Ann Intern Med. 2015 Nov 3;163(9):653-62. doi: 10.7326/M15-0667.
Management of chronic neck pain may benefit from additional active self-care-oriented approaches.
To evaluate clinical effectiveness of Alexander Technique lessons or acupuncture versus usual care for persons with chronic, nonspecific neck pain.
Three-group randomized, controlled trial. (Current Controlled Trials: ISRCTN15186354).
U.K. primary care.
Persons with neck pain lasting at least 3 months, a score of at least 28% on the Northwick Park Questionnaire (NPQ) for neck pain and associated disability, and no serious underlying pathology.
12 acupuncture sessions or 20 one-to-one Alexander lessons (both 600 minutes total) plus usual care versus usual care alone.
NPQ score (primary outcome) at 0, 3, 6, and 12 months (primary end point) and Chronic Pain Self-Efficacy Scale score, quality of life, and adverse events (secondary outcomes).
517 patients were recruited, and the median duration of neck pain was 6 years. Mean attendance was 10 acupuncture sessions and 14 Alexander lessons. Between-group reductions in NPQ score at 12 months versus usual care were 3.92 percentage points for acupuncture (95% CI, 0.97 to 6.87 percentage points) (P = 0.009) and 3.79 percentage points for Alexander lessons (CI, 0.91 to 6.66 percentage points) (P = 0.010). The 12-month reductions in NPQ score from baseline were 32% for acupuncture and 31% for Alexander lessons. Participant self-efficacy improved for both interventions versus usual care at 6 months (P < 0.001) and was significantly associated (P < 0.001) with 12-month NPQ score reductions (acupuncture, 3.34 percentage points [CI, 2.31 to 4.38 percentage points]; Alexander lessons, 3.33 percentage points [CI, 2.22 to 4.44 percentage points]). No reported serious adverse events were considered probably or definitely related to either intervention.
Practitioners belonged to the 2 main U.K.-based professional associations, which may limit generalizability of the findings.
Acupuncture sessions and Alexander Technique lessons both led to significant reductions in neck pain and associated disability compared with usual care at 12 months. Enhanced self-efficacy may partially explain why longer-term benefits were sustained.
Arthritis Research UK.
慢性颈痛的治疗可能受益于额外的主动自我保健方法。
评估针对慢性非特异性颈痛患者的亚历山大技术课程或针灸与常规护理相比的临床效果。
三组随机对照试验。（当前对照试验：ISRCTN86043015）。
英国初级保健。
颈痛持续至少 3 个月、北威克公园问卷（NPQ）颈痛和相关残疾评分至少为 28%、且无严重潜在病理的患者。
12 次针灸或 20 次一对一亚历山大课程（总计 600 分钟）加常规护理与单独常规护理。
NPQ 评分（主要结局）在 0、3、6 和 12 个月（主要终点）以及慢性疼痛自我效能感量表评分、生活质量和不良事件（次要结局）。
共招募了 517 名患者，颈痛的中位持续时间为 6 年。平均出勤率为 10 次针灸和 14 次亚历山大课程。与常规护理相比，12 个月时 NPQ 评分的组间降低分别为针灸 3.92 个百分点（95%CI，0.97 至 6.87 个百分点）（P=0.009）和亚历山大课程 3.79 个百分点（CI，0.91 至 6.66 个百分点）（P=0.010）。针灸和亚历山大课程的 NPQ 评分从基线的 12 个月降低分别为 32%和 31%。与常规护理相比，两种干预措施在 6 个月时参与者的自我效能均有所提高（P<0.001），与 12 个月时 NPQ 评分的降低显著相关（针灸，3.34 个百分点[CI，2.31 至 4.38 个百分点]；亚历山大课程，3.33 个百分点[CI，2.22 至 4.44 个百分点]）。未报告任何严重不良事件被认为可能或肯定与任何干预措施有关。
从业者属于英国的两个主要专业协会，这可能限制了研究结果的普遍性。
与常规护理相比，针灸和亚历山大技术课程均能显著减轻颈痛和相关残疾，12 个月时的效果持续存在。增强的自我效能感可能部分解释了为什么长期受益得以维持。
关节炎研究英国。
