When you have neck pain, do you instinctively reach for that bottle of ibuprofen or acetaminophen? If so, is that the best option? Who can we trust for the answer? Since between 10-20% of the population suffer from chronic or persistent neck pain, this is a VERY IMPORTANT question!
If we look at the literature published in peer-reviewed journals by authors who have no financial incentives in the outcome of the study, we can find accurate, non-biased information to answer this question. So, let’s start with a landmark study published in SPINE, a leading medical journal that reviewed ALL the publications printed between 2000 and 2010 on neck pain—a total of 32,000 articles with over 25,000 hours of review. (Haldeman S, Carroll L, Cassidy JD, et. al. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: Executive Summary. Spine 2008,33(4S):S5-S7). This resulted in a 220-page comprehensive report from a multidisciplinary International Task Force involving seven years of work from 50+ researchers from 19 different clinical scientific disciplines worldwide looking at the MOST EFFECTIVE approaches available (both surgical and non-surgical) for patients suffering from neck pain.
Highlights from the study include the following:
1) Manipulation/mobilization are safe, effective, and appropriate treatment approaches for most patients with disabling neck pain (both traumatic and non-traumatic).
2) Neck pain patients should be informed of ALL effective treatment options so they can choose effectively.
3) The very rare risk of vertebrobasilar artery (VBI) stroke is NO DIFFERENT when comparing patients consulting a doctor of chiropractic verses a primary care medical physician as the stroke event, in most cases, has occurred prior to the visit.
4) The treatment option(s) available should consider the potential side effects and personal preferences of the patient.
5) For most neck pain patients, treatments that were found to be safe and effective include manipulation, mobilization, exercise, education, acupuncture, analgesics, massage, and low-level laser therapy.
6) For non-neurological neck pain, ineffective treatments (poor choices) include surgery, collars, TENS (transcutaneous electrical nerve stimulation), most injection therapies (including corticosteroid injections and rhizotomy).
7) For neck pain WITH nerve compression, there is very little research published on non-surgical care. Here, in the absence of serious pathology or progressive neurological loss, start with the most conservative (like chiropractic!) followed by more invasive treatments like epidural steroid injections (ESIs) and surgery.
8) Whiplash patients should follow similar guidelines as described above.
9) Some benefit from the chosen treatment should be seen within the first two to four weeks of care.
10) Be realistic about treatment goals—neck pain is often recurrent (comes and goes) as most people (50-80%) will NOT experience complete resolution of symptoms and will have neck pain again one to five years later.
Another study published in The Annals of Internal Medicine (“Spinal Manipulation, Medication, or Home Exercise with Advice for Acute and Subacute Neck Pain: A Randomized Trial. 3 January 2012, Vol.156, No. 1, Part 1) reports similar information favoring spinal manipulation and exercise, as these were found to be SUPERIOR to medication use. Another study reported excellent results for 27 patients utilizing chiropractic care who had herniated cervical disks WITH spinal cord compression verified on MRI (70% improved after an average of 12 visits)! TRY CHIROPRACTIC FIRST!!!
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