Spinal manipulation, home exercise found to be better than medication for neck pain

Twelve weeks of spinal manipulation therapy (SMT) led to greater relief from neck pain than medication up to one year after treatment, and home exercise with advice (HEA) offered about the same relief as either treatment.

Researchers conducted a randomized, controlled trial among 272 people with symptoms of mechanical, nonspecific neck pain equivalent to grades I or II according to the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders classification, current neck pain of 2 to 12 weeks' duration, and a neck pain score of 3 or greater on a scale of 0 to 10. Participants were asked to refrain from seeking additional treatment for neck pain outside the study during the 12-week intervention.

This group was then randomized to 12 weeks of SMT (n=90), medication (n=91), or HEA (n=91). The first line of therapy for the medication group was nonsteroidal anti-inflammatory drugs, acetaminophen, or both. If participants did not respond to these drugs or could not tolerate them, they received narcotics. Muscle relaxants were also used. Participants and clinicians could not be blinded to treatments. Results appeared in the Jan. 3 Annals of Internal Medicine.

The primary outcome was participant-rated pain, measured at 2, 4, 8, 12, 26, and 52 weeks. Improvement in participant-rated pain was significantly better with SMT compared with medication at 12 weeks (0.94 greater reduction in pain [95% CI, 0.37 to 1.51]; P=0.001) and in longitudinal analyses that incorporated pain ratings every 2 weeks from baseline to 12 weeks (0.55 greater reduction in pain [95% CI, 0.10 to 1.00]; P=0.017).

At 12 weeks, a significantly higher absolute proportion of the SMT group experienced pain reductions of at least 50%. Differences in participant-rated pain improvement between the SMT and HEA groups were smaller and not statistically significant. Differences between the HEA and medication groups were also not statistically significant, although a higher absolute proportion of the HEA group experienced pain reductions of at least 75% at 12 weeks compared with the medication group.

At 26 and 52 weeks, participant-rated pain improvement favored SMT over medication, but not SMT over HEA or HEA over medication, compared with baseline. A higher absolute proportion in the SMT group than in the medication group experienced reductions of pain of at least 50% at 26 but not 52 weeks.