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Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial
Gert Bronfort1, Roni Evans, Alfred V Anderson
1Northwestern Health Sciences University, Pain Management and Rehabilitation Center, Minneapolis, Minnesota, USA. gbronfort@nwhealth.edu
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.
