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Randomized Controlled Trial
. 2012 Jan 3;156(1 Pt 1):1-10.
doi: 10.7326/0003-4819-156-1-201201030-00002.

Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial

Affiliations
Randomized Controlled Trial

Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial

Gert Bronfort et al. Ann Intern Med. .

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.

Comment in

  • Pain in the neck: many (marginally different) treatment choices.
    Walker BF, French SD. Walker BF, et al. Ann Intern Med. 2012 Jan 3;156(1 Pt 1):52-3. doi: 10.7326/0003-4819-156-1-201201030-00010. Ann Intern Med. 2012. PMID: 22213495 No abstract available.
  • Acute and subacute neck pain.
    Ernst E. Ernst E. Ann Intern Med. 2012 May 1;156(9):668; author reply 669. doi: 10.7326/0003-4819-156-9-201205010-00017. Ann Intern Med. 2012. PMID: 22547481 No abstract available.
  • Acute and subacute neck pain.
    Chapman G. Chapman G. Ann Intern Med. 2012 May 1;156(9):669; author reply 669. doi: 10.7326/0003-4819-156-9-201205010-00018. Ann Intern Med. 2012. PMID: 22547482 No abstract available.

Summary for patients in

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