Bronfort et al. (2012), Annals of Internal Medicine
In a study funded by NIH’s National Center for Complementary and Alternative Medicine to test the effectiveness of different approaches for treating mechanical neck pain, 272 participants were divided into three groups that received either spinal manipulative therapy (SMT) from a doctor of chiropractic (DC), pain medication (over-the-counter pain relievers, narcotics and muscle relaxants) or exercise recommendations. After 12 weeks, about 57 percent of those who met with DCs and 48 percent who exercised reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group. After one year, approximately 53 percent of the drug-free groups continued to report at least a 75 percent reduction in pain; compared to just 38 percent pain reduction among those who took medication.

Abstract

Background:
Mechanical neck pain is a common condition that affects an estimated 70% of persons at some point in their lives. Little research exists to guide the choice of therapy for acute and subacute neck pain.

Objective:
To determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term.

Design:
Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00029770)

Setting:
1 university research center and 1 pain management clinic in Minnesota.

Participants:
272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks.

Intervention:
12 weeks of SMT, medication, or HEA.

Measurements:
The primary outcome was participant-rated pain, measured at 2, 4, 8, 12, 26, and 52 weeks after randomization. Secondary measures were self-reported disability, global improvement, medication use, satisfaction, general health status (Short Form-36 Health Survey physical and mental health scales), and adverse events. Blinded evaluation of neck motion was performed at 4 and 12 weeks.

Results:
For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks (P ≤ 0.010), and HEA was superior to medication at 26 weeks (P = 0.02). No important differences in pain were found between SMT and HEA at any time point. Results for most of the secondary outcomes were similar to those of the primary outcome.

Limitations:
Participants and providers could not be blinded. No specific criteria for defining clinically important group differences were prespecified or available from the literature.

Conclusion:
For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term.
However, a few instructional sessions of HEA resulted in similar outcomes at most time points.

Primary Funding Source:
National Center for Complementary and Alternative Medicine, National Institutes of Health.

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