Blog | Wednesday, February 8, 2012

Don't reach for the pills when you tweak your neck

Neck pain is a very common problem. Many of us have woken up with a painful neck and found that we couldn't turn our head because of painful muscle spasm. Doctors use various treatments for neck pain. Pain medication, spinal manipulation by a chiropractor, and physical therapy for stretching exercises are all popular remedies, but there is very little scientific evidence to support any of them. I frequently used to prescribe anti-inflammatory pain medications as an initial treatment, but not anymore.

Day 80 - A Pain in the Neck by Menage a Moi via Flickr and a Creative Commons licenseAnnals of Internal Medicine published a study that sheds some light on the issue. Researchers recruited 272 patients suffering from neck pain for at least two weeks. They were randomized to three groups, each of which were assigned a different treatment for 12 weeks.

One group was prescribed medication by a physician. Medications included anti-inflammatory pain medicines (like ibuprofen or naproxen), acetaminophen (Tylenol), muscle relaxants, and even narcotics if the doctor thought they were indicated. The second group saw a chiropractor once or twice per week for spinal manipulation. The third group met twice with physical therapists who taught them to do home exercises. They were asked to continue the exercises for the 12 weeks of treatment.

All patients were followed for a year after the start of the study to periodically measure their pain and range of motion.

Surprisingly, both the home exercise group and the chiropractic spinal manipulation group did much better than the medication group. And there was not a significant difference in outcomes between the home exercise group and the chiropractor group.

So the next time you get a crick in your neck, check out the home exercises in the supplement to the Annals study. If you can't figure them out yourself, get a physical therapist to teach them to you. Or see a chiropractor. And I'll still prescribe pain medicine if pressed but first I'll recommend the more effective treatments.

Learn more:
For Neck Pain, Chiropractic and Exercise Are Better Than Drugs (NY Times, Well column)
Neck Pain? Skip the Pills, Just Stretch Like a Chicken (Wall Street Journal, Health & Wellness)
Is Spinal Manipulation an Effective Treatment for Neck Pain? (Annals of Internal Medicine, Summaries for Patients)
Neck exercises (Annals of Internal Medicine, supplement)
Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain (Annals of Internal Medicine article)
Pain in the Neck: Many (Marginally Different) Treatment Choices (Annals of Internal Medicine editorial)

Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000. Holding privileges at Cedars-Sinai Medical Center, he is also an assistant clinical professor at UCLA's Department of Medicine. This post originally appeared at his blog.