Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain

A Randomized Trial

  1. Gert Bronfort, DC, PhD;
  2. Roni Evans, DC, MS;
  3. Alfred V. Anderson, DC, MD;
  4. Kenneth H. Svendsen, MS;
  5. Yiscah Bracha, MS; and
  6. Richard H. Grimm, MD, MPH, PhD

Annals of Internal Medicine, January 3rd, 2012, vol. 156 no. 1 Part 1 1-10

From Northwestern Health Sciences University, Pain Management and Rehabilitation Center, and Berman Center for Outcomes and Clinical Research at the Minneapolis Medical Research Foundation, Minneapolis, Minnesota.


Background: Mechanical 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.

Objective: To 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.

Design: Randomized, controlled trial. (ClinicalTrials.gov registration number:NCT00029770)

Setting: 1 university research center and 1 pain management clinic in Minnesota.

Participants: 272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks.

Intervention: 12 weeks of SMT, medication, or HEA.

Measurements: The 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.

Results: For 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.

Limitations: Participants and providers could not be blinded. No specific criteria for defining clinically important group differences were prespecified or available from the literature.

Conclusion: For 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 Source: National Center for Complementary and Alternative Medicine, National Institutes of Health.