Five non-surgical neck pain treatments work equally well

In brief

  • Comparing the effects of five non-surgical treatments for neck pain — nonsteroidal anti-inflammatory drugs (NSAIDs), Cox-2 inhibiting NSAIDs, exercise, mobilization, and manipulation — no one treatment option for neck pain was found to be clearly superior when both benefits and harms were considered.
  • Health-care practitioners should consider other factors such as a patient’s treatment preference and his or her attitude toward risk to determine the “best” treatment for an individual’s neck pain.

Why was this study done?

The most common treatments for neck pain in Canada and the United States are exercise, anti-inflammatory drugs and manual therapies such as mobilization. It can be difficult to decide which treatment to offer to a patient. Each treatment has potentially beneficial, as well as harmful, effects. This study aimed to identify the best treatment for neck pain among these treatments, by comparing their harms and benefits.

How was the study done?

The study used a method called “decision analysis” to compare the effects of five non-surgical treatments for neck pain: nonsteroidal anti-inflammatory drugs (NSAIDs); Cox-2 inhibiting NSAIDs; exercise; mobilization; and manipulation. Researchers compared the treatments by looking at their effectiveness and risks, and patient preferences for the treatment’s beneficial and harmful treatment effects. Data from the systematic review conducted by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders was used wherever possible.

What did the researchers find?

On average, the harmful treatment effects had minimal impact on patients’ life expectancy, and on quality-adjusted life expectancy, which considers health-related quality of life as well as length of life. In addition, there was no single treatment that was clearly superior. In other words, the differences among treatments were too small to conclude that one treatment was better than another.

What are some strengths and weaknesses of the study?

This is the first study to compare non-surgical neck pain treatments using a decision analysis model. Because there are gaps in current neck pain research, the researchers had to draw on other sources of evidence for certain estimates. For instance, there is little evidence on NSAIDs estimated effectiveness for neck pain, so the researchers drew on evidence on its effectiveness for other musculoskeletal conditions.

Publication Information

Title: 

Author(s): 

van der Velde G, Hogg-Johnson S, Bayoumi A, Cassidy D, Côté P, Boyle E, Llewellyn-Thomas H, Chan S, Subrata P, Hoving J, Hurwitz E, Bombardier C, Krahn M

Journal: 

Spine, 2008: vol. 33, no 4, pp. S184-S191