European Spine Journal

, Volume 17, Supplement 1, pp 123–152 | Cite as

Treatment of Neck Pain: Noninvasive Interventions

Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders
  • Eric L. Hurwitz
  • Eugene J. Carragee
  • Gabrielle van der Velde
  • Linda J. Carroll
  • Margareta Nordin
  • Jaime Guzman
  • Paul M. Peloso
  • Lena W. Holm
  • Pierre Côté
  • Sheilah Hogg-Johnson
  • J. David Cassidy
  • Scott Haldeman
Best Evidence

Study Design.

Best evidence synthesis.


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.


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.


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.


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.


best evidence synthesis cervical spine neck pain whiplash-associated disorder 


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Eric L. Hurwitz
    • 1
  • Eugene J. Carragee
    • 2
    • 3
  • Gabrielle van der Velde
    • 4
    • 5
    • 6
    • 7
  • Linda J. Carroll
    • 8
  • Margareta Nordin
    • 9
    • 10
  • Jaime Guzman
    • 11
    • 12
  • Paul M. Peloso
    • 13
  • Lena W. Holm
    • 14
  • Pierre Côté
    • 5
    • 6
    • 7
    • 15
  • Sheilah Hogg-Johnson
    • 5
    • 16
  • J. David Cassidy
    • 6
    • 7
    • 15
  • Scott Haldeman
    • 17
    • 18
  1. 1.Department of Public Health Sciences, John A. Burns School of MedicineUniversity of Hawaii at MânoaHonoluluUSA
  2. 2.Department of Orthopaedic SurgeryStanford University School of MedicineStanfordUSA
  3. 3.Orthopaedic Spine Center and Spinal Surgery ServiceStanford University Hospital and ClinicsStanfordUSA
  4. 4.Department of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  5. 5.Institute for Work and HealthTorontoCanada
  6. 6.Centre of Research Excellence in Improved Disability Outcomes (CREIDO)University Health Network Rehabilitation Solutions, Toronto Western HospitalTorontoCanada
  7. 7.Division of Health Care and Outcomes ResearchToronto Western Research InstituteTorontoCanada
  8. 8.Department of Public Health Sciences, and the Alberta Centre for Injury Control and Research, School of Public HealthUniversity of AlbertaEdmontonCanada
  9. 9.Department of Orthopaedics and Environmental Medicine and Program of Ergonomics and Biomechanics, School of Medicine and Graduate School of Arts and ScienceNew York UniversityNew YorkUSA
  10. 10.Occupational and Industrial Orthopaedic Center (OIOC)New York University Medical CenterNew YorkUSA
  11. 11.Department of MedicineUniversity of British ColumbiaVancouverCanada
  12. 12.Occupational Health and Safety Agency for Healthcare in British ColumbiaVanCouverCanada
  13. 13.Endocrinology, Analgesia and InflammationMerck & Co.RahwayUSA
  14. 14.Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
  15. 15.Departments of Public Health Sciences and Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  16. 16.Department of Public Health SciencesUniversity of TorontoTorontoCanada
  17. 17.Department of NeurologyUniversity of CaliforniaIrvineUSA
  18. 18.Department of Epidemiology, School of Public HealthUniversity of CaliforniaLos AngelesUSA

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