https://immattersacp.org/weekly/archives/2015/11/03/1.htm

Acupuncture, Alexander technique may be effective for long-term relief of chronic neck pain

The maintenance of benefit from 6 months (when the interventions ended) to 12 months is notable given that the median duration of neck pain was 6 years, the authors wrote.


Acupuncture sessions and Alexander technique lessons both led to significant reductions in neck pain and associated disability compared with usual care at 12 months, a study found.

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To evaluate clinical effectiveness of acupuncture or Alexander technique lessons (an educational process in which patients learn how to avoid unnecessary muscular and mental tension in everyday activities by unlearning maladaptive physical habits) compared to usual care for patients with chronic, nonspecific neck pain, researchers conducted a 3-group, randomized controlled trial in the U.K. primary care setting.

Researchers recruited 517 patients from 33 general practices in 4 cities. Patients had neck pain lasting at least 3 months; a score of at least 28% on the Northwick Park Questionnaire (NPQ), a validated, patient-completed instrument used to measure neck pain and associated disability (10 of 36 points for car drivers and 9 of 32 points for nondrivers); and no serious underlying pathology. The study population was predominantly female (69%) and white British (90%) patients, with a mean age of 53.2 years (SD, 13.8 years). Median duration of prior neck pain was 72 months (range, 5 to 600 months), and mean baseline NPQ score was 39.8% (SD, 11.1%).

Patients were randomized to 12 acupuncture sessions or 20 one-to-one Alexander lessons (both 600 minutes total) plus usual care versus usual care alone. Mean attendance was 10 acupuncture sessions and 14 Alexander lessons. Patients were assessed by the primary end point of NPQ score at 0, 3, 6, and 12 months.

Results appeared in Annals of Internal Medicine on Nov. 3.

At 12 months, compared to usual care, the acupuncture group had an extra 3.92 percentage-point reduction in NPQ score (95% CI, 0.97 to 6.87 percentage points; P=0.009), while the Alexander lessons group had a 3.79 percentage-point reduction (95% CI, 0.91 to 6.66 percentage points; P=0.010). The 12-month reductions in NPQ score from baseline were 32% for acupuncture and 31% for Alexander lessons, compared with 23% for usual care. Significantly larger decreases in pain and associated disability also occurred in the intervention groups at months 3 and 6. There were no reported serious adverse events related to either intervention.

The maintenance of benefit from 6 months (when the interventions ended) to 12 months is notable given that the median duration of neck pain was 6 years, the authors wrote.

“Because people must continue applying what they learn to gain long-term benefit, both interventions are likely to be more suitable for those motivated to engage in self-care,” they wrote. “This view is supported by our evidence showing that self-efficacy in pain management increased after acupuncture or Alexander lessons and was associated with lower pain scores sustained for more than 6 months after the intervention ended.”