Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis

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.

Registration: PROSPERO CRD42019124501.