Active treatment of chronic neck pain
Evidence SummariesLevel of Evidence = C
Active treatment consisting of proprioceptive training, relaxation and behavioural support may be more effective than home exercises or rest in chronic neck pain.
In a randomized comparative study with single-blind outcome assessments 1 the efficacy of a multimodal treatment emphasizing proprioceptive training (ACTIVE) was compared with activated home exercises (HOME) and recommendation of exercise (CONTROL) in patients with nonspecific chronic neck pain. Seventy-six patients (22 men, 54 women) with chronic, nonspecific neck pain participated. Sixty-two participated the 1-year follow-up. Subjective pain and disability, cervical ranges of motion, and pressure pain threshold in the shoulder region were measured at baseline, at 3 months, and at 12 months. The ACTIVE treatment consisted of 24 sessions of proprioceptive exercises, relaxation, and behavioral support. The HOME regimen included a neck lecture and two sessions of practical training for home exercises and instructions for maintaining a diary of progress. The CONTROL treatment included a lecture regarding care of the neck with a recommendation to exercise. The average self-experienced total benefit was highest in the ACTIVE group, and the HOME group rated over the CONTROL group (P < 0.001). Differences between the groups in favour of the ACTIVE treatment were recorded in reduction of neck symptoms and improvements in general health and self-experienced working ability (P < 0.01-0.03). Changes in measures of mobility and pressure pain threshold were minor.
Comment: The quality of evidence is downgraded by sparse data and indirectness of evidence; only subjective outcomes were improved.
1. Taimela S, Takala EP, Asklöf T, Seppälä K, Parviainen S. Active treatment of chronic neck pain: a prospective randomized intervention. Spine 2000 Apr 15;25(8):1021-7. [PMID:10767816]
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