Spinal Manipulation, Medication, or Home Exercise with Advice – Which is the BEST Treatment for Neck Pain?

Hello everyone and Happy New Year! 2012 is already producing some incredible research in the fields of chiropractic and medicine. Today I would like to share with you a recent article, published on January 3^rd, in the journal Annals of Internal Medicine. This original research article is a collaboration of both medical doctors and chiropractors with the goal of discovering which treatment or treatments are best for patients presenting with neck pain.

Mechanical neck pain is a very common condition that approximately 70% of people experience at some point during their lives. Neck pain results in millions of ambulatory calls and hospital visits each year and the health costs associated with neck pain are increasing. Although neck pain is not necessarily life-threatening, it can have a very negative effect on a person’s productivity and their quality of life in general. At the time the study was done, there was very little evidence to guide the therapy of choice for patients coming to our offices complaining of neck pain. The goal of this study was to test whether spinal manipulation (a chiropractic adjustment) is more effective than medication or home exercise for acute (1-4 weeks in duration) and subacute (4-12 weeks in duration) neck pain.

Information for this study was gathered in Minneapolis, Minnesota from 2001 to 2007, using participants between the ages of 18 and 65 years. The primary symptom of the study participants was non-specific neck pain of 2-12 weeks duration.

The participants were randomly assigned to one of the following three groups:

1.       Spinal manipulation group – treated in 15-20 minute visits using chiropractic spinal adjustments (a high-velocity type of joint thrust manipulation) and mobilizations (a low-velocity type of joint oscillation) of the neck and upper back.

2.       Medication group – treated in 15-20 minute visits using prescription medication, including anti-inflammatories, acetaminophen (Tylenol), narcotics, and/or muscle relaxants.

3.       Home exercise and advice group – provided in two 1-hour sessions, participants were given instructions for neck exercises and stretches as well as advice on how to adjust their daily activities to limit their neck pain.

RESULTS:

The results of this study show that spinal manipulation proved more effective than medication in both the short and long term, according to numerous measures of neck pain and function.  The spinal manipulation group, as well as the home exercise group, had similar long term benefits, but participants who received medication seemed to fare worse, with a consistently higher use of pain medication throughout the trial’s observation period. Although the frequency of reported side effects was similar among the three groups, the nature of the side effects differed. 40% of the spinal manipulation group reported side effects, as did 46% of the home exercise group – of these two groups, the side effects reported were musculoskeletal in nature, mainly sore muscles. 60% of the medication group reported side effects, which were more systemic in nature, mainly stomach irritation, dry mouth and drowsiness. It is important to note that the participants in the medication group reported higher levels of medication use after the study period was over. 

What should I take away from this study?

Next time that you have neck pain, don’t run for the medicine cabinet! Go see your chiropractor - he or she will provide the appropriate examination, diagnosis, treatment (be it spinal manipulation or mobilization), and home-care exercises for the best combination of therapies to get you feeling better, faster!

Of course, here is the link to the original article should you choose to read it: http://www.annals.org/content/156/1_Part_1/1.full.pdf+html