Current Literature
Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial.
Annals of Internal Medicine.
2012;156(1 Pt 1):1-10.
Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH.
This overview was created under the auspices of KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional interest.
Bronfort and colleagues conducted a randomized, controlled trial to examine three interventions for treatment of acute and subacute neck pain: spinal manipulation, medication, or home exercise with advice.
Subjects (N=272) were aged 18 to 65 years and recruited via mailings and newspaper and radio advertisements targeted to those with neck pain. Subjects also had mechanical, nonspecific neck pain (per Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders classification, grade I or II), current neck pain for 2 to 12 weeks, and a neck pain score ≥3 (0–10 scale).
Subjects were randomized by permutated blocks of different sizes to one of three interventions:
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Spinal manipulation (n=91): focus on techniques including low-amplitude spinal adjustments and mobilization
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Medication (n=90): nonsteroidal anti-inflammatory drugs, acetaminophen, or a combination of the two was first-line therapy; those who could not tolerate first-line therapy received narcotic medications
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Home exercise with advice (n=91): focus on simple self-mobilization exercise of the neck and shoulder joints (ie, extension, flexion, rotation) with no resistance; program individualized to each patient. Booklet and cards showing each exercise, information about basic anatomy, and advice regarding the proper way to perform daily actions (ie, lifting, pushing) were also provided
Maximum duration of each treatment was 12 weeks. All spinal manipulation and medication visits were 15 to 20 minutes and included a brief history and examination, and subjects were advised to stay active or modify activity as needed. Home exercise with advice visits were two 1-hour sessions, 1 to 2 weeks apart.
The study’s primary outcome was participant-rated pain (per scale where 0=no symptoms and 10=highest severity of pain). Outcomes were assessed at two baseline appointments and at weeks 2, 4, 8, and 12 after randomization. Additional data were collected via mail surveys at weeks 26 and 52. Secondary outcomes included global improvement, medication use, satisfaction with care, spine motion, and scores on the Neck Disability Index and the Short Form-36 Health Survey.
Results
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At 12 weeks, significant improvement was seen with spinal manipulation vs medication (0.94 greater reduction in pain [95% confidence interval, 0.37 to 1.51]; P=0.001) and significantly higher proportion of subjects in the spinal manipulation group had pain reduction of ≥50%. Differences in pain improvement ratings between the spinal manipulation and home exercise with advice groups and the home exercise with advice and medication groups were not statistically significant
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When examined at the 26- and 52-week endpoints, results were similar: when compared with baseline, pain improvement ratings favored spinal manipulation over medication, but not spinal manipulation over home exercise with advice or home exercise with advice over medication
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Secondary outcomes were similar to primary outcomes by group. Spinal manipulation showed greater improvements both at end of treatment and during study follow-up for global improvement, satisfaction with care, and SF-36 physical function, and long-term medication use
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No serious adverse events were reported
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This overview was created under the auspices of KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional interest.
April 2012
