• Van der Velde GM
• Hogg-Johnson S
• Bayoumi AM
• Cassidy JD
• Côté P
• Boyle E
• Llewellyn-Thomas H
• Chan S
• Subrata P
• Lucas-Hoving J
• Hurwitz EL
• Bombardier C
• Krahn M

• Anti-Inflammatory Agents, Non-Steroidal / adverse effects
• Decision Support Techniques
• Exercise Therapy / adverse effects
• Iatrogenic Disease / epidemiology
• Manipulation, Spinal / adverse effects
• Neck Pain / therapy
• Quality of Life
• Risk Assessment
• Treatment Outcome

OBJECTIVE: To identify the best treatment for nonspecific neck pain.

SUMMARY OF BACKGROUND DATA: In Canada and the United States, the most commonly prescribed neck pain treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), exercise, and manual therapy. Deciding which treatment is best is difficult because of the trade-offs between beneficial and harmful effects, and because of the uncertainty of these effects.

METHODS: (Quality-adjusted) life expectancy associated with standard NSAIDs, Cox-2 NSAIDs, exercise, mobilization, and manipulation were compared in a decisionanalytic model. Estimates of the course of neck pain, background risk of adverse events in the general population, treatment effectiveness and risk, and patient-preferences were input into the model. Assuming equal effectiveness, we conducted a baseline analysis using risk of harm only. We assessed the stability of the baseline results by conducting a second analysis that incorporated effectiveness data from a high-quality randomized trial.

RESULTS: There were no important differences across treatments. The difference between the highest and lowest ranked treatments predicted by the baseline model was 4.5 days of life expectancy and 3.4 quality-adjusted life-days. The difference between the highest and lowest ranked treatments predicted by the second model was 7.3 quality-adjusted life-days.

CONCLUSION: When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior.

This abstract is reproduced with the permission of the publisher. Click on the above link for the PubMed record; full text by subscription.
Republished from: Spine 2008 Feb 15;33(4 Suppl):S184-191. Free full text is available through PubMed Central.