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.
Bibliographical noteFunding Information:
Source(s) of support : The work was supported by the Italian Ministry of Health “Efficacia degli interventi riabilitativi nel back pain: una network meta-analisi” (L3026). The funding sources had no controlling role in the study design, data collection, analysis, interpretation, or report writing.
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