Spinal Manipulation More Effective than Medication for Neck Pain

spinal manipulation therapy for neck painA new study carried out by researchers at Northwestern Health Sciences University has found spinal manipulation therapy better for neck pain relief than medication. Publishing their results in the Annals of Internal Medicine’s January 2012 edition, the researchers have stressed the findings are not applicable to all patients and that individual treatment protocols are always warranted. The big surprise from the study was that home exercises for neck pain were also more effective than neck pain medication, meaning that many patients could treat themselves without the side-effects of popular drugs.

Neck Pain Home Exercises Successful

The paper, which may influence treatment decisions by physicians for patients with chronic neck pain, notes that the history of neck pain, the patients’ preferences for treatment, and their previous experience of such therapy will also factor into any treatment choices. Dr. Bronfort, the lead author of the study, along with fellow researchers devised a programme for patients where they learnt how to avoid certain triggers for neck pain including specific sleeping and working postures. The patients were also given a two hour instruction class in self care which included home-based neck exercises. Of the 272 patients taking part in the study, a third were treated with neck pain medication, a third with spinal manipulation therapy, and a third with home exercise and advice. Unfortunately the nature of the study meant that there was no control group receiving no intervention against which to compare all groups. The treatments lasted for twelve weeks and the spinal manipulation was administered by five experienced chiropractors.

Neck Pain Medications

The neck pain medications used in this particular trial were largely prescription drugs including non-steroidal anti-inflammatory medications, acetaminophen, or a combination of the two. Some patients received opioid medications if the NSAIDs and acetaminophen were insufficient for relieving pain. Muscle relaxants were also administered to some patients and patients were given usual advice on modifying activities as needed to help their condition.

Measuring Success at Relieving Neck Pain

Patients in the trial were assessed for pain levels at 2, 4, 8, 12, 26, and 52 weeks. The group receiving spinal manipulation therapy had a significant reduction in neck pain in comparison to the medicated group at the 8, 12, 26, and 52 week marks. Home exercises for neck pain proved more effective than medication at 26 weeks but no clear differences were noticed between the effectiveness of spinal manipulation therapy (SMT) and home neck exercises at any point in the study.

The patients receiving either SMT or conducting neck exercises at home reported benefits in terms of reduced use of medications, improved general health and activity levels, and fewer adverse events. Interestingly, those patients receiving SMT were more satisfied than those carrying out the exercises alone at home. Almost half (46%) of the home exercise group and 40% of the SMT group reported adverse events however, the most common of which was musculoskeletal pain, followed by paraesthesia, headaches, stiffness, and crepitus (joint cracking and associated noise). The medicated group had a 60% incidence of reporting adverse events, usually gastrointestinal symptoms, drowsiness, dry mouth, cognitive effects, rashes, and insomnia.

Limits to the Study

The study is useful in that it fills a research gap looking at spinal manipulation therapy in contrast to neck pain medications and home exercise. However, the patients could not be blinded to the care they received and the benefits of the SMT may in part have come from more frequent interaction with the chiropractors. The authors did suggest that the treatment may be helpful not only in the short term but also in reducing the risks of chronic conditions developing although more research needs conducting to establish such a theory. Other concerns expressed about the study, aside from the lack of placebo control, include the risk of vertebral artery stroke associated with SMT, and the lack of a cost-benefit analysis to accompany the study. This type of research may prompt further study into alternatives to neck pain medications including home neck exercises and spinal manipulation therapy for neck pain.


Bronfort, G., Evans, R., Anderson, A.V., Svendsen, K.H., Bracha, Y, Grimm, R.H., (2012),.Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain, A Randomized Trial, Ann Intern Med. 2012;156:1-10, 52-53.

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