Hypoalgesic Effect of Neural Mobilization Versus Ibuprofen Pharmacologic Treatment

Hypoalgesic Effect of Median Nerve Neural Mobilization Versus Ibuprofen Pharmacologic Treatment in Patients With Cervicobrachial Pain

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.

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.