Complementary therapies for neck pain

Perhaps this escaped you, but your neck is an amazing thing. At the very top, it houses a rock-hard cage — the cervical vertebrae —that contains and protects the top of the spinal cord, connecting your brain to the rest of your body. Despite this, the neck is fully mobile, allowing you to turn, bend, and nod your head. Then there are the blood vessels, the esophagus, the windpipe, and the thyroid (among other structures). And, of course, day in and day out, your neck carries around the equivalent of a bowling ball — your 11-pound skull and its contents. No wonder, then, that sometimes the neck gets sore.

Neck pain matters

For many people with neck pain, it's much more than just a "pain in the neck." It's a leading cause of doctor's visits and disability. Improvement can be slow. In many cases, there is no single treatment that is uniformly successful. Chronic (long-lasting) neck pain is an agonizing condition for millions of people worldwide.

A pain of many causes

Neck pain is not a disease. It's a symptom, and a number of conditions can cause it. Some of the more common causes are:

• muscle strain or spasm
• disc disease
• arthritis
• an injury

In many cases, though, the precise reason for neck pain can't be identified. Add that to the fact that treatments don't always work well, or work quickly, and it can be a remarkably frustrating problem.

That's why the results of a new study are so encouraging — and potentially important.

Complementary therapies for neck pain

Research published in the latest edition of the Annals of Internal Medicine compared two alternative approaches to the treatment of chronic neck pain with the results of standard care. The researchers randomly divided patients with neck pain into three treatment groups:

• "Usual care." This includes the treatments ordinarily recommended by primary care physicians, such as medications and referral to a physical therapist.
• Acupuncture. These patients received usual care, plus up to 12 acupuncture sessions over 5 months.
• Alexander Technique. This group received usual care plus 20 one-on-one instruction sessions regarding the Alexander technique, a method of self-care that emphasizes "self-observation and subtle behavioral change" to control one's response to pain and improve how activities of daily living are carried out.

This study is making news because of its major finding: when the participants were assessed a year after the start of the study (that is, 6 to 7 months after completing treatment), those assigned to acupuncture or Alexander Technique lessons reported significantly less pain and disability than those receiving usual care alone. No serious side effects due to treatment were reported.

Of course, there are caveats

Before we declare victory over neck pain, we should mention some important limitations of this research. They include:

• More than half of the patients with neck pain originally considered for the study were excluded. The most common reasons for exclusion were the presence of only minor pain, a "serious" cause of neck pain (such as rheumatoid arthritis), or prior surgery
• Differences in the amount of improvement between the three groups was somewhat modest. For example, compared with symptoms at study entry, there was a 32% improvement in the pain score with acupuncture, 31% with the Alexander Technique, and 23% for usual care.
• These study subjects were particularly motivated to enroll in a clinical trial that required a good deal of time and commitment.
• These treatments require not only a big time commitment but, outside of clinical trials, may be expensive.
• We don't know whether the benefits extend beyond 1 year.

What do the results mean for neck pain sufferers?

Even with the encouraging results of this study, we need better treatments for neck pain and to understand why they work. For example, the improvements noted in the acupuncture and Alexander Technique groups could be due to the placebo effect. Many chronic pain conditions improve significantly with lots of personal contact between patients and practitioners and an expectation of improvement, both of which are key parts of acupuncture and the Alexander Technique. If these two features alone — as opposed to the actual interventions — could explain the findings of this trial, that means we need to figure out how to exploit this effect so that more people can benefit from it. Finally, future research could demonstrate even better outcomes with a combination of acupuncture, Alexander Technique lessons, and other non-medication approaches.

Considering how much stress we put on our necks, it's unlikely neck pain will ever be completely eliminated. So, we should be open to any new approach that is safe and better than what we already have.