Castellini G, Pillastrini P, Vanti C, et al. Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis. J Physiother. 2022 Oct;68(4):244-254. doi: 10.1016/j.jphys.2022.09.007. Epub 2022 Oct 17. (Systematic review)

QUESTION: Which is the most effective conservative intervention for patients with non-specific chronic neck pain (CNSNP)?

DESIGN: A systematic review and network meta-analysis of randomised clinical trials.

PARTICIPANTS: Adults with CNSNP of at least 3 months duration.

INTERVENTIONS: All available pharmacological and non-pharmacological interventions.

OUTCOME MEASURES: The primary outcomes were pain intensity and disability. The secondary outcome was adverse events.

RESULTS: Overall, 119 RCTs (12,496 patients; 32 interventions) were included. Risk of bias was low in 50.4% of trials, unclear in 22.7% and high in 26.9%. Compared with inert treatment, a combination of active and/or passive multimodal non-pharmacological inventions (eg, exercise and manual therapy) were effective for pain on a 0-to-10 scale at 1 month (MD range 0.84 to 3.74) and at 3 to 6 months (MD range 1.06 to 1.49), and effective on disability on a 0-to-100 scale at 1 month (MD range 10.26 to 14.09) and 3 to 6 months (MD range 5.60 to 16.46). These effects ranged from possible to definite clinical relevance. Compared with inert treatment, anti-inflammatory drugs alone or in combination with another non-pharmacological treatment did not reduce pain at 1 month or 3 to 6 months. At 12 months, no superiority was found over inert treatment on both outcomes. Most mild adverse events were experienced following acupuncture/dry needling intervention. On average, the evidence varied from low to very low certainty.

CONCLUSIONS: While multimodal non-pharmacological interventions may reduce pain and disability for up to 3 to 6 months of follow-up when compared with inert treatment, the evidence was very uncertain about their effects. Better quality and larger trials are needed to improve the certainty of evidence.


Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Psychologist 5 / 7
Physician 5 / 7
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Comments from MORE raters

Psychologist rater

Given the complexities of managing chronic pain, I consider this a much-needed addition to the clinical literature. It tells us with little doubt that while there is no one answer, there are many questions that need to be explored.

Psychologist rater

Not terribly informative.

Rehab Clinician (OT/PT) rater

Critical reflection: were there no studies on pharmacological agents; although, this was the scope?
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