diagnosis and patient factors, as emphasized by 1 and 1. Given the complexity and variability of chronic neuropathic and musculoskeletal pain, a personalized approach that incorporates the latest evidence and guidelines is essential for optimizing outcomes, as highlighted by the most recent and highest quality study 1.
From the Research
Treatment Options for Chronic Neuropathic and Musculoskeletal Pain
- Chiropractic adjustment and steroid injection are two potential treatment options for chronic neuropathic and musculoskeletal pain, but their effectiveness depends on various factors.
- According to 2, spinal manipulation, which is a key component of chiropractic care, can lead to a small benefit for chronic neck and low back pain.
- Additionally, 3 provides evidence-based recommendations for chiropractic management of patients with chronic musculoskeletal pain, including spinal manipulation/mobilization and other manual therapy.
- However, there is limited evidence on the effectiveness of chiropractic adjustments specifically for neuropathic pain, although 4 reports a case of a patient with hereditary spastic paraplegia and chronic pain who experienced reduced pain and improved functionality after chiropractic therapy.
Steroid Injections
- Steroid injections are commonly used to treat musculoskeletal pain, but their effectiveness for chronic neuropathic pain is less clear.
- There is no direct evidence in the provided studies to support the use of steroid injections for chronic neuropathic pain.
- However, 2 suggests that a multimodal treatment approach, which may include injections, can be effective for chronic musculoskeletal pain.
Alternative Treatment Options
- Other non-pharmacologic, non-invasive treatment approaches, such as exercise, cognitive behavior therapy, and mindfulness techniques, may be effective for chronic musculoskeletal pain, as suggested by 2 and 3.
- Gabapentin, an anticonvulsant, has been shown to be effective in treating neuropathic pain, as reported in 5 and 6.
- These alternative treatment options may be considered in conjunction with or instead of chiropractic adjustments or steroid injections, depending on the individual patient's needs and preferences.