THE BACK PAGE RESEARCH REVIEW Evidence-based treatment of neck pain (part 2 of 2) REVIEWED BY SHAWN THISTLE Study title: Evidence-based guidelines for the chiropractic treatment of adults with neck pain Authors: Bryans R, Decina P, Descarreaux M, et al. Publication information: Journal of Manipulative & Physiological Therapeutics 2014; 37: 42-63 short-term benefit. Grade of recom-mendation: moderate. I Transcutaneous nerve stimulation (TENS) n the last issue, we presented a study of several databases, published be-tween January 2004 and December 2011, to develop treatment guide-lines for neck pain among adults. Following are some of the Guideline Development Committee’s recommenda-tions for the chiropractic treatment of adults with neck pain, which could also apply to other manual therapy providers: exercise is recommended in the treat-ment of chronic neck pain for short-and long-term benefit. Grade of rec-ommendation: strong. • There is insufficient evidence that supports a recommendation for TENS for the treatment of chronic neck pain. Thoracic spinal manipulation Exercise Spinal manipulation (SMT) • Used with other treatment modalities, SMT is recommended for treatment of acute neck pain for both short-and long-term benefit. Grade of recommendation: moderate. • For treatment of chronic neck pain for short-and long-term benefit. Grade of recommendation: weak. • As part of a multimodal approach, in-cluding advice, upper thoracic manipu-lation, low-level laser therapy and others, for treatment of chronic neck pain for short-and long-term benefit. Grade of recommendation: strong. Spinal mobilization • Used with advice and exercise is recom-mended for the treatment of acute neck pain for short-and long-term benefit. Grade of recommendation: moderate. • Recommended for treatment of chronic neck pain for short-term benefit. Grade of recommendation: moderate. • Home exercise with advice or training is recommended in the treatment of acute neck pain for both long-and short-term benefits. Grade of recom-mendation: weak. • Regular home stretching (three to five 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 anal-gesic intake. Grade of recommendation: strong. • Home strengthening and endurance exercises with advice/training/supervi-sion are recommended for both short-and long-term benefits in the treatment of chronic neck pain. Grade of recom-mendation: strong. • Exercise, consisting of stretching, isomet-ric, stabilization and strengthening, when combined with infrared radiation, massage or other physical therapies is recommended for short-and long-term benefits as part of a multimodal ap-proach to the treatment of chronic neck pain. Grade of recommendation: strong. • There is insufficient evidence that supports a recommendation for the use of thoracic manipulation in combina-tion with electrotherapy or exercise for the treatment of acute neck pain, due to inconsistent findings. • There is insufficient evidence that sup-ports a recommendation for the use of thoracic manipulation for the treatment of chronic neck pain because of incon-sistent findings from three low-risk-of-bias studies. Conclusions, applications Massage Manual therapy • Used with advice, stretching and • Massage, when provided in combina-tion with self-care, stretching and/or exercise, is recommended for the treat-ment of chronic neck pain for DR. SHAWN THISTLE owns and operates Research Review Service Inc., helping clinicians integrate scientific evidence into practice through subscription-based service (researchreviewservice.com), online courses (onlinecourses.researchreviewservice.com) and seminars (epicureanscholar.com). 46 Canadian Chiropractor October 2014 The authors point out these guidelines should be considered a supportive tool, developed for practitioners and their patients to help in making treatment decisions. They should not, however, be considered a standard of care. As valua-ble as guidelines are, bear in mind that evidence from research is only one ele-ment of evidence-informed patient care, which should also incorporate clinical expertise and patient values. The dissemination and integration of Clinical Practice Guidelines (CPGs) like these is paramount to the advancement and improvement of patient care. One of the most impor-tant take-home messages from this CPG (and the literature in general) is that combining spinal manipulation/ mobilization with exercise can lead to better patient outcomes. (These guidelines were reviewed by Dr. Mi-chael Haneline for Research Review Service.) www.canadianchiropractor.ca
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