MONDAY, Jan. 2 (HealthDay News) — Spinal manipulation and home exercise are more effective at relieving neck pain in the long term than medications, according to new research.
People undergoing spinal manipulation therapy for neck pain also reported greater satisfaction than people receiving medication or doing home exercises.
“We found that there are some viable treatment options for neck pain,” said Gert Bronfort, vice president of research at the Wolfe-Harris Center for Clinical Studies at Northwestern Health Sciences University in Bloomington, Minn.
“What we don’t really know yet is how to individualize these treatments for each particular patient. All are probably still viable treatment options, but what we don’t know is what each particular patient will need,” Bronfort said, adding that it’s possible a combination of treatments might be helpful, too.
Results of the study are published in the Jan. 3 issue of the Annals of Internal Medicine. Funding for the study was provided by the U.S. National Center for Complementary and Alternative Medicine.
Neck pain is an extremely common problem. About three-quarters of adults report having neck pain at some point in their lives, according to background information in the study. Neck pain is responsible for millions of health care visits each year, and it can have a negative impact on quality of life.
Spinal manipulation is one type of treatment that’s offered for neck pain, and it can be administered by chiropractors, physical therapists, osteopaths and other health care providers, according to the study.
But, there isn’t much evidence for treating neck pain with spinal manipulation. There also isn’t a great deal of information on how effective medications or home exercise programs are for treating neck pain, the researchers noted.
Bronfort and colleagues thought that spinal manipulation might prove to be more effective than medications or home exercise therapy. To test their hypothesis, they recruited 272 people between the ages of 18 and 65 who had neck pain. Their neck pain had no known cause, such as a trauma or pinched nerve, and the patients been experiencing the pain for between two and 12 weeks when the study began.
The study volunteers were randomly selected for one of three treatment groups. One group received spinal manipulations over a 12-week period. Each individual was allowed to choose the number of spinal manipulations they felt they needed.
The second group received medications, both over the counter and prescription, depending on their needs. First-line medications included nonsteroidal anti-inflammatory medications or acetaminophen (Tylenol). If people didn’t get relief from these drugs, narcotic pain medications and muscle relaxants were offered.
The third group was assigned two one-hour sessions of home exercise. The goal of the home-exercise program was to improve movement in the neck area. Participants were instructed to do the exercises six to eight times per day.
At the 12th week, 82 percent of people receiving spinal manipulation reported at least a 50 percent reduction in pain, compared with 69 percent of those on medication and 77 percent doing home exercises. Also at week 12, of people receiving spinal manipulation, 32 percent reported feeling a 100 percent reduction in pain, compared with 13 percent on medications and 30 percent doing home exercises.
At one year, 27 percent of those receiving spinal manipulation said they felt a 100 percent reduction in pain versus 17 percent of those on medications and 37 percent of those doing home exercises.
“For me, as an ER doctor, this study offers an interesting perspective,” said Dr. Robert Glatter, an attending physician in emergency medicine at Lenox Hill Hospital in New York City. “It’s a small study, but it found that home exercises and spinal manipulation were effective. So, should we be referring to physical therapists, osteopaths or chiropractors from the ER?”
“This study shows that basically neck pain will get better on its own,” said Dr. Victor Khabie, chief of the departments of surgery and sports medicine at Northern Westchester Hospital in Mount Kisco, N.Y. “It would’ve been good if they had a no-treatment group, too,” he added.
“Everyone heals differently. There are different pathways to healing, and whether you feel you’re better off with chiropractic, home exercises or medications, this study shows that all three are basically just as effective. Whatever your pathway to healing, in about six to eight weeks, you should start to feel better,” said Khabie.
He also noted that it’s important for anyone receiving spinal manipulation to know that there are rare, but serious risks that can occur with neck manipulations.
All three experts said anyone experiencing neck pain needs to have it evaluated to make sure there isn’t a serious or correctable cause of the pain. This is especially true if you’ve been in a car accident, or if you have any neurological symptoms, such as repeatedly dropping things, or if you have pain radiating down your arm.
Learn more about neck pain, its causes and treatment from the U.S. National Library of Medicine.
SOURCES: Gert Bronfort, D.C., Ph.D., vice president and professor, research, Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, Bloomington, Minn.; Robert Glatter, M.D., attending physician, emergency medicine, Lenox Hill Hospital, New York City; Victor Khabie, M.D., co-director, Orthopedic and Spine Institute, and chief, surgery, and chief, sports medicine, Northern Westchester Hospital, Mt. Kisco, N.Y.; Jan. 3, 2012, Annals of Internal Medicine
Last Updated: Jan. 03, 2012
Copyright © 2012 HealthDay. All rights reserved.
When researchers randomized 272 neck pain patients to receive either spinal manipulation, medication, or instructions on home exercises, they found some differences that were statistically significant. But the big picture is that all the patients tended to get better and those who got manipulation or home exercise instructions fared about the same. And that the bottom line message that readers get from the news story. The story didn’t mention costs and it could have provided more details about potential harms, but overall it gives readers a fair overview of the research and the broader background of neck pain treatment.
News reports should always distinguish between study results that really mean something to people dealing with illnesses and those that are merely statistically significant, but clinically underwhelming. This story reports key findings about measured differences, but also helps readers to see the main message; that those differences didn’t make a dramatic difference to how patients felt… and that important questions remain.
The study raises some interesting questions. It’s difficult to know if similar results would be seen for patients coming for care in usual practice settings, rather than in response to newspaper and radio ads recruiting subjects. It’s also worth looking at effective care versus efficient care. If two group instructional sessions are as good as 15 individual chiropractic sessions on average, one could surmise that home exercise might provide more bank for the buck. The story could have done a better job driving this point home. AS
It’s too bad this story didn’t mention costs. Considering that the trial found only small differences in the effectiveness of the treatments, it seems that cost might be a key deciding factor for many people with neck pain. It’s notable that two educational sessions about home exercise were as effective as 15 chiropractic sessions.
The story includes both some of the specific results reported by researchers as well as more conversational descriptions of the overall experiences of people in this trial. Readers get the message that people with neck pain tend to feel better as time passes no matter which treatment option they used and that none of the treatments is clearly superior or can deliver sure-fire pain relief.
This rating is a close call. The story does warn readers that spinal manipulation can pose “rare, but serious risks.” Also, none of the trial participants reported a serious adverse event. But the story could have been more specific and reported that, as the editorial accompanying the research article pointed out, “neck manipulation has a rare but potentially catastrophic risk for vertebral artery stroke.” Also, the story should have at least briefly mentioned some of the harms that can be caused by the pain medications (including acetaminophen, narcotics and muscle relaxants) that were prescribed to some participants.
This story gives readers the important highlights of the study design and how the researchers measured effectiveness. It also includes a comment from an independent source that the trial would have been better if it had included a no-treatment group (in order to look for improvements that were due simply to the passage of time or a placebo effect).
The story could have pointed out that unlike major drug trials that use placebo pills there was no way to prevent patients from knowing which treatment they received, which means the researchers can’t be sure that the reports from patients weren’t partially influenced by their beliefs about how effective a treatment might be. For instance, it could be that people who got spinal manipulation from a professional (and paid for it) might tend to believe that the treatment was more effective than a set of exercises that they did themselves at home.
The story accurately reports that neck pain is common. It also includes cautionary statements about the uncertainty that exists about what sort of treatment works best, thus helping readers keep expectations in line with reality.
The story includes quotes from multiple independent sources. It reports that funding for this trial was provided by “U.S. National Center for Complementary and Alternative Medicine.” It might have been helpful to point out that the center is part of the National Institutes of Health, so that it would be clear to readers that it is a public institution. Although the story does not report on any potential conflicts of interest on the part of the researchers, the article authors did not disclose any conflicts in their journal article.
The trial was set up as a direct comparison of popular treatments for neck pain, and that is just how the story presents it. It even includes a comment from an independent source that this sort of neck pain tends to improve on its own. As mentioned above, the story could have provided more details about the potential harms of the various treatment options.
It is clear that all of the treatments included in this trial are widely available.
The story points out that this trial was designed to address the lack of solid evidence comparing common treatments for back pain, while also noting that this trial doesn’t answer all of the questions.
The story does not appear to rely on a news release.