title: Identifying the best treatment among common nonsurgical neck pain treatments: a decision analysis.
abstract: METHODS
  Decision analysis.
  
  
  OBJECTIVE
  To identify the best treatment for nonspecific neck pain.
  
  
  BACKGROUND
  In Canada and the United States, the most commonly prescribed neck pain treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), exercise, and manual therapy. Deciding which treatment is best is difficult because of the trade-offs between beneficial and harmful effects, and because of the uncertainty of these effects.
  
  
  METHODS
  (Quality-adjusted) life expectancy associated with standard NSAIDs, Cox-2 NSAIDs, exercise, mobilization, and manipulation were compared in a decision-analytic model. Estimates of the course of neck pain, background risk of adverse events in the general population, treatment effectiveness and risk, and patient-preferences were input into the model. Assuming equal effectiveness, we conducted a baseline analysis using risk of harm only. We assessed the stability of the baseline results by conducting a second analysis that incorporated effectiveness data from a high-quality randomized trial.
  
  
  RESULTS
  There were no important differences across treatments. The difference between the highest and lowest ranked treatments predicted by the baseline model was 4.5 days of life expectancy and 3.4 quality-adjusted life-days. The difference between the highest and lowest ranked treatments predicted by the second model was 7.3 quality-adjusted life-days.
  
  
  CONCLUSIONS
  When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior.
authors.affiliation: Institute for Work & Health, Toronto, ON, Canada. gvdvelde@uhnresearch.ca
authors.forename: Gabrielle
authors.initials: G
authors.lastname: van der Velde
authors.forename: Sheilah
authors.initials: S
authors.lastname: Hogg-Johnson
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bayoumi
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.forename: Eleanor
authors.initials: E
authors.lastname: Boyle
authors.forename: Hilary
authors.initials: H
authors.lastname: Llewellyn-Thomas
authors.forename: Stella
authors.initials: S
authors.lastname: Chan
authors.forename: Peter
authors.initials: P
authors.lastname: Subrata
authors.forename: Jan Lucas
authors.initials: JL
authors.lastname: Hoving
authors.forename: Eric
authors.initials: E
authors.lastname: Hurwitz
authors.forename: Claire
authors.initials: C
authors.lastname: Bombardier
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D003661:Decision Support Techniques; D005081:Exercise Therapy / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D008017:Life Expectancy / Q000639:trends; D008297:Male; D020393:Manipulation, Spinal / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D019547:Neck Pain / Q000503:physiopathology / Q000628:therapy*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D018570:Risk Assessment; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal