Chiropractic + Naturopathic Doctor

Research Review: October 2014

Shawn Thistle   

Features Research

Study title: Evidence-based guidelines for the chiropractic treatment of adults with neck pain

Study title: Evidence-based guidelines for the chiropractic treatment of adults with neck pain

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Authors: Bryans R, Decina P, Descarreaux M, et al.

Publication information: Journal of Manipulative & Physiological Therapeutics 2014; 37: 42-63

In the last issue, we presented a study of several databases, published between January 2004 and December 2011, to develop treatment guidelines for neck pain among adults.

Following are some of the Guideline Development Committee’s recommendations for the chiropractic treatment of adults with neck pain, which could also apply to other manual therapy providers:

Spinal manipulation (SMT)

  • Used with other treatment modalities, SMT is recommended for treatment of acute neck pain for both short- and long-term benefit. Grade of recommendation: moderate.
  • For treatment of chronic neck pain for short- and long-term benefit. Grade of recommendation: weak.
  • As part of a multimodal approach, including advice, upper thoracic manipulation, low-level laser therapy and others, for treatment of chronic neck pain for short- and long-term benefit. Grade of recommendation: strong.

Spinal mobilization

  • Used with advice and exercise is recommended for the treatment of acute neck pain for short- and long-term benefit. Grade of recommendation: moderate.
  • Recommended for treatment of chronic neck pain for short-term benefit. Grade of recommendation: moderate.

Manual therapy

  • Used with advice, stretching and exercise is recommended in the treatment of chronic neck pain for short- and long-term benefit. Grade of recommendation: strong.

Exercise

  • Home exercise with advice or training is recommended in the treatment of acute neck pain for both long- and short-term benefits. Grade of recommendation: weak.
  • Regular home stretching (three to five times per week) with advice/training is recommended in the treatment of chronic neck pain for long- and short-term benefits in reducing pain and analgesic intake. Grade of recommendation: strong.
  • Home strengthening and endurance exercises with advice/training/supervision are recommended for both short- and long-term benefits in the treatment of chronic neck pain. Grade of recommendation: strong.
  • Exercise, consisting of stretching, isometric, stabilization and strengthening, when combined with infrared radiation, massage or other physical therapies is recommended for short- and long-term benefits as part of a multimodal approach to the treatment of chronic neck pain. Grade of recommendation: strong.

Massage

  • Massage, when provided in combination with self-care, stretching and/or exercise, is recommended for the treatment of chronic neck pain for short-term benefit. Grade of recommendation: moderate.

Transcutaneous nerve stimulation (TENS)

  • There is insufficient evidence that supports a recommendation for TENS for the treatment of chronic neck pain.

Thoracic spinal manipulation

  • There is insufficient evidence that supports a recommendation for the use of thoracic manipulation in combination with electrotherapy or exercise for the treatment of acute neck pain, due to inconsistent findings.
  • There is insufficient evidence that supports a recommendation for the use of thoracic manipulation for the treatment of chronic neck pain because of inconsistent findings from three low-risk-of-bias studies.

Conclusions, applications
The authors point out these guidelines should be considered a supportive tool, developed for practitioners and their patients to help in making treatment decisions. They should not, however, be considered a standard of care. As valuable as guidelines are, bear in mind that evidence from research is only one element of evidence-informed patient care, which should also incorporate clinical expertise and patient values.

The dissemination and integration of Clinical Practice Guidelines (CPGs) like these is paramount to the advancement and improvement of patient care. One of the most important take-home messages from this CPG (and the literature in general) is that combining spinal manipulation/mobilization with exercise can lead to better patient outcomes. (These guidelines were reviewed by Dr. Michael Haneline for Research Review Service.)


Dr. SHAWN THISTLE owns and operates Research Review Service Inc., helping clinicians integrate scientific evidence into practice through subscription-based service (researchreviewservice.com), online courses (onlinecourses.researchreviewservice.com) and seminars (epicureanscholar.com).


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