Canadian evidence review yields updated recommendations for acute & chronic pain
By Peter W. Crownfield, Executive Editor
Dynamic Chiropractic – February 1, 2014, Vol. 32, Issue 03

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The January 2014 issue of JMPT features the award-winning papers from the World Federation of Chiropractic’s 2013 Congress, perhaps the most intriguing of which in terms of clinical relevance is “Evidence-Based Guidelines for the Chiropractic Treatment of Adults With Neck Pain.”1 The systematic literature review and subsequent recommendations serve as an update to the Neck Pain Guideline published in 2005 by Canada’s Guidelines Development Committee, with Roland Bryans, DC, committee chair, serving as lead author.

Following a literature search of controlled clinical trials through December 2011, 560 studies were narrowed to 41 that met the authors’ inclusion criteria and served as the basis for their treatment recommendations, graded as strong, moderate or weak based on the number, quality and consistency of research results. Treatment strategies given strong recommendations for chronic neck pain included manipulation, manual therapy and exercise in combination with other modalities; as well as stretching, strengthening and endurance exercises alone. Mobilization, as well as massage in combination with other therapies, received moderate recommendations for chronic neck pain. Manipulation and mobilization in combination with other modalities received moderate recommendations for treating acute neck pain.

Treatment strategies not recommended based on insufficient evidence and/or inconsistent findings included thoracic manipulation (acute and chronic neck pain), traction (chronic neck pain), trigger-point therapy (acute neck pain), TENS (chronic neck pain) and laser (chronic neck pain)…..

Acute Neck Pain

• Manipulation / Multimodal: “Spinal manipulative therapy is recommended for the treatment of acute neck pain for both short- and long-term benefit (pain and the number of days to recover) when used in combination with other treatment modalities (advice, exercise, and mobilization; grade of recommendation – moderate).”
  

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• Mobilization/  Multimodal:“Mobilization is recommended for the treatment of acute neck pain for short-term (up to 12 weeks) and long-term benefit (days to recovery, pain) in combination with advice and exercise (grade of recommendation – moderate).”
• Exercise: “Home exercise with advice or training is recommended in the treatment of acute neck pain for both long- and short-term benefits (neck pain; grade of recommendation – weak).”

Chronic Neck Pain

• Manipulation / Multimodal. “Spinal manipulative therapy is recommended in the treatment of chronic neck pain as part of a multimodal approach (including advice, upper thoracic high-velocity low-amplitude thrust, low-level laser therapy, soft-tissue therapy, mobilizations, pulsed short-wave diathermy, exercise, massage, and stretching) for both short- and long-term benefit (pain, disability, cROMs; grade of recommendation – strong).”
• Manual Therapy / Multimodal: “Manual therapy is recommended in the treatment of chronic neck pain for the short- and long-term benefit (pain, disability, cROM, strength) in combination with advice, stretching, and exercise (grade of recommendation – strong).
• Exercise: “Regular home stretching (3-5 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).”
• Exercise / Multimodal: “Exercise (including stretching, isometric, stabilization, and strengthening) is recommended for short- and long-term benefits (pain, disability, muscle strength, QoL, cROM) as part of a multimodal approach to the treatment of chronic neck pain when combined with infrared radiation, massage, or other physical therapies (grade of recommendation – strong).”
• Mobilization: “Mobilization is recommended for the treatment of chronic neck pain for short-term (immediate) benefit (pain, cROM; grade of recommendation – moderate)”
• Massage / Multimodal: “Massage is recommended for the treatment of chronic neck pain for short-term (up to 1 month) benefit (pain, disability, and cROM) when provided in combination with self-care, stretching, and/or exercise (grade of recommendation – moderate).”
• Manipulation: “Spinal manipulative therapy is recommended in the treatment of chronic neck pain for short- and long-term benefit (pain, disability; grade of recommendation – weak).”

In their conclusion, the authors note that their findings suggest “interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain” and that “increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.”

Reference

1. Bryans R, et al. Evidence-based guidelines for the chiropractic treatment of adults with neck pain. JMPT, January 2014;37(1):42-63.