Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial.
BACKGROUND
Mechanical neck pain is a common condition that affects an estimated 70% of persons at some point in their lives. Little research exists to guide the choice of therapy for acute and subacute neck pain.


OBJECTIVE
To determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term.


METHODS
Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00029770)


METHODS
1 university research center and 1 pain management clinic in Minnesota.


METHODS
272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks.


METHODS
12 weeks of SMT, medication, or HEA.


METHODS
The primary outcome was participant-rated pain, measured at 2, 4, 8, 12, 26, and 52 weeks after randomization. Secondary measures were self-reported disability, global improvement, medication use, satisfaction, general health status (Short Form-36 Health Survey physical and mental health scales), and adverse events. Blinded evaluation of neck motion was performed at 4 and 12 weeks.


RESULTS
For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks (P ≤ 0.010), and HEA was superior to medication at 26 weeks (P = 0.02). No important differences in pain were found between SMT and HEA at any time point. Results for most of the secondary outcomes were similar to those of the primary outcome.


CONCLUSIONS
Participants and providers could not be blinded. No specific criteria for defining clinically important group differences were prespecified or available from the literature.


CONCLUSIONS
For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points.


BACKGROUND
National Center for Complementary and Alternative Medicine, National Institutes of Health.
Northwestern Health Sciences University, Pain Management and Rehabilitation Center, Minneapolis, Minnesota, USA. gbronfort@nwhealth.edu
Gert
G
Bronfort
Roni
R
Evans
Alfred V
AV
Anderson
Kenneth H
KH
Svendsen
Yiscah
Y
Bracha
Richard H
RH
Grimm
D000082:Acetaminophen / Q000009:adverse effects / Q000627:therapeutic use*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D005081:Exercise Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000009:adverse effects; D008875:Middle Aged; D019547:Neck Pain / Q000188:drug therapy / Q000628:therapy*; D010147:Pain Measurement; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen