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bibliography * The PainScience Bibliography contains plain language summaries of thousands of scientific papers and others sources, like a specialized blog. This page is about a single scientific paper in the bibliography, Bronfort 2012.

Spinal manipulative therapy for neck pain works only slightly

updated
Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012 Jan;156(1 Pt 1):1–10. PubMed #22213489.
Tags: spinal adjustment, chiropractic, treatment, neck, inflammation, spine, manual therapy, controversy, debunkery, head/neck, pain problems

PainSci summary of Bronfort 2012?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★☆?4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

This reasonably well-designed, big, 12-week NCCAM trial of spinal manipulative therapy (SMT) for neck pain concludes with an important disclaimer: although SMT “won” and chiropractors cite this study as evidence that adjustment works, the authors acknowledge that just “a few instructional sessions of home exercise with advice resulted in similar outcomes at most time points.” And so SMT is damned, damned, damned with (extremely) faint praise yet again, as it always is, every time it gets studied: it costs vastly more and performs barely better than sending someone home to do a few simple exercises! Now that hurts.

original abstractAbstracts 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: Mechanical neck pain is a common condition that affects an estimated 70% of persons at some point in their lives. Little research exists to guide the choice of therapy for acute and subacute neck pain.

OBJECTIVE: To determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term.

DESIGN: Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00029770)

SETTING: 1 university research center and 1 pain management clinic in Minnesota.

PARTICIPANTS: 272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks.

INTERVENTION: 12 weeks of SMT, medication, or HEA.

MEASUREMENTS: The primary outcome was participant-rated pain, measured at 2, 4, 8, 12, 26, and 52 weeks after randomization. Secondary measures were self-reported disability, global improvement, medication use, satisfaction, general health status (Short Form-36 Health Survey physical and mental health scales), and adverse events. Blinded evaluation of neck motion was performed at 4 and 12 weeks.

RESULTS: For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks (P ≤ 0.010), and HEA was superior to medication at 26 weeks (P = 0.02). No important differences in pain were found between SMT and HEA at any time point. Results for most of the secondary outcomes were similar to those of the primary outcome.

LIMITATIONS: Participants and providers could not be blinded. No specific criteria for defining clinically important group differences were prespecified or available from the literature.

CONCLUSION: For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points. Primary Funding Source: The National Center for Complementary and Alternative Medicine, National Institutes of Health.

related content

These two articles on PainScience.com cite Bronfort 2012 as a source:


This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: