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• 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)
  • Recruited via mailings and newspaper and radio advertisements targeted to those with neck pain
  • Aged 18 to 65 years
  • 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
  • Neck pain score ≥3 (0–10 scale)
• Subjects randomized by permutated blocks of different sizes to one of three interventions:
  • Spinal manipulation (n=91): focus on techniques including low-amplitude spinal adjustments and mobilization
  • 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
  • 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.
• 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.
• Primary outcome: participant-rated pain (per scale where 0=no symptoms and 10=highest severity of pain)
  • 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

Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain. Ann Intern Med. 2012;156:1-10.

April 2012