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Behavior Programs No Different in Treating Chronic Neck Pain

Neck pain affects many people around the world. In the Netherlands, between 9 percent and 22 percent of the population complain about neck pain at some point. One third of Dutch adults have neck pain during a one-year period. Of these, 5 percent to 10 percent will develop a chronic pain disorder. Unfortunately, when people with neck pain visit their doctor, many times, there is no specific cause that can be found. This type of pain, which can also be aggravated by psychological and social factors, is then labelled nonspecific neck pain or neck pain of unknown origin.

In treating nonspecific neck pain, the usual approach is through exercises, manipulation, massage, physical methods, mobilization, and even biopsychosocial techniques. However, there is not a lot of information in the medical literature that backs up the effectiveness of any one of these treatments or management strategies.

Increasingly, doctor are managing patients with subacute neck pain with behavioral treatment, which seems to be effective for patients who are afraid of bringing on more pain or worsening pain, which results in less movement and activity. With this knowledge, researchers have developed a behavioral graded activity program. The authors of this article studied to if such a program would be at least as effective among patients with psychological factors that influence their subacute neck pain as is manual therapy (exercises).

Researchers randomized 146 adult patients who complained of nonspecific neck pain. Half the group was assigned to behavioral graded activities. These included learning skills and increase healthy behavior, having an active role in managing the pain, using and therapist as needed, and working towards preset goals, a gradually increasing exercise program. The manual therapy group were given exercises to restore restricted movement and increase the patients' level of activity and participation. If health costs were taken into account, the manual therapy group used fewer resources with an average of 5.2 treatments per patient compared with 8.2 treatments in the behavior group. This also is found in visits to the general practitioner. The manual group visited the doctor a mean of 0.5 times, compared with 0.8 times with the behavior group. However, this changed when it came to specialist visits. The manual group mean visits remained at 0.5 while the behavior group dropped to 0.03 times. Lost days of work averaged 2.1 days in the manual group, but 4.3 days for the behavior group.

While examining the study outcomes, the researchers found that the physical therapists who ran the programs did not always follow the protocols of the behavior management activity program (only 52.1 percent did), while 80 percent of the manual therapy programs consisted of manipulations or mobilizations, with or without exercises.

Taking into account all the findings, the researchers noted that after one year, the success rate regarding pain and disability of the behavior program was 89.4 percent and for the manual program, 86.5 percent. The authors concluded that the differences, while present, were marginal and not statistically significant to warrant changing programs from one in favor of another.

References: Jan J. M. Pool, PhD, PT, MT, et al. Is a Behavioral Graded Activity Program More Effective Than Manual Therapy in Patients With Subacute Neck Pain? In Spine. May 1, 2010. Vo. 35, No. 10. Pp. 1017-1024.

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