Identifying the best treatment among common nonsurgical neck pain treatments: a decision analysis.
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 decisionanalytic 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.
van der Velde
Gabrielle
G
Institute for Work & Health, Toronto, Canada. gvdvelde@uhnresearch.ca
Hogg-Johnson
Sheilah
S
Bayoumi
Ahmed M
AM
Cassidy
J David
JD
Côté
Pierre
P
Boyle
Eleanor
E
Llewellyn-Thomas
Hilary
H
Chan
Stella
S
Subrata
Peter
P
Hoving
Jan Lucas
JL
Hurwitz
Eric
E
Bombardier
Claire
C
Krahn
Murray
M