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No clear winner for neck pain treatment: study

By Kathleen Raven

NEW YORK (Reuters Health) - Exercise and strengthening may not be the best approach for all kinds of neck- and whiplash-related pain, according to a new analysis by Canadian researchers.

The results directly contradict a 2008 recommendation by the Neck Pain Task Force in Canada. Instead, the new research "suggests that people with neck pain have many options when choosing how to improve it," Janet Freburger told Reuters Health.

"There were no major differences between the types of exercise programs, or (evidence) that exercise in general was beneficial," said Freburger, an associate director at the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. She was not involved in the research.

After reviewing 10 randomized controlled trials for neck pain treatment published since 2008, researchers concluded that certain treatments may be helpful for specific types of neck pain, depending on whether it is mild or severe.

"If you have neck pain, whether it started two days ago or two weeks ago, one of the best things you can do is gently move and stretch your neck muscles," said study author Dr. Pierre Côté, an epidemiologist at the University of Ontario Institute of Technology in Oshawa.

"Longer lasting and more severe neck pain usually requires more work," Côté added.

Neck pain is the fourth leading cause of chronic disability in the U.S., the researchers write in The Spine Journal.

What the researchers did find is that certain exercises appear to help specific kinds of neck pain.

Two randomized control trials - considered medicine's gold standard for evidence - found that qigong, a type of gentle stretching and breathing, reduced low-grade neck pain, when patients were compared to a group that did not do qigong.

Another trial appeared to show that Iyengar yoga, which includes classical yoga poses, helped with milder forms of neck pain.

Interestingly, one study found that patients who were supervised during strengthening exercises did no better than a neck pain group assigned to do exercises at home.

For those who suffered from whiplash-associated neck pain, a study found little difference between a group assigned to do exercises and a group just given advice about self care.

Overall, the trials found that for mild neck pain (considered grades 1 and 2), unsupervised range of motion exercise, over-the-counter painkillers and manual massage were about equally effective.

For persistent grade 1 and 2 neck pain and whiplash pain, supervised qigong and combined strengthening, range of motion and flexibility exercises are better than doing nothing.

"One of the key messages is: move your neck and your condition will probably benefit at least some," Côté said.

"And before physicians prescribe an exercise program for their patients, they should discuss different options with them," he added.

"If a patient is not interested in yoga, then he or she could try strengthening exercises."

SOURCE: http://bit.ly/1mg5ykc The Spine Journal, online February 18, 2014.

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