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Treatment of Neck Pain: Noninvasive Interventions

Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

  • Best Evidence
  • Published:
European Spine Journal Aims and scope Submit manuscript

Study Design.

Best evidence synthesis.

Objective.

To identify, critically appraise, and synthesize literature from 1980 through 2006 on noninvasive interventions for neck pain and its associated disorders.

Summary of Background Data.

No comprehensive systematic literature reviews have been published on interventions for neck pain and its associated disorders in the past decade.

Methods.

We systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of noninvasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our best evidence synthesis.

Results.

Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 (47%) were accepted as scientifically admissible, and 139 of these related to noninvasive interventions (including health care utilization, costs, and safety). For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short-or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus.

Conclusion.

Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies.

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Authors and Affiliations

  1. Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Mânoa, 1960 East-West Road, Biomed. D-104H, Honolulu, HI, 96822, USA

    Eric L. Hurwitz DC, PhD

  2. Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, USA

    Eugene J. Carragee MD, FACS

  3. Orthopaedic Spine Center and Spinal Surgery Service, Stanford University Hospital and Clinics, Stanford, CA, USA

    Eugene J. Carragee MD, FACS

  4. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Gabrielle van der Velde DC

  5. Institute for Work and Health, Toronto, Canada

    Gabrielle van der Velde DC, Pierre Côté DC, PhD & Sheilah Hogg-Johnson PhD

  6. Centre of Research Excellence in Improved Disability Outcomes (CREIDO), University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Canada

    Gabrielle van der Velde DC, Pierre Côté DC, PhD & J. David Cassidy DC, PhD, DrMedSc

  7. Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada

    Gabrielle van der Velde DC, Pierre Côté DC, PhD & J. David Cassidy DC, PhD, DrMedSc

  8. Department of Public Health Sciences, and the Alberta Centre for Injury Control and Research, School of Public Health, University of Alberta, Edmonton, Alberta, Canada

    Linda J. Carroll PhD

  9. Department of Orthopaedics and Environmental Medicine and Program of Ergonomics and Biomechanics, School of Medicine and Graduate School of Arts and Science, New York University, New York, USA

    Margareta Nordin PT, DrMedSc

  10. Occupational and Industrial Orthopaedic Center (OIOC), New York University Medical Center, New York, USA

    Margareta Nordin PT, DrMedSc

  11. Department of Medicine, University of British Columbia, Vancouver, Canada

    Jaime Guzman MD, MSc, FRCP(C)

  12. Occupational Health and Safety Agency for Healthcare in British Columbia, VanCouver, Canada

    Jaime Guzman MD, MSc, FRCP(C)

  13. Endocrinology, Analgesia and Inflammation, Merck & Co., Rahway, NJ, USA

    Paul M. Peloso MD, MSc, FRCP(C)

  14. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    Lena W. Holm DrMedSc

  15. Departments of Public Health Sciences and Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Pierre Côté DC, PhD & J. David Cassidy DC, PhD, DrMedSc

  16. Department of Public Health Sciences, University of Toronto, Toronto, Canada

    Sheilah Hogg-Johnson PhD

  17. Department of Neurology, University of California, Irvine, CA, USA

    Scott Haldeman DC, MD, PhD

  18. Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA

    Scott Haldeman DC, MD, PhD

Authors
  1. Eric L. Hurwitz DC, PhD
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  2. Eugene J. Carragee MD, FACS
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  3. Gabrielle van der Velde DC
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  8. Lena W. Holm DrMedSc
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  9. Pierre Côté DC, PhD
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  11. J. David Cassidy DC, PhD, DrMedSc
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  12. Scott Haldeman DC, MD, PhD
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Corresponding author

Correspondence to Eric L. Hurwitz DC, PhD.

Additional information

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Corporate/Industry, Foundation, and Professional Organizational funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Reprinted with permission from Lippincott Williams & Wilkins, Hurwitz EL, Carragee EJ, van der Velde G, et al., Treatment of Neck Pain: Noninvasive Interventions, Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders, SPINE, Volume 33, Number 4S, pp S123–S152

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Hurwitz, E.L., Carragee, E.J., van der Velde, G. et al. Treatment of Neck Pain: Noninvasive Interventions. Eur Spine J 17 (Suppl 1), 123–152 (2008). https://doi.org/10.1007/s00586-008-0631-z

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