Non-specific neck pain, predicting what therapy works.
Along with back pain, neck pain is one of the most common musculoskeletal disorders in humans. It's estimated that in one year, between almost 6 percent and 22 percent of people experience some sort of neck pain. While there are many specific causes of neck pain (injury, tumor, arthritis, for example), there are also many times that there is no obvious reason for the pain. This is called non-specific neck pain. This type of pain can be very difficult to treat because the doctors don't have anything solid to go on.
If you have been diagnosed with non-specific neck pain, there's a good chance you would be referred for physiotherapy or for spinal manipulation if a wait-and-see approach doesn't work. While studies have found that physiotherapy and/or manipulation can help relieve non-specific neck pain, there doesn't seem to be much agreement as to which patients would benefit from these therapies.
The authors of this article wanted to identify which patients would be best for physiotherapy and/or manipulation, and why. To do this, researchers reviewed three earlier studies of patients with non-specific neck pain who were assigned to either usual care, physiotherapy, spinal manipulation, or behavioral graded activity. At the end of the analysis, those who were in the behavior graded activity were not included in the study findings because it is not a commonly used treatment.
The patients who went for physiotherapy were given exercises to improve strength or range of motion of the neck. There may also have been heat applications as well. Patients attended a maximum of 18 sessions, which were about 30 minutes each. Spinal manipulation therapy consisted of several techniques at the level of the cervical spine (the neck) but did not use high velocity thrust techniques. Patients attended a maximum of six sessions of 30 to 45 minutes.
Usual care is the term used for patients who received advice on how to care for themselves to manage the pain and discomfort. The doctors gave the patients a booklet on ergonomic advice and exercises to improve their strength and function. If needed, the patients took over the counter medications to relieve the pain.
The researchers also looked at the differences between the patients and if these differences made it possible to predict if their assigned treatment would be effective. The differences - or variables - included their sex, level of education, if they'd had neck pain in the past, how long they have experienced this episode of neck pain, if the pain was radiating or stayed in the neck area, if the pain was caused by a trauma or injury, their overall health, if they experienced headaches and/or dizziness, if they had back pain, and what their pain intensity level was on a scale of zero to 10, with zero being no pain and 10 being the worst possible. Patients were also asked about which treatment they preferred if they had a preference.
The results of the analysis showed that the variables that had the most effect on predicting if treatment would be successful were the intensity of the pain, the age of the person and that there was no back pain. Patients with these predictors showed up to a 25 percent recovery or improvement. The other variables did not seem to have any play in whether treatment was effective.
The authors concluded that the type of treatment for non-specific neck pain that is provided to a patient should be based on predictors that would indicate if the treatment has a higher chance of being effective.
Jasper Mattijs Schellingerhout, et al. Which subgroups of patients with non-specific pain are more likely to benefit from spinal manipulation therapy, physiotherapy, or usual care? In Pain. October 2008. Vol. 139. No. 3. Pp. 670-680.
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