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Evidence summaries

Physical Treatments in Uncomplicated Neck Pain

Active physiotherapy and electromagnetic therapy appear to be modestly effective for uncomplicated neck pain. There is insufficient evidence on the effects of most physical treatments - heat or cold, traction, biofeedback, spray and stretch, acupuncture, and laser - in patients with uncomplicated neck pain. Level of evidence: "B"

A topic in Clinical Evidence 1 summarizes the evidence on physical treatments on uncomplicated neck pain without severe neurological deficit. Four systematic reviews were found 2 3 5 (see note). Two considered all physical modalities 3 (see note) and the other two considered traction only 2 or acupuncture only 5. The first systematic review identified 13 RCTs (in 760 patients) and found no significant benefit from any of the following physical treatments: heat or cold, traction, electrotherapy, biofeedback, spray and stretch, acupuncture, or laser. The second systematic review (search date 1996) identified 17 RCTs (1202 patients) and found possible benefit for pulsed electromagnetic therapy and active physiotherapy but not for traction, acupuncture or other therapies. One RCT included in both reviews involved 47 patients and found that active physiotherapy and exercise significantly reduced pain immediately after treatment compared with passive treatment. One RCT showed benefit from electromagnetic therapy. The third systematic review (search date 1992) identified three RCTs in 639 people comparing traction versus a range of alternative treatments. The RCTs found no consistent pain reduction from traction. The fourth review (search date 1998) identified 13 RCTs comparing needle or laser acupuncture with a range of control procedures but found no consistent benefit for the acupuncture groups.

Note: One of the original reviews (Gross AR, et al. Physical medical modalities for mechanical neck disorders. Cochrane Database Syst Rev. 1998;(2):CD000961) has been removed from the references since it has been withdrawn from the Cochrane Library.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes, and variability in results across studies).

    References

    • Binder A. Physical treatments in neck pain. Clinical evidence 2000;4:634-5.
    • van der Heijden GJ, Beurskens AJ, Koes BW, Assendelft WJ, de Vet HC, Bouter LM. The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods. Phys Ther 1995 Feb;75(2):93-104. [PubMed]
    • Kjellman GV, Skargren EI, Oberg BE. A critical analysis of randomised clinical trials on neck pain and treatment efficacy. A review of the literature. Scand J Rehabil Med 1999 Sep;31(3):139-52. [PubMed]
    • White AR, Ernst E. A systematic review of randomized controlled trials of acupuncture for neck pain. Rheumatology (Oxford) 1999 Feb;38(2):143-7. [PubMed]

Primary/Secondary Keywords