Papers

Conservative management of mechanical neck pain: systematic overview and meta-analysis

^a Division of Graduate Studies and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada, ^b Chedoke-McMaster Hospitals and School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada, ^c Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, ^d Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Correspondence to: Dr C H Goldsmith, Centre for Evaluation of Medicines, St Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.

Abstract

Objective: To review the efficacy of conservative management of mechanical neck disorders.
Methods: Published and unpublished reports were identified through computerised and manual searches of bibliographical databases, reference lists from primary articles, and letters to authors, agencies, foundations, and content experts. Selection criteria were applied to blinded articles, and selected articles were scored for methodological quality. Effect sizes were calculated from raw pain scores and combined by using meta-analytic techniques when appropriate.
Results: Twenty four randomised clinical trials met the selection criteria and were categorised by type of intervention: nine used manual treatments; 12 physical medicine methods; four drug treatment; and three education of patients (four trials investigated more than one form of intervention). The intervention strategies were summarised separately. Pooling of studies was considered only within each category. Five of the nine trials that used manual treatment in combination with other treatments were combined. One to four weeks after treatment the pooled effect size was -0.6 (95% confidence interval -0.9 to -0.4), equivalent to an improvement of 16 (6.9 to 23.1) points on a 100 point scale. Sensitivity analyses on study quality, chronicity, and data imputation did not alter this estimate. For other interventions, studies could not be combined to arrive at pooled estimates of effect.
Conclusions: There is little information available from clinical trials to support many of the treatments for mechanical neck pain. In general, conservative interventions have not been studied in enough detail to assess efficacy or effectiveness adequately.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Cervical spondylosis and neck pain

Allan I Binder
BMJ 2007 334: 527-531. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Lewis, M., James, M., Stokes, E., Hill, J., Sim, J., Hay, E., Dziedzic, K. (2007). An economic evaluation of three physiotherapy treatments for non-specific neck disorders alongside a randomized trial. Rheumatology (Oxford) 46: 1701-1708 [Abstract] [Full text]  
• Binder, A. I (2007). Cervical spondylosis and neck pain. BMJ 334: 527-531 [Full text]  
• Moffett, J., McLean, S. (2006). The role of physiotherapy in the management of non-specific back pain and neck pain. Rheumatology (Oxford) 45: 371-378 [Abstract] [Full text]  
• Freburger, J. K, Carey, T. S, Holmes, G. M (2006). Effectiveness of Physical Therapy for the Management of Chronic Spine Disorders: A Propensity Score Approach. ptjournal 86: 381-394 [Abstract] [Full text]  
• Freburger, J. K, Carey, T. S, Holmes, G. M (2005). Management of Back and Neck Pain: Who Seeks Care From Physical Therapists?. ptjournal 85: 872-886 [Abstract] [Full text]  
• White, P., Lewith, G., Prescott, P., Conway, J. (2004). Acupuncture versus Placebo for the Treatment of Chronic Mechanical Neck Pain: A Randomized, Controlled Trial. ANN INTERN MED 141: 911-919 [Abstract] [Full text]  
• Ernst, E. (2004). Balanced judgements on complementary/alternative medicine. Is informed consent necessary?. Rheumatology (Oxford) 43: 666-666 [Full text]  
• Ylinen, J., Takala, E.-P., Nykanen, M., Hakkinen, A., Malkia, E., Pohjolainen, T., Karppi, S.-L., Kautiainen, H., Airaksinen, O. (2003). Active Neck Muscle Training in the Treatment of Chronic Neck Pain in Women: A Randomized Controlled Trial. JAMA 289: 2509-2516 [Abstract] [Full text]  
• Smith, M., Carber, L. (2002). Chiropractic Health Care in Health Professional Shortage Areas in the United States. Am. J. Public Health 92: 2001-2009 [Abstract] [Full text]  
• White, P., Lewith, G., Berman, B., Birch, S. (2002). Reviews of acupuncture for chronic neck pain: pitfalls in conducting systematic reviews. Rheumatology (Oxford) 41: 1224-1231 [Abstract] [Full text]  
• Hurwitz, E. L., Morgenstern, H., Harber, P., Kominski, G. F., Yu, F., Adams, A. H. (2002). A Randomized Trial of Chiropractic Manipulation and Mobilization for Patients With Neck Pain: Clinical Outcomes From the UCLA Neck-Pain Study. Am. J. Public Health 92: 1634-1641 [Abstract] [Full text]  
• Posner, J., Glew, C. (2002). Neck Pain. ANN INTERN MED 136: 758-759 [Full text]  
• MAYOU, R., BRYANT, B. (2002). Psychiatry of whiplash neck injury. Br. J. Psychiatry 180: 441-448 [Abstract] [Full text]  
• Meeker, W. C., Haldeman, S. (2002). Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine. ANN INTERN MED 136: 216-227 [Abstract] [Full text]  
• Haldeman, S., Carey, P., Townsend, M., Papadopoulos, C. (2001). Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ 165: 905-906 [Full text]  
• Philadelphia Panel Members, , Clinical Specialty Experts, , Albright, J., Allman, R., Bonfiglio, R. P., Conill, A., Dobkin, B., Guccione, A. A, Hasson, S. M, Russo, R., Shekelle, P., Susman, J. L, Ottawa Methods Group, , Brosseau, L., Tugwell, P., Wells, G. A, Robinson, V. A, Graham, I. D, Shea, B. J, McGowan, J., Peterson, J., Poulin, L., Tousignant, M., Corriveau, H., Morin, M., Pelland, L., Laferriere, L., Casimiro, L., Tremblay, L. E (2001). Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Neck Pain. ptjournal 81: 1701-1717 [Abstract] [Full text]  
• Irnich, D., Behrens, N., Molzen, H., Konig, A., Gleditsch, J., Krauss, M., Natalis, M., Senn, E., Beyer, A., Schops, P., Cummings, M. (2001). Randomised trial of acupuncture compared with conventional massage and ""sham"" laser acupuncture for treatment of chronic neck pain Commentary: Controls for acupuncture{---}can we finally see the light?. BMJ 322: 1574-1574 [Abstract] [Full text]  
• White, P. F., Craig, W. F., Vakharia, A. S., Ghoname, E.-s. A., Ahmed, H. E., Hamza, M. A. (2000). Percutaneous Neuromodulation Therapy: Does the Location of Electrical Stimulation Effect the Acute Analgesic Response?. Anesth. Analg. 91: 949-954 [Abstract] [Full text]  
• Di Fabio, R. P (1999). Manipulation of the Cervical Spine: Risks and Benefits. ptjournal 79: 50-65 [Abstract] [Full text]  
• Kaptchuk, T. J., Eisenberg, D. M. (1998). Chiropractic: Origins, Controversies, and Contributions. Arch Intern Med 158: 2215-2224 [Abstract] [Full text]  
• Shekelle, P. G. (1998). What Role for Chiropractic in Health Care?. NEJM 339: 1074-1075 [Full text]