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A discouraging review of education for neck pain

PainSci » bibliography » Haines et al 2009
Tags: neck, education, head/neck, spine, treatment

One article on PainSci cites Haines 2009: The Complete Guide to Neck Pain & Cricks

PainSci notes on Haines 2009:

The effectiveness of education for neck pain (and probably any pain problem) depends a lot on the causes of the pain and the type of education, making it very hard to study. This Cochrane review found only 10 studies to review, and only two were rated as high quality. The authors conclude that these studies show little promise in educational therapy. I have to acknowledge that this does not look good, and there’s no reason to be particularly optimistic about educational therapy. And yet I admit to a hopeful bias: I think further research could change this picture, given the complexity of the problem and the lack of good quality research done so far. There are too many reasons to believe that confidence is relevant to recovery to dismiss educational therapy just yet. It doesn’t look good, but it isn’t over! Bear in mind that another review of the subject in Spine (Hurwitz) from just a year earlier concluded that, “For whiplash-associated disorders, there is evidence that educational videos … more beneficial than usual care or physical modalities.”

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND CONTEXT: Neck pain is common, disabling, and costly. The effectiveness of patient education strategies is unclear.

PURPOSE: To assess whether patient education strategies are of benefit for pain, function/disability, global perceived effect, quality of life, or patient satisfaction, in adults with neck pain with or without radiculopathy.

STUDY DESIGN: Cochrane systematic review.

METHODS: Computerized bibliographic databases were searched from their start to May 31, 2008. Eligible studies were randomized trials investigating the effectiveness of patient education strategies for neck pain. Paired independent reviewers carried out study selection, data abstraction, and methodological quality assessment. Relative risk and standardized mean differences were calculated. Because of differences in intervention type or disorder, no studies were considered appropriate to pool.

RESULTS: Of the 10 selected trials, two (20%) were rated as of high quality. Patient education was assessed as follows: 1) eight trials of advice focusing on activation compared with no treatment, or to various active treatments, including therapeutic exercise, manual therapy, and cognitive behavioral therapy, showed either inferiority or no difference for pain, spanning a full range of follow-up periods, acuity and disorder types. When compared with rest, two trials that assessed acute whiplash-associated disorder showed moderate evidence of no difference for advice focusing on activation; 2) two trials studying advice focusing on pain and stress coping skills found moderate evidence of no benefit for chronic neck pain at intermediate- to long-term follow-up; and 3) one trial compared the effects of neck school to no treatment, yielding limited evidence of no benefit for pain, at intermediate-term follow-up in mixed acute/subacute/chronic neck pain.

CONCLUSIONS: This review has not shown effectiveness for educational interventions for neck pain of various acuity stages and disorder types and at various follow-up periods, including advice to activate, advice on stress coping skills, and neck school. In future research, further attention to methodological quality is necessary. Studies of multimodal interventions should consider study designs, such as factorial designs, that permit discrimination of specific educational components.

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