Implementing AHRQ Effective Health Care Reviews

Helping Clinicians Make Better Treatment Choices

Chronic Neck Pain: Nonpharmacologic Treatment

 

Am Fam Physician. 2019 Aug 1;100(3):180-182.

Author disclosure: No relevant financial affiliations.

Key Clinical Issue

Which noninvasive nonpharmacologic treatments for chronic neck pain improve function or pain for at least one month?

Evidence-Based Answer

Combination exercise (including three of four exercise categories: muscle performance, mobility, muscle reeducation, and aerobic) slightly improves function and pain in the short term (one to less than six months). (Strength of Recommendation [SOR]: B, based on inconsistent or limited-quality patient-oriented evidence.) Low-level laser therapy moderately improves function and pain in the short term. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) Acupuncture slightly improves function in the short and intermediate term (six to less than 12 months) but is not more effective than sham acupuncture for pain. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) The Alexander technique, a mind-body practice, slightly improves function in the short and intermediate term. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) Massage does not improve function in the short or intermediate term. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) Physical therapist–led relaxation techniques do not improve pain or function when compared with no treatment or advice alone.1 (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.)

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CLINICAL BOTTOM LINE

Summary of Key Findings and Strength of Evidence for Chronic Neck Pain Interventions Compared with Usual Care, Placebo, Sham, Attention Control, or Waitlist

InterventionOutcomeStudiesStrength of evidence

Exercise

Short-term function

2 RCTs

No difference

● ○ ○

Short-term pain

4 RCTs

No difference

● ○ ○

Combination exercise

Short- and long-term function

2 RCTs

Small effect

● ○ ○

Short-term pain

2 RCTs

Small effect

● ○ ○

Physical therapist–led relaxation training

Short- and intermediate-term function

1 RCT

No difference

● ○ ○

Short- and intermediate-term pain

1 RCT

No difference

● ○ ○

Low-level laser therapy

Short-term function

2 RCTs

Moderate effect

● ● ○

Short-term pain

3 RCTs

Moderate effect

● ● ○

Massage

Short- and intermediate-term function

2 RCTs

No difference

● ○ ○

Mind-body practices

Short- and intermediate-term function

3 RCTs

Small effect

● ○ ○

Acupuncture

Short- and intermediate-term function

9 RCTs

Small effect

● ○ ○

Short-, intermediate-, and long-term pain

8 RCTs

No difference

● ○ ○


Strength of evidence scale

● ● ● High: High confidence that the evidence reflects the true effect. Further research is very unlikely to change the confidence in the estimate of effect.

● ● ○ Moderate: Moderate confidence that the evidence reflects the true effect. Further research may change the confidence in the estimate of effect and may change the estimate.

● ○ ○ Low: Low confidence that the evidence reflects the true effect. Further research is likely to change the confidence in the estimate of effect and is likely to change the estimate.

○ ○ ○ Insufficient: Evidence either is unavailable or does not permit a conclusion.

RCT = randomized controlled trial.

Adapted from the Agency for Healthcare Research and Quality, Effective Health Care Program. Noninvasive nonpharmacological treatment for chronic pain: a systematic review. Agency for Healthcare Research and Quality; June 2018. Accessed September 15, 2018. https://effectivehealthcare.ahrq.gov/topics/nonpharma-treatment-pain/research-2018

CLINICAL BOTTOM LINE

Summary of Key Findings and Strength of Evidence for Chronic Neck Pain Interventions Compared with Usual Care, Placebo, Sham, Attention Control, or Waitlist

InterventionOutcomeStudiesStrength of evidence

Exercise

Short-term function

2 RCTs

No difference

● ○ ○

Short-term pain

4 RCTs

No difference

● ○ ○

Combination exercise

Short- and long-term function

2 RCTs

Small effect

● ○ ○

Short-term pain

2 RCTs

Small effect

● ○ ○

Physical therapist–led relaxation training

Short- and intermediate-term function

1 RCT

No difference

● ○ ○

Short- and intermediate-term pain

1 RCT

No difference

● ○ ○

Low-level laser therapy

Short-term function

2 RCTs

Moderate effect

● ● ○

Short-term pain

3 RCTs

Moderate effect

● ● ○

Massage

Short- and intermediate-term function

2 RCTs

No difference

● ○ ○

Mind-body practices

Short- and intermediate-term function

3 RCTs

Small effect

● ○ ○

Acupuncture

Short- and intermediate-term function

9 RCTs

Small effect

● ○ ○

Short-, intermediate-, and long-term pain

8 RCTs

No difference

● ○ ○


Strength of evidence scale

● ● ● High: High confidence that the evidence reflects the true effect. Further research is very unlikely to change the confidence in the estimate of effect.

● ● ○ Moderate: Moderate confidence that the evidence reflects the true

Address correspondence to Tyler W. Barreto, MD, at tylerbarreto@seamarchc.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Agency for Healthcare Research and Quality, Effective Health Care Program. Noninvasive nonpharmacological treatment for chronic pain: a systematic review. Agency for Healthcare Research and Quality; June 2018. Accessed September 15, 2018. https://effectivehealthcare.ahrq.gov/topics/nonpharma-treatment-pain/research-2018...

2. Hoy DG, Protani M, De R, et al. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010;24(6):783–792.

3. Hoy D, March L, Woolf A, et al. The global burden of neck pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(7):1309–1315.

4. Lauche R, Stumpe C, Fehr J, et al. The effects of tai chi and neck exercises in the treatment of chronic nonspecific neck pain: a randomized controlled trial. J Pain. 2016;17(9):1013–1027.

5. Aslan Telci E, Karaduman A. Effects of three different conservative treatments on pain, disability, quality of life, and mood in patients with cervical spondylosis. Rheumatol Int. 2012;32(4):1033–1040.

6. Cho JH, Nam DH, Kim KT, et al. Acupuncture with nonsteroidal anti-inflammatory drugs (NSAIDs) versus acupuncture or NSAIDs alone for the treatment of chronic neck pain: an assessor-blinded randomised controlled pilot study. Acupunct Med. 2014;32(1):17–23.

7. Birch S, Jamison RN. Controlled trial of Japanese acu-puncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment. Clin J Pain. 1998;14(3):248–255.

8. Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug-drug interactions with over-the-counter NSAIDs. Ther Clin Risk Manag. 2015;11:1061–1075.

The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to produce evidence to improve health care and to make sure the evidence is understood and used. A key clinical question based on the AHRQ Effective Health Care Program systematic review of the literature is presented, followed by an evidence-based answer based upon the review. AHRQ's summary is accompanied by an interpretation by an AFP author that will help guide clinicians in making treatment decisions. For the full review and evidence summary, go to https://effectivehealthcare.ahrq.gov/topics/nonpharma-treatment-pain/research-2018.

This series is coordinated by Kenny Lin, MD, MPH, Deputy Editor.

A collection of Implementing AHRQ Effective Health Care Reviews published in AFP is available at https://www.aafp.org/afp/ahrq.

 

 

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