Northwestern Health Sciences University, Pain Management and Rehabilitation Center, Minneapolis, Minnesota, USA.
Ann Intern Med. 2012 Jan 3;156(1 Pt 1):1-10. doi: 10.7326/0003-4819-156-1-201201030-00002.
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.
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.
Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00029770)
1 university research center and 1 pain management clinic in Minnesota.
272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks.
12 weeks of SMT, medication, or HEA.
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.
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.
Participants and providers could not be blinded. No specific criteria for defining clinically important group differences were prespecified or available from the literature.
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.
National Center for Complementary and Alternative Medicine, National Institutes of Health.
机械性颈部疼痛是一种常见病症，估计有 70%的人在其一生中的某个阶段会受到影响。对于急性和亚急性颈部疼痛的治疗，现有的研究很少能提供指导。
确定脊柱推拿疗法（SMT）、药物治疗和家庭运动加建议（HEA）对急性和亚急性颈部疼痛的短期和长期疗效。
随机对照试验。（ClinicalTrials.gov 注册号：NCT00029770）
明尼苏达州的一个大学研究中心和一个疼痛管理诊所。
272 名年龄在 18 至 65 岁之间、患有 2 至 12 周非特异性颈部疼痛的患者。
12 周的 SMT、药物治疗或 HEA。
主要结局是参与者在随机分组后 2、4、8、12、26 和 52 周时自评的疼痛程度。次要测量指标包括自我报告的残疾程度、整体改善情况、药物使用情况、满意度、一般健康状况（健康调查简表-36 身心健康量表）和不良事件。在 4 周和 12 周时对颈部运动进行盲法评估。
在 8、12、26 和 52 周时，SMT 在疼痛方面的疗效明显优于药物治疗（P ≤ 0.010），而在 26 周时，HEA 优于药物治疗（P = 0.02）。在任何时间点，SMT 与 HEA 在疼痛方面均无显著差异。大多数次要结局的结果与主要结局相似。
参与者和提供者无法被蒙蔽。没有预先规定或可从文献中获得用于定义临床重要组间差异的具体标准。
对于患有急性和亚急性颈部疼痛的患者，SMT 在短期和长期内均比药物治疗更有效。然而，几次家庭运动加建议的指导课程在大多数时间点都产生了相似的结果。
美国国立卫生研究院国家补充与综合健康中心。
