Neck pain is one of the most common and disabling symptoms that prompts patients to visit emergency rooms and primary care offices. Treatment options for neck pain include the use medication; spinal manipulation therapy (SMT) applied by chiropractors, physical therapists and osteopaths; and self-mobilization exercises, or what experts call “home exercise with advice.”
Until recently, none of these therapies demonstrated a clear benefit over others but now results of a well designed scientific study published in the January 3, 2012 Annals of Internal Medicine issue sheds new light and useful information on the treatment choices for neck pain.
This comparative study took place from 2001-2007 with 272 participants, ages 18-65 years who had experienced non-specific neck pain for 2 to 12 weeks and were divided into three treatment groups: medication, spinal manipulation therapy, and home exercise with advice. The exercise program involved two hour-long one-on-one therapy sessions, one to two weeks apart, in which patients were taught gentle controlled movement of the neck and shoulder joints, which they then practiced at home.
Interestingly, at the end of the study both the spinal manipulation and home exercise groups had outcomes superior to those of the medication group. People receiving medication experienced more pain and poorer outcomes than those prescribed the other two approaches. Neck manipulation has a rare but catastrophic risk of stroke. So self-mobilization exercises seem to be the safest place to start.
Yet most initial visits to an emergency room or a health professional’s office will result in a prescription for pain medication and/or a muscle relaxant. Prescribing medications for neck pain is at best a partial and risky solution. These medications carry significant risks of side effects, which include gastrointestinal bleeding (NSAIDs), addiction and abuse (opioid pain relievers) and drowsiness (muscle relaxants).
Home exercise or “hands on” approaches such as spinal manipulation can offer greater effectiveness and less risk, especially if they involve thorough patient education and direct participation in care and recovery. I’ve found that when patients become partners in healing, they seem to fare much better. This study supports the importance of an integrative approach to healing where proven evidence-based complementary treatments can often minimize or eliminate the need of riskier prescription medication.
Joseph Mosquera MD
Spinal Manipulation, Medication, or Home Exercise With Advice for
Acute and Subacute Neck Pain: A Randomized Trial [Annals of