Pains in the neck are common, and here we're talking about the real, physical pain about 70% of us will complain of at some point in our lifetime, not those annoying folks who may have foisted themselves on you for the holidays, as Rick and I quip in the podcast and on this week's YouTube. Good news gladdens our new year with this study in Annals of Internal Medicine, evaluating three methods for treating neck pain.
A total of 272 people who had neck pain of 2 to 12 weeks duration were randomized to receive either spinal manipulation from a chiropractor, a home-based exercise program taught and overseen by a therapist, or medication prescribed by a physician. Study participants were 18 to 65 years of age.
Pain was the primary outcome measure. Pain assessments were performed at 2, 4, 8, 12, 26 and 52 weeks after randomization and were self-reported by participants. Other assessments included self-reported disability, use of medications, general satisfaction and health status, and overall improvement. The study found that spinal manipulation and home exercise were comparable at most time points in the study, and both were better than medication. Yay! I say. As any listener to the podcast or reader of the blog knows, I am a BIG fan of low intervention, self-administered therapies whenever and wherever possible, and this sure seems like one of them. Let's take a closer look at the therapies used.
Spinal manipulation was provided by one of six chiropractors, all of whom had a minimum of five years of practice experience. Treatment lasted about 20 minutes and consisted largely of manipulating those areas of the neck and ribcage (cervical and thoracic, you wonks) that were relatively immobile. The home exercise program was taught in two one-hour sessions at a university-affiliated outpatient clinic about one to two weeks apart. Exercises to increase the mobility of the neck and shoulder joints, including the entire range of motion, were taught. No resistance was employed. Participants were instructed to perform 5 to 10 repetitions of each exercise up to 6 to 8 times per day. Those randomized to the exercise intervention also received laminated cards and a booklet illustrating the exercises. The program included demonstrations and instruction on how to lift, push and pull and perform other daily actions. Finally, the medication group was attended by a physician, who began initially with prescription nonsteroidal anti-inflammatory medications but progressed to narcotics if needed. Muscle relaxants were also used.
Spinal manipulation and home exercise were comparable and both superior to medications. Here's what Rick and I have to say about that: all medications come with side effects, and for those who may already be taking one or more, adding another isn't desirable. So we're glad to see that this strategy was least successful in treating neck pain. Regarding the comparison of spinal manipulation or home exercise, Rick opines that this could be a choice the patient can make based on personal preference, while I advocate for home exercise as the most likely means of sustaining lasting relief. Go figure.
Other topics this week include a study in JAMA demonstrating the cardiovascular risk reduction in people who've had bariatric surgery, a study in BMJ looking at studies (!) and a special issue of the Lancet examining the global impact of illicit drug use. Until next week, y'all live well!
Pain in the Neck,10 Comments