Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial
Summary provided by Dean L. Smith, D.C., Ph.D.
Bronfort G, Evans R, Anderson A.V, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012 Jan 3;156(1 Pt 1):1-10.
The lifetime prevalence of neck pain is nearly 75% and the condition is associated with increasing health care costs as well as reductions in productivity and quality of life. The objective of the study was to test the hypothesis that spinal manipulation is more effective than medication or home exercise for acute and subacute neck pain.
Participants were between the ages of 18-65, had mechanical, non-specific neck pain equivalent to grades I or II according to the Bone and Joint Decade 2000-2010 Task Force on Neck Pain, had neck pain between 2-12 weeks, and had a 3/10 or greater neck pain.
Participants were randomized into one of 3 groups: 1) SMT performed by chiropractors; 2) medication prescribed by licensed physician; or 3) home exercise with advice (HEA) provided by therapists. The SMT group received 12 weeks of low amplitude spinal adjustments and mobilization to areas of hypomobility using diversified techniques. The number of treatments was determined by the chiropractor. Adjunct therapy and advice to stay active was recommended as needed. The medication group received NSAIDs, acetaminophen or both as first line therapy. Muscle relaxers and advice to stay active were recommended as needed. The home exercise group with advice was provided in two one-hour sessions with emphasis on self mobilization exercise of neck and shoulders.
Outcome measures included pain (Numerical Rating Scale), Neck Disability Index, global improvement, medication use, satisfaction with care, SF-36 and cervical spine motion.
Results at 12 weeks indicated a significantly higher proportion of the SMT group compared to the medication group experienced reductions of pain of at least 50%. Differences in pain improvement between SMT and HEA were not significant, but differences in pain between HEA and medication groups were not statistically significant either. Longer-term analyses showed similar findings.
SMT was superior to medication at the end of treatment and during follow up in terms of global improvement, participant satisfaction, SF-36 physical function, and long-term medication use (1.26 days fewer per week of use at 52 weeks). The SMT and HEA groups fared similarly on secondary outcomes, but SMT performed better for patient satisfaction with care in both short and long term. It is important to note that no serious adverse events were reported in the study. Forty percent of SMT group and 46% of HEA group had reported adverse events primarily musculoskeletal pain. Sixty percent of the medication group reported side effects, the most common being gastrointestinal symptoms and drowsiness.
- Adults with current neck pain of 2 to 12 weeks’ duration were randomized into 12 weeks of either chiropractic spinal adjustments, medication, or home exercise with advice
- Chiropractic spinal adjustments and home exercise were more effective than management with medication in both the short term and long term
- Those receiving chiropractic adjustments were more satisfied with their care than either the home exercise group or the medication group
- Participants in the medication group reported higher levels of medication use after the intervention