Treatment Of Non-specific Neck Pain Research Articles

Effects of Kinesio Taping on Neck Pain: A Meta-Analysis and Systematic Review of Randomized Controlled Trials.

Neck pain constitutes a prevalent and burdensome health issue, substantially impairing patients' quality of life and functional capabilities. Kinesio taping (KT), a commonly employed intervention within physical therapy, holds promise for mitigating such symptoms; however, a comprehensive evaluation of its efficacy and evidence base is lacking. Therefore, this study endeavors to systematically investigate the therapeutic effects of KT on both subjective neck pain intensity and objective measures of physical activity limitations through a rigorous meta-analytic approach. By synthesizing existing literature and scrutinizing methodological nuances, we aim to furnish healthcare practitioners with evidence-informed insights, facilitating more judicious clinical decision-making and optimizing patient outcomes. According to the PRISMA guidelines, we conducted searches on PubMed, Cochrane Library, Embase, and Web of Science for randomized controlled trials (RCTs) investigating the efficacy of KT in treating neck pain. Screening was performed based on predefined inclusion and exclusion criteria. Characteristics of the included RCTs were extracted. Trial heterogeneity was assessed using the I2 statistic. Meta-analysis was conducted using Stata 17 software. Risk of bias and methodological quality were evaluated using the Cochrane Risk of Bias 2 tool and the PEDro scale, respectively. In our analysis of 10 RCTs involving 620 patients meeting our inclusion criteria, KT demonstrated significant beneficial effects on neck pain, notably surpassing conventional treatment (weighted mean difference = -0.897, 95% CI -1.30 to -0.49, P < 0.001). Subgroup analysis further revealed that KT exhibited particularly pronounced efficacy in the treatment of nonspecific neck pain and mechanical neck pain, with a more substantial effect observed after 4 weeks of KT intervention compared to 1 week. Moreover, KT demonstrated superior efficacy in alleviating pain symptoms compared to both conventional treatment and sham interventions. KT has demonstrated efficacy in reducing neck pain and improving cervical dysfunction among patients. Prolonged KT treatment or its combination with other therapeutic modalities may potentially enhance therapeutic outcomes. PROSPERO CRD42024524685.

Muscle energy technique to reduce pain and disability in cases of non-specific neck pain: A systematic review and meta-analysis of randomized controlled trials

BackgroundTo investigate the effectiveness of muscle energy technique (MET) for treatment of non-specific neck pain (NSNP). MethodsA literature search was performed using electronic databases from their inception until October 2023 for randomized controlled trials (RCTs) that investigated the effects of MET on NSNP. A change in pain intensity and reduced disability were the primary and secondary outcomes, respectively, standardized using Hedges’ g. A random effects model was used for data pooling. ResultsThis study included 26 RCTs comprising 1170 participants. The results showed that MET significantly reduced pain intensity (Hedges' g = −0.967 95 % CI = −1.417 to −0.517, p < 0.001). However, subgroup analysis revealed that this significant benefit was observed only when MET was combined with other treatments and not with MET monotherapy. MET also reduced disability (Hedges’ g = −0.545, 95 % CI = −1.015 to − 0.076, p = 0.023). Meta-regression analysis showed that an increase in treatment duration/session per week contributed to greater pain reduction. No adverse events were reported following the MET. ConclusionsIn conclusion, our meta-analysis suggests MET's potential effectiveness within a combined treatment for NSNP. However, the evidence's low certainty is likely influenced by bias and study variations. To strengthen these findings, future research should focus on higher-quality clinical trials, longer follow-up periods, and prediction interval presentations.

Comparative Effects of Percussion Theragun Versus Physical Activity in Non-Specific Neck Pain in Young Adults – A Randomized Clinical Tr

Background: The percussion theragun uses fast oscillatory back and forth movements to produce vibrations of different frequencies. Handheld percussive massage treatment has acquired fame as of late, for both remedial use and in sports practice. Physical activity is any movement that uses energy that improves strength, flexibility. With both the possible treatment options, the study raises the question of which of the two produces better results in subjects with Non-specific neck pain in terms of reduction of pain and increase in range. The objective of this study was to assess and compare the therapeutic effects of the percussion theragun with physical activity for the treatment of non-specific neck pain. Method and Measures: The study was conducted on 36 subjects with non-specific neck pain who were given 3 consecutive sessions (in a span of 3 days) of intervention. Through randomized method subjects were divided into the percussion theragun group (group A) and conventional physical activity group (group B). Outcome measures such as VAS (visual analogue scale) and Neck range of motion were assessed Results: The nonspecific neck pain participants in Group A and Group B showed significant improvement in extension, right lateral flexion, left lateral flexion neck ROM and reduction in VAS after exposed to the respective intervention. However, the Group A showed a significant improvement in VAS and ROM when compared with Group B. Conclusion: The current study provided the evidence to prove that the protocols used in this study show significant reduction in pain and range of motion in subjects with non-specific neck pain in both the groups. The percussion theragun group showed significantly greater improvement than the physical activity group.

Randomized Feasibility Pilot Trial of Adding a New Three-Dimensional Adjustable Posture-Corrective Orthotic to a Multi-Modal Program for the Treatment of Nonspecific Neck Pain.

The aim of this study was to investigate the feasibility and effect of a multimodal program for the management of chronic nonspecific neck pain CNSNP with the addition of a 3D adjustable posture corrective orthotic (PCO), with a focus on patient recruitment and retention. This report describes a prospective, randomized controlled pilot study with twenty-four participants with CNSNP and definite 3D postural deviations who were randomly assigned to control and study groups. Both groups received the same multimodal program; additionally, the study group received a 3D PCO to perform mirror image® therapy for 20−30 min while the patient was walking on a treadmill 2−3 times per week for 10 weeks. Primary outcomes included feasibility, recruitment, adherence, safety, and sample size calculation. Secondary outcomes included neck pain intensity by numeric pain rating scale (NPRS), neck disability index (NDI), active cervical ROM, and 3D posture parameters of the head in relation to the thoracic region. Measures were assessed at baseline and after 10 weeks of intervention. Overall, 54 participants were screened for eligibility, and 24 (100%) were enrolled for study participation. Three participants (12.5%) were lost to reassessment before finishing 10 weeks of treatment. The between-group mean differences in change scores indicated greater improvements in the study group receiving the new PCO intervention. Using an effect size of 0.797, α > 0.05, β = 80% between-group improvements for NDI identified that 42 participants were required for a full-scale RCT. This pilot study demonstrated the feasibility of recruitment, compliance, and safety for the treatment of CNSNP using a 3D PCO to a multimodal program to positively affect CNSNP management.

Effectiveness of Specific Neck Exercise for Nonspecific Neck Pain; Usefulness of Strategies for Patient Selection and Tailored Exercise-A Systematic Review With Meta-Analysis.

Specific neck exercises (SNE) targeting deep cervical flexors and extensors are commonly used for the treatment of nonspecific neck pain (NSNP). However, whether SNE are more effective than alternative exercise interventions (AEI) remains unclear. Furthermore, it has been postulated that SNE may be most effective when they are tailored and targeted to patients with evidence of motor control dysfunction, yet this notion also remains unproven. The objectives of this study were to compare the effectiveness of SNE with that of AEI for reducing pain and disability in people with NSNP and to assess whether the effectiveness of SNE is increased when the exercises are tailored and provided to patients with evidence of motor control dysfunction. For this systematic review with meta-analysis, Medline, Web of Science, Scopus, and Physiotherapy Evidence Database were searched. Eligibility criteria included randomized controlled trials evaluating the effectiveness of SNE against that of AEI in people with NSNP. Meta-analysis included subgroup analyses to determine the effect of exercise tailoring and participant selection criteria on the effectiveness of SNE. Twelve studies were included. Meta-analysis revealed greater effectiveness of SNE in the short to medium term for reducing pain (pooled standardized mean difference [SMD] = -0.41; 95% CI = -0.76 to -0.06; P = .02) and disability (pooled SMD = -0.41; 95% CI = -0.78 to -0.04; P = .03) but no differences in the long term for pain (pooled SMD = -1.30; 95% CI = -3.35 to 0.75; P = .21) and disability (pooled SMD = -1.81; 95% CI = -4.29 to 0.67; P = .15), although evidence was limited for the latter. The effectiveness of SNE was not superior in studies that included only participants with motor control dysfunction or when exercises were tailored to each participant. Overall, the studies were of low quality. Grading of Recommendations Assessment, Development and Evaluation revealed low certainty, serious risk of bias, and inconsistency of findings for short- to medium-term effects and very low certainty, serious risk of bias, and very serious inconsistency for long-term effects. The preferential use of SNE may be recommended to achieve better short- to medium-term outcomes, although the low quality of evidence affects the certainty of these findings. Currently used strategies for selecting patients and tailoring SNE are not supported by the evidence and therefore cannot be recommended for clinical practice. SNE are more effective than AEI for reducing pain and disability in patients with NSNP in the short to medium term, but overall evidence is of low quality, affecting the certainty of the findings. Tests of muscle dysfunction (mostly the craniocervical flexion test) currently used in studies to select patients and tailor SNE do not result in greater effectiveness of these exercises. Evidence suggests SNE are more effective than other forms of exercise, although evidence is overall of low quality. Use of the craniocervical flexion test in isolation to select participants and/or tailor SNE cannot be recommended.

Neck pain as the problem of our time

During life, neck pain occurs in 20-70% of people, its prevalence in the total population is 4.9%, and the annual morbidity varies from 30 to 70%. Neck pain significantly reduces the quality of life and can lead to disability. It was found that the economic burden of neck pain is high and is associated with the amount of money spent on treatment, with «lost profits» due to employee illness, compensation for examinations and sick leave. Over the past decade, there has been an increase in the prevalence of neck pain, which increases the importance of improving the diagnostics, prevention and treatment of neck pain. Depending on the duration, neck pain is classified as acute, subacute and chronic. Neck pain may be non-specific (skeletal-muscular), secondary (specific, symptomatic) or associated with discogenic radiculopathy or cervical myelopathy. Nonspecific neck pain is the most common. Effective treatment of nonspecific neck pain includes therapeutic gymnastics, manual therapy, recommendations on lifestyle, activity and ergonomics in the organization of the workplace. Identification and correction of risk factors of neck pain occurrence, persistence and chronization are of great importance in the prevention and treatment of patients. Neck pain pharmacotherapy includes drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs): lor-noxicam, which has shown its effectiveness and good tolerance in the treatment of neck pain, cervicocranialgia, postoperative and skeletal-muscular pain. It is recommended to prescribe a short course of NSAIDs therapy in minimal therapeutic doses. In the chronic course of neck pain, antidepressants may be prescribed, especially when combined with depression.

Clinical effectiveness of manipulation and mobilisation interventions for the treatment of non-specific neck pain: protocol for a systematic review and meta-analysis

IntroductionNon-specific neck pain (NSNP) is a common musculoskeletal condition resulting in pain, physical limitations and associated functional disability. Current guidelines recommend manipulation and/or mobilisation as part of the multimodal management...

Addition of a new three-dimensional adjustable cervical thoracic orthosis to a multi-modal program in the treatment of nonspecific neck pain: study protocol for a randomised pilot trial

BackgroundNonspecific neck pain (NSNP) is one of the most common musculoskeletal problems treated by orthopaedic physicians and physiotherapists. Posture has emerged as one of the major risk factors associated with NSNP, but most previous studies ignored correct posturing as an effective treatment. Therefore, one of the major challenges faced by clinicians is how to incorporate 3D posture findings into the treatment plane. The present study will evaluate the feasibility of conducting a larger randomized trial. This pilot study is designed to investigate the hypothesis that a multimodal programme supplemented with the addition of a 3D adjustable cervico thoracic posture corrective orthotic (CTPCO) will yield short- and long-term improvement on NSNP management outcomes.Methods/designThis pilot, single-blind, randomized controlled trial will divide 24 patients into two groups (study and control) using block randomization. Both groups will receive conventional treatment consisting of a moist hot pack, soft tissue mobilization, manual therapy and therapeutic exercise. The study group will undergo ambulatory mirror-image functional re-training wearing a 3D adjustable CTPCO. The primary outcome is feasibility, including recruitment (e.g., time to complete enrolment, recruitment rate), patient retention and adherence to treatment allocation (e.g., session attendance, home practice, use of non-study treatments). The secondary outcomes used to assess the effectiveness of the treatment will include neck pain (measures using the visual analogue scale (VAS)) and neck disability (measures using the neck disability index (NDI)), among other outcome measures, compared between the experimental and control groups. Three-dimensional posture parameters of head measurements will be provided by a Global Posture System (GPS). The outcome measures for determining the treatment effect will be assessed at three intervals: pre-treatment, after 10 weeks of intervention and after 3 months at follow-up.DiscussionThis randomized controlled pilot trial will inform the design of a future full-scale trial. The outcomes will provide some resources for the incorporation of ambulatory mirror-image functional re-training intervention compared to a control group intervention for neck pain, disability and 3D posture parameters.Trial registrationProspectively registered at ClinicalTrials.gov, NCT03331120. Registered on 22 October 2017.

Effectiveness of static stretching in comparison with muscle energy technique in treatment of non-specific neck pain.

Effectiveness of static stretching in comparison with muscle energy technique in treatment of non-specific neck pain.

Microcurrent Point Stimulation Applied to Lower Back Acupuncture Points for the Treatment of Nonspecific Neck Pain.

Objectives: Although acupuncture and microcurrent are widely used for chronic pain, there remains considerable controversy as to their therapeutic value for neck pain. We aimed to determine the effect size of microcurrent applied to lower back acupuncture points to assess the impact on the neck pain.Design: This was a cohort analysis of treatment outcomes pre- and postmicrocurrent stimulation, involving 34 patients with a history of nonspecific chronic neck pain.Subjects and Settings: Consenting patients were enrolled from a group of therapists attending educational seminars and were asked to report pain levels pre-post and 48 hours after a single MPS application.Interventions and Measurements: Direct current microcurrent point stimulation (MPS) applied to standardized lower back acupuncture protocol points was used. Evaluations entailed a baseline visual analog scale (VAS) pain scale assessment, using a VAS, which was repeated twice after therapy, once immediately postelectrotherapy and again after a 48-h follow-up period. All 34 patients received a single MPS session. Results were analyzed using paired t tests.Results and Outcomes: Pain intensity showed an initial statistically significant reduction of 68% [3.9050 points; 95% CI (2.9480, 3.9050); p = 0.0001], in mean neck pain levels after standard protocol treatment, when compared to initial pain levels. There was a further statistically significant reduction of 35% in mean neck pain levels at 48 h when compared to pain levels immediately after standard protocol treatment [0.5588 points; 95% CI (0.2001, 0.9176); p = 0.03], for a total average pain relief of 80%.Conclusions: The positive results in this study could have applications for those patients impacted by chronic neck pain.

Educational Interventions May Help Prevent Low Back Pain but Are Not Effective in the Prevention and Treatment of Nonspecific Neck Pain.

Educational Interventions May Help Prevent Low Back Pain but Are Not Effective in the Prevention and Treatment of Nonspecific Neck Pain.

A Comparative Study between Combinations of Ultrasound Therapy with Active Chin Tuck Exercise and Ultrasound Therapy with Sub Occipital Muscle Release in the Management of Non-Specific Neck Pain due to Sub Occipital Muscle Tightness among Computer Professionals

Neck pain is more common in people who spend most of their day working at a desk, in front of the computer with a ‘bent-forward’ posture or ‘forward head carriage’ posture. Non-Specific Neck Pain is most often caused by continuous forward head carrying posture leading to sub-occipital muscle tightness, decreased cervical mobility and obliterated cervical spine curvature. Forward head posture is commonly adopted by visual display terminal [VDT] workers involving a combination of lower cervical flexion and upper cervical extension. The rotatory motion of C1 and C2 is coupled to a vertical translation of the same two vertebrae. The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The first three joints in the neck allow for most movement of the neck and head. The lower joints in the neck and those of the upper back create a supportive structure for the head to sit on. If this support system is affected, then the muscles in the area will becometight, causing neck pain. A constant forward head posture reduces the average length of the rectus capitis posterior minor, the superior oblique, rectus capitis posterior major and inferior oblique muscles. It contributes to the development of chronic neck pain. Forward head posture is the anterior positioning of the cervical spine. In this position, head is slightly leaning forward which causes strain in cervical joints and muscles. There will be flexion in lower cervical region and extension in upper cervical region. Question: To determine the efficacy of physiotherapeutic techniques in the treatment of Non-Specific Neck Pain due to Sub-occipital muscle tightness among computer professionals. To systematically compare the efficacy of Active Chin Tucking Exercises and sub occipital muscle release in the treatment of Non-Specific Neck Pain due to Sub-occipital muscle tightness among computer professionals. Design: Comparative Study design Methodology: It is a pre and post-test Experimental study, 20 computer professionals aged between 22 and 30 years who fulfilled inclusion criteria were randomly selected and assigned in to two groups of 10 subjects each. Group A was assigned for Ultrasound Therapy with Active Chin Tucking Exercises and Group B for Ultrasound Therapy with Sub Occipital Muscle release Technique. The study was conducted for a period of 7 days. Pain and neck function were measured before and after intervention by Visual Analog Scale and Copenhagen Neck Function Disability Scale respectively. The data collected from 20 subjects were evaluated statistically. Descriptive analytical study was done by using Paired’ test and Unpaired’ test. Conclusion: It is concluded that there is reduction of pain & there is improvement in Neck function among computer professionals treated with Ultrasound Therapy and Active Chin Tuck Exercise for their neck pain & also in group treated with Ultrasound Therapy and Sub Occipital Muscle Release Technique for their neck pain. It is concluded that combination of Ultrasound Therapy with Active Chin Tuck Exercise training group showed statistically significant improvement & found superior in improving neck function, whereas Ultrasound Therapy with Sub Occipital Muscle Release Technique training group showed statistically significant reduction in pain.

Joint mobilisation versus mechanical traction in the treatment of non-specific neck pain in adult patients: A retrospective review

Acute non-specific neck pain is one of the most common musculoskeletal condition referred to physiotherapists by general practitioners.

Systematic review of manual therapies for nonspecific neck pain

ObjectiveTo evaluate the effectiveness of manual therapies in the treatment of nonspecific neck pain. Materials and methodsMedline and the Cochrane Library were searched for randomized controlled trials of manual therapy or mobilization, used alone or with exercises to treat pain and functional impairment related to nonspecific neck pain. Cochrane Back Review Group criteria were used to assess the quality of the trials and the level of evidence (unclear, limited, moderate, or high) for short-, medium-, and long-term effects. ResultsOf 27 identified trials, 18 were of high quality. In acute neck pain, effective treatments were thoracic manipulation combined with electrothermal therapy in the short term and cervical manipulation in the long term. In chronic neck pain and neck pain of variable duration, both pain and function improved consistently at all follow-up time points. None of the manual therapies used alone or in combination was superior over the others. In the long term, exercises alone or combined with manual therapies were superior over manual therapies used alone. ConclusionManual therapies contribute usefully to the management of nonspecific neck pain. The level of evidence is moderate for short-term effects of upper thoracic manipulation in acute neck pain, limited for long-term effects of neck manipulation, and limited for all techniques and follow-up durations in chronic neck pain.

Cost-effectiveness of conservative treatments for neck pain: a systematic review on economic evaluations

PurposeVarious conservative interventions have been used for the treatment of non-specific neck pain. The aim of this systematic review was to investigate the cost-effectiveness of conservative treatments for non-specific neck pain.MethodsClinical and economic electronic databases, reference lists and authors’ databases were searched up to 13 January 2011. Two reviewers independently selected studies for inclusion, performed the risk of bias assessment and data extraction.ResultsA total of five economic evaluations met the inclusion criteria. All studies were conducted alongside randomised controlled trials and included a cost-utility analysis, and four studies also conducted a cost-effectiveness analysis. Most often, the economic evaluation was conducted from a societal or a health-care perspective. One study found that manual therapy was dominant over physiotherapy and general practitioner care, whilst behavioural graded activity was not cost-effective compared to manual therapy. The combination of advice and exercise with manual therapy was not cost-effective compared to advice and exercise only. One study found that acupuncture was cost-effective compared to a delayed acupuncture intervention, and another study found no differences on cost-effectiveness between a brief physiotherapy intervention compared to usual physiotherapy. Pooling of the data was not possible as heterogeneity existed between the studies on participants, interventions, controls, outcomes, follow-up duration and context related socio-political differences.ConclusionAt present, the limited number of studies and the heterogeneity between studies warrant no definite conclusions on the cost-effectiveness of conservative treatments for non-specific neck pain.

Avoidable costs of physical treatments for chronic back, neck and shoulder pain within the Spanish National Health Service: a cross-sectional study

BackgroundBack, neck and shoulder pain are the most common causes of occupational disability. They reduce health-related quality of life and have a significant economic impact. Many different forms of physical treatment are routinely used. The objective of this study was to estimate the cost of physical treatments which, despite the absence of evidence supporting their effectiveness, were used between 2004 and 2007 for chronic and non-specific neck pain (NP), back pain (BP) and shoulder pain (SP), within the Spanish National Health Service in the Canary Islands (SNHSCI).MethodsChronic patients referred from the SNHSCI to private physical therapy centres for NP, BP or SP, between 2004 and 2007, were identified. The cost of providing physical therapies to these patients was estimated. Systematic reviews (SRs) and clinical practice guidelines (CPGs) for NP, BP and SP available in the same period were searched for and rated according to the Oxman and AGREE criteria, respectively. Those rated positively for ≥70% of the criteria, were used to categorise physical therapies as Effective; Ineffective; Inconclusive; and Insufficiently Assessed. The main outcome was the cost of physical therapies included in each of these categories.Results8,308 chronic cases of NP, 4,693 of BP and 5,035 of SP, were included in this study. Among prescribed treatments, 39.88% were considered Effective (physical exercise and manual therapy with mobilization); 23.06% Ineffective; 13.38% Inconclusive, and 23.66% Insufficiently Assessed. The total cost of treatments was € 5,107,720. Effective therapies accounted for € 2,069,932.ConclusionsSixty percent of the resources allocated by the SNHSCI to fund physical treatment for NP, BP and SP in private practices are spent on forms of treatment proven to be ineffective, or for which there is no evidence of effectiveness.

Identifying the Best Treatment Among Common Nonsurgical Neck Pain Treatments: A Decision Analysis

Study Design Decision analysis. Objective To identify the best treatment for nonspecific neck pain. Summary of Background Data In Canada and the United States, the most commonly prescribed neck pain treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), exercise, and manual therapy. Deciding which treatment is best is difficult because of the trade-offs between beneficial and harmful effects, and because of the uncertainty of these effects. Methods (Quality-adjusted) life expectancy associated with standard NSAIDs, Cox-2 NSAIDs, exercise, mobilization, and manipulation were compared in a decisionanalytic model. Estimates of the course of neck pain, background risk of adverse events in the general population, treatment effectiveness and risk, and patient-preferences were input into the model. Assuming equal effectiveness, we conducted a baseline analysis using risk of harm only. We assessed the stability of the baseline results by conducting a second analysis that incorporated effectiveness data from a high-quality randomized trial. Results There were no important differences across treatments. The difference between the highest and lowest ranked treatments predicted by the baseline model was 4.5 days of life expectancy and 3.4 quality-adjusted life-days. The difference between the highest and lowest ranked treatments predicted by the second model was 7.3 quality-adjusted life-days. Conclusion When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior.

Identifying the Best Treatment Among Common Nonsurgical Neck Pain Treatments

Decision analysis. To identify the best treatment for nonspecific neck pain. In Canada and the United States, the most commonly prescribed neck pain treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), exercise, and manual therapy. Deciding which treatment is best is difficult because of the trade-offs between beneficial and harmful effects, and because of the uncertainty of these effects. (Quality-adjusted) life expectancy associated with standard NSAIDs, Cox-2 NSAIDs, exercise, mobilization, and manipulation were compared in a decision-analytic model. Estimates of the course of neck pain, background risk of adverse events in the general population, treatment effectiveness and risk, and patient-preferences were input into the model. Assuming equal effectiveness, we conducted a baseline analysis using risk of harm only. We assessed the stability of the baseline results by conducting a second analysis that incorporated effectiveness data from a high-quality randomized trial. There were no important differences across treatments. The difference between the highest and lowest ranked treatments predicted by the baseline model was 4.5 days of life expectancy and 3.4 quality-adjusted life-days. The difference between the highest and lowest ranked treatments predicted by the second model was 7.3 quality-adjusted life-days. When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior.

Identifying the Best Treatment Among Common Nonsurgical Neck Pain Treatments

Decision analysis. To identify the best treatment for nonspecific neck pain. In Canada and the United States, the most commonly prescribed neck pain treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), exercise, and manual therapy. Deciding which treatment is best is difficult because of the trade-offs between beneficial and harmful effects, and because of the uncertainty of these effects. (Quality-adjusted) life expectancy associated with standard NSAIDs, Cox-2 NSAIDs, exercise, mobilization, and manipulation were compared in a decision-analytic model. Estimates of the course of neck pain, background risk of adverse events in the general population, treatment effectiveness and risk, and patient-preferences were input into the model. Assuming equal effectiveness, we conducted a baseline analysis using risk of harm only. We assessed the stability of the baseline results by conducting a second analysis that incorporated effectiveness data from a high-quality randomized trial. There were no important differences across treatments. The difference between the highest and lowest ranked treatments predicted by the baseline model was 4.5 days of life expectancy and 3.4 quality-adjusted life-days. The difference between the highest and lowest ranked treatments predicted by the second model was 7.3 quality-adjusted life-days. When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior.

Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomised controlled trial

BackgroundManipulation is a common treatment for non-specific neck pain. Neck manipulation, unlike gentler forms of manual therapy such as mobilisation, is associated with a small risk of serious neurovascular injury and can result in stroke or death. It is thought however, that neck manipulation provides better results than mobilisation where clinically indicated. There is long standing and vigorous debate both within and between the professions that use neck manipulation as well as the wider scientific community as to whether neck manipulation potentially does more harm than good. The primary aim of this study is to determine whether neck manipulation provides more rapid resolution of an episode of neck pain than mobilisation.Methods/Design182 participants with acute and sub-acute neck pain will be recruited from physiotherapy, chiropractic and osteopathy practices in Sydney, Australia. Participants will be randomly allocated to treatment with either manipulation or mobilisation. Randomisation will occur after the treating practitioner decides that manipulation is an appropriate treatment for the individual participant. Both groups will receive at least 4 treatments over 2 weeks. The primary outcome is number of days taken to recover from the episode of neck pain. Cox regression will be used to compare survival curves for time to recovery for the manipulation and mobilisation treatment groups.DiscussionThis paper presents the rationale and design of a randomised controlled trial to compare the effectiveness of neck manipulation and neck mobilisation for acute and subacute neck pain.