What's the Best Treatment for Neck Pain?The standard treatment approach to nonspecific neck pain is with the use of nonsteroidal antiinflammatory drugs (NSAIDs). Hands-on care such as chiropractic or physical therapy manual therapy (joint mobilization and/or manipulation) is a close second. Exercise is always suggested as well.
Despite all the research that's been done on specific treatments for neck pain, it's still not clear which one is best. It may depend on the patient's goals. Is it strictly pain relief? Pain relief and improved neck motion? Or perhaps the goal is to return to full function that was present before the episode of neck pain started.
Each method of treatment has its benefits and harms. Patient satisfaction and quality of life should be considered. In this study, results from five different types of treatment were evaluated. The main measure was the effect of treatment on changes in life expectancy and quality.
Patients receiving care for neck pain from a physician, physical therapist, or chiropractor were divided into five treatment groups. Treatments included NSAIDs, selective Cox-2 inhibiting NSAIDs (Coxibs), exercise, manipulation, and mobilization.
The harm and benefit of each treatment approach were reviewed for each patient. A decision-making model was used to track patients over a full year's time. The data was broken down into 13 four-week cycles.
The authors used information from other studies to calculate the risk of adverse events for these patients. The specific studies and measures were explained. Rates of hospitalization for heart attacks and serious GI bleeding, heart failure, and stroke were reported. These problems occurred as a result of taking NSAIDs.
The authors found there were no risks of harm in doing exercises or receiving joint mobilization. Mortality (death) and life expectancy did not change with these two treatments. There was a small risk of decreased life expectancy with NSAIDs and manipulation.
Using quality of life and life expectancy as the measures of outcome, there was no difference in effectiveness of the five treatments discussed. The authors could not recommend one single treatment above the others for the treatment of nonspecific neck pain. Patient attitudes and preferences should be taken into consideration when deciding on the best treatment approach.
Gabrielle van der Velde, DC, et al. Identifying the Best Treatment Among Common Nonsurgical Neck Pain Treatments. In Spine. Supplement to February 15, 2008. Vol. 33. No. 4S. Pp. S184-S191.
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