At this point there’s a sizable body of research suggesting that Chiropractic care is an effective way to treat persistent neck pain in particular – but how about acute neck pain?
Types of Neck Pain
Neck pain, like most forms of spinal pain, comes in two varieties – these are chronic (or lower level, long term pain) and acute – (or sharp and -hopefully -shorter term pain). The two aren’t necessarily mutually exclusive either – acute pain often follows an injury or re-injury event, with chronic pain developing over the longer term.
Once patients have discovered chiropractic they’re generally quick to head to the clinic when an injury or incident of pain occurs – we also see our fair share of people suffering with acute pain who just don’t know where else to turn! In general, though, we see far more chronic neck pain patients than acute ones – the reasons for this are twofold – firstly, until someone has tried chiropractic or has been recommended by a friend they trust, it’s often not their first course of action – by the time we see many patients they usually tried a number of approaches and are often just managing pain with painkillers. The second major issue is that less research on the effectiveness of chiropractic in cases of acute neck pain has been conducted – in fact, this may well be (at least in part) a consequence of the first point!
How Common is Acute Neck Pain?
Just because we tend to see less acute pain patients does not mean it’s less common – in fact, we have known for decades that up to 50% experienced neck pain each year[1], and recurrence is frequent – meaning many of us will experience multiple episodes.[2] Since the neck is such a critical part of the body, it’s also no surprise that the Global Burden of Disease study ranks musculoskeletal neck pain along with low back pain as the leading cause of non-fatal disability in almost all age groups – Frankly, it’s hard to do much if you can’t move your neck!.[3] The total cost to society of neck pain is unknown; however, a recent review estimated that the annual spending on personal health care and public health for lower back and neck pain combined was USD 87.6 billion in the US alone. [4]
Treating Neck Pain
Neck pain and back pain are the most common reasons for musculoskeletal visits to the GP – and these make up about a third of all total visits.[5] The most common treatment options – it’s the usual suspects, patients are often advised to wait for an expected favourable natural resolution, usually supported with analgesic medication, and/or referred to physiotherapy treatment. A common over the counter solution are topical NSAIDs, which can be beneficial in many cases. Manual therapies, such as chiropractic represent an alternative to these medicine based approaches or may be used alongside. Since most NHS GP’s do not have the option to refer a patient for chiropractic treatment, rates of referral in the UK are very low (there are a handful of PCT’s which do provide chiropractic) – however even in countries where this is an option the referral rare is still quite low – one recent Dutch study suggested that GPs refer about 8% of people with neck pain to manual therapy, which often includes spinal manipulative therapy (SMT) intervention.[6] Some of the major factors holding this rate back are fear of complications associated with cervical Spinal Manipulation and limited support in current guidelines, due to a lack of research.
New Research
At least one recent study has sought to gain insight into these issues, although it is clear from its own conclusions that more work is needed in this area. The 2021 meta study, conducted in Norway[7] worked to review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. Only Six studies met the inclusion criteria for the meta study – however in its results the overall pooled effect size for neck pain was still shown to be very large –1.37 (in statistics, anything over 0.8 is considered to be a large effect size), favouring treatments with SMT compared with controls. One of the studies also suggested that spinal manipulation was statistically significantly better than medicine. Critically, however, it was also shown that only minor transient side effects were reported, which included increased pain and headache, but no serious AEs were reported – at the very least this suggests that there’s not likely to be any real harm in using spinal manipulation as an approach to treat acute neck pain.
Notwithstanding the relatively small number of studies applicable to the meta-research, the authors still felt confident to conclude that spinal manipulation alone or in combination with other modalities was effective for patients with acute neck pain – although more research is needed.
Struggling with Acute Neck Pain?
At Complete Chiropractic we have decades of experience helping people to overcome all kinds of neck pain – and whether you’re struggling with something chronic or acute, we’d love to help you too!
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[1] Carroll LJ, Hogg-Johnson S, van der Velde G, Haldeman S, Holm LW, et al. Course and Prognostic Factors for Neck Pain in the General Population: Results of the Bone and Joint Decade 2000–2010 Task Force on Pain and Its Associated Disorders Spine (Phila Pa 1976). 2008 (Feb 15); 33 (4 Suppl): S75–82
[2] Hogg-JohnsonS, van derVelde G, Carroll LJ, HolmLW, Cassidy JD,GuzmanJ, et al. The Burden and Determinants of Neck Pain in the General Population: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders Spine (Phila Pa 1976). 2008 (Feb 15); 33 (4 Suppl): S39–51
[3] Vos T, Allen C, Arora M, et al. Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 310 Diseases and Injuries, 1990-2015: a Systematic Analysis for the Global Burden of Disease Study 2015 Lancet. 2016 (Oct 8); 388 (10053): 1545–1602
[4] Dieleman JL, Baral R, Birger M, et al. US Spending on Personal Health Care and Public Health, 1996-2013
JAMA 2016 (Dec 27); 316 (24): 2627-2646
[5] Kinge, J.M.; Knudsen, A.K.; Skirbekk, V.; Vollset, S.E. Musculoskeletal disorders in Norway: Prevalence of chronicity and use of primary and specialist health care services. BMC Musculoskelet. Disord. 2015, 16, 75.
[6] Dikkers, M.F.; Westerman, M.J.; Rubinstein, S.M.; van Tulder, M.W. Why Neck Pain Patients are Not Referred to Manual Therapy: A Qualitative Study among Dutch Primary Care Stakeholders. PLoS ONE 2016, 11, e0157465.
[7] Aleksander Chaibi, Knut Stavem and Michael Bjørn Russell, Spinal Manipulative Therapy for Acute Neck Pain:
A Systematic Review and Meta-Analysis of Randomised Controlled Trials J Clinical Medicine 2021 (Oct 28); 10 (21): 5011
