• Gert Bronfort, Roni Evans, Alfred V Anderson, Kenneth H Svendsen, Yiscah Bracha, and Richard H Grimm.
• Northwestern Health Sciences University, Pain Management and Rehabilitation Center, Minneapolis, Minnesota, USA. gbronfort@nwhealth.edu
• Ann. Intern. Med. 2012 Jan 3;156(1 Pt 1):1-10.

BackgroundMechanical neck pain is a common condition that affects an estimated 70% of persons at some point in their lives. Little research exists to guide the choice of therapy for acute and subacute neck pain.ObjectiveTo determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term.DesignRandomized, controlled trial. (ClinicalTrials.gov registration number: NCT00029770)Setting1 university research center and 1 pain management clinic in Minnesota.Participants272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks.Intervention12 weeks of SMT, medication, or HEA.MeasurementsThe primary outcome was participant-rated pain, measured at 2, 4, 8, 12, 26, and 52 weeks after randomization. Secondary measures were self-reported disability, global improvement, medication use, satisfaction, general health status (Short Form-36 Health Survey physical and mental health scales), and adverse events. Blinded evaluation of neck motion was performed at 4 and 12 weeks.ResultsFor pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks (P ≤ 0.010), and HEA was superior to medication at 26 weeks (P = 0.02). No important differences in pain were found between SMT and HEA at any time point. Results for most of the secondary outcomes were similar to those of the primary outcome.LimitationsParticipants and providers could not be blinded. No specific criteria for defining clinically important group differences were prespecified or available from the literature.ConclusionFor participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points.Primary Funding SourceNational Center for Complementary and Alternative Medicine, National Institutes of Health.

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