Pain in the Neck

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!

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{ 5 comments… read them below or add one }


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Cecila May 8, 2013 at 6:04 pm

Thanks for sharing your thoughts on bariatric surgery and heart benefit.


back pain management April 4, 2013 at 3:51 am

Why visitors still use to read news papers when in this technological globe everything
is available on net?


pharma-express May 15, 2012 at 2:19 pm

I prefer good massage. it is simply great. all the pain is goes away


Amir October 9, 2012 at 4:43 am

First and foremost, fialomybrgia IS a real illness. There is at least one specific test that is used as part of making a differential diagnosis. I'm shocked that the first respondant here doesn't want to understand and accept this for a fact. Further, although it wouldn't be used simply because of it's cost, there are specific tests that can be done during a functional MRI that shows the differences in pain responses between an FM patient and a non-FM patient.Have you ever seen a chiropractor for an evaluation and help? It is possible to get some help from a DC, but it's not for everyone. I have other types of arthritis, in addition to FM, so it may be that I would get more relief from a chiro than does someone else. But it's something to try.Have you been referred to a pain clinic? This would be a way for you to get a more updated combination of meds and to help to find other specific management methods that will also be of assistance to you.And when did you last see a rheumatologist? Yes, FM exists, but there are a few other types of arthritis that can mimic some of the effects of FM and that are more easily dealt with. This doesn't mean that you don't have FM or that you're not in pain, it's just a way of checking that there isn't anything else going on. Having any one chronic illness does not make you immune from any other type of medical problem, inlcuding other chronic illnessesMake certain that you stretch and exercise (to tolerance) every day. Doing all of this in heated pool, as a part of an arthritis aquafit program, can do wonders to help relieve some of the pain, and to increase flexibility. It's also a way to get out on a regular basis, and that helps greatly, too.


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