Spinal Manipulation or Home Exercise More Effective Than Medication for Acute Neck Pain, Study Finds

[Why Syzygy]

http://nccam.nih.gov/research/results/spotlight/010312.htm

Spinal manipulation or home exercise was more effective than medication for treatment of acute to sub-acute neck pain, according to a recent NCCAM-funded study published in the Annals of Internal Medicine. Researchers from Northwestern Health Sciences University and the Minneapolis Medical Research Foundation randomly assigned 272 participants with neck pain, aged 18 to 65, to receive either spinal manipulation therapy, medication, or home exercise instruction.

In the study, spinal manipulation therapy consisted of various techniques, including spinal adjustments (low amplitude, high velocity) and mobilization (low velocity) of areas of the spine. Participants in the medication group received non-steroidal anti-inflammatory drugs, acetaminophen, or both; those who did not respond to these medications or could not tolerate them received narcotic medications. Home exercise with instruction focused on gentle self-controlled movement of the neck and shoulder joints, and participants were instructed to do the exercises six to eight times each day. In addition, participants in this group received two individualized hour-long sessions of one-on-one exercise instruction, as well as written directions for exercise at home.

The researchers observed significant short-term and long-term improvements in participant-rated pain in the spinal manipulation group compared with those receiving medication. At 12 weeks, 82 percent of participants in the spinal manipulation group (compared to 69 percent in the medication group) experienced reductions of pain of at least 50 percent. Similar findings occurred at 26 and 52 weeks. Additionally, the spinal manipulation group reported greater global improvement, participant satisfaction, and function than the medication group. Home exercise with instruction was just as effective as spinal manipulation at each time point.

Few studies exist to date on the management of neck pain with noninvasive methods, such as spinal manipulation, home exercise, or medications. According to the researchers, the findings from this study suggest that both spinal manipulation and home exercise may be viable treatment options for managing neck pain.

[Patiod]

1. Spinal manipulation for neck pain - danger doesn't justify benefit

http://www.news-medical.net/news/2007/07/03/27106.aspx

There are too many potential dangers of manipulation for my liking.

Drugs: No (although I have had to use a dose of muscle relaxant when I've gone into spasm)
Spinal manipulation of the neck: No
Exercise, careful PT or gentle massage: Yes

[LaurenG]

3. I don't know, even my neurosurgeon is considering it for me

and I have chiari. The team that is working with me is open to this from the pain management doc to the physical therapist. I think there is a place for manipulation in many instances.

[Patiod]

4. Read very carefully about the increased risk of stroke

Just for myself (and I've had some pretty bad spasming) I wouldn't risk stroke for some possibility of potential short-term pain relief. If, in addition, the pain relief wasn't very clearly proven to be 1) long lasting and 2) statistically significantly better than PT or gentle massage - then I definitely wouldn't risk stroke.

The risk of stroke tells me that I need to look to evidence-based medicine for my choices. Here's a good, careful not-black-and-white analysis.

http://www.sciencebasedmedicine.org/index.php/neck-manipulation-risk-vs-benefit/

Remember, chiropractors are a big business lobby just like the phama companies are. They see threats to their practices from careful scientific evaluation of the results of their therapy, and often rely on small, poorly-executed studies to justify what they do.

I should note that Big Pharma provides my livelihood AND I take NO drugs except an occasional aspirin, and one muscle relaxant per spasm episode (I hate them- they make me depressed - but I keep them in a prominent place in my closet). I'm 100% behind you in terms of NOT approaching neck pain via pharmaceuticals. I'm a huge proponent of PT - I've been cured twice of pretty severe problems with hard work at the hands of a good, licensed experienced physical therapists. I know not every condition responds to PT, though, and know enough people dealing with chronic pain to understand that sometimes you are driven to try anything

Good luck to you, Lauren.

[Warpy]

2. All medication ever did was help me sleep through the worst.

I have chronic pain there, pain so bad that I blew off a C7 fracture 15 years ago. Fortunately, it was a stable fracture so I didn't end up a quad.

If I have an acute problem, I ice it. I try to see if I can reach the trigger point and dig my thumbs in to relax it. Then I wait for it to go away.

[flamingdem]

5. Best to use a physical therapist

Too many incompetents and quacks among chiropractors, and the PT you use should be recommended from a reliable source such as a university hospital.

[HuckleB]

6. +1,000,000,000,000

[Sgent]

7. I would also consider going to an osteopath (DO)

many will do some manipulation for musco-skeletal issues -- although I wouldn't go to ones that make osteopathy the focus of their practice, but rather ones that use it very occasionally.