Neck pain is a common condition, affecting millions of Americans. In many cases, x-rays do not show anything visibly wrong with the neck, suggesting that the problem is a relatively subtle one involving soft tissues. (Conversely, x-rays of people without neck pain often show arthritis; this suggests that even when positive x-ray results are found in people with neck pain, they may be unrelated.) Subtle or not in origin, the discomfort of neck pain can be severe, and lead to real disability.
The cause of soft-tissue neck pain is not known. Symptoms may follow a whiplash injury, or simply arise, apparently, from bad posture or chronic tension.
NOTE: It is unclear that any conventional medicine intervention for neck pain or whiplash speeds recovery or produces any other long term benefit.9-10,20
Although several alternative treatments for neck pain have shown promise, none possess meaningful scientific substantiation.
A 2006 review of the literature found 10 controlled studies of acupuncture for chronic neck pain.21 The pooled results suggest that acupuncture may be more effective than fake acupuncture, at least in the short term. However, overall the study quality was fairly low. Subsequently, a pilot study showed that 10 weeks of acupuncture combined with physical therapy was more effective than either acupuncture or physical therapy alone for chronic neck pain, at least over the short-term.23 Other randomized trials have found that real acupuncture (versus placebo treatment) improved the quality of life in people with chronic neck pain.26,28
In another study, 124 people with chronic or acute whiplash were randomized to receive 12 sessions of real or sham electroacupuncture (electricity is applied to the acupuncture points).27 While those receiving real electroacupunture did have less pain, the results were not clinically significant, and there were no improvements in disability or quality of life. Interestingly, in a study of 177 people with chronic neck pain, fake acupuncture proved more effective than massage.5 If acupuncture does have an effect on neck pain, it is probably modest.
Millions of Americans report that chiropractic spinal manipulation has relieved their neck pain, but there is as yet little scientific evidence supporting the use of spinal manipulation for this purpose.1,2,11-12,25 Most studies have found manipulation (with or without related therapies such as mobilization or massage) to be no more effective than other treatments for this condition.
One large study (almost 200 participants) found that a special exercise program called MedX was more effective than chiropractic spinal manipulation.3 However, a study reported in 2006 showed that a single high-velocity, low-amplitude (eg, chiropractic-style) manipulation of the neck was more effective than a single mobilization procedure in improving range of motion and pain in people with neck pain.19 And a 2010 systematic review including 17 randomized trials found mixed results for the benefits of manual therapy (including manipulation and mobilization) combined with exercise.24 According to these researchers, high-quality studies showed manual therapy plus exercise to be more effective than exercise alone in the short-term, but there was no difference over the long-term.
Osteopathic manipulation, a form of treatment often compared to chiropractic, is widely believed to help neck pain, but there is as yet no meaningful scientific evidence to support its use for this condition.14 Many people with neck pain use massage therapy for relief, but, again, scientific support is lacking, and one study found fake laser acupuncture more effective than massage for neck pain.5
In one study, an ambitious holistic treatment regimen for neck pain (including craniosacral osteopathy along with Rosen Bodywork and Gestalt Psychotherapy) failed to prove more effective than no treatment.16
Other herbs and supplements sometimes recommended for neck pain, either on the basis of their use for related conditions, or because of their known medical properties, include boswellia, butterbur, chondroitin, ginger, glucosamine, proteolytic enzymes, and turmeric.
Qigong is an ancient Chinese practice involving various breathing exercises and physical postures, which are thought by its practitioners to enhance general health. In one study, Qigong was no more effective than conventional physical therapy exercise techniques in the treatment of chronic, nonspecific neck pain.22 Some benefits were also found when Qigong was combined with movement exercises in a review of 27 randomized trials with 3,005 adults. Most of the trials reviewed had biases that may have affected the final results.30
Dry cupping is an ancient technique used to treat pain. The technique involves placing cups on the skin and then removing the air from the cups to create a vacuum. In a small randomized study, 50 people with chronic neck pain were randomized to dry cupping or the wait-list (no treatment).29 Those who underwent the treatment reported a decrease in their neck pain. In the absence of a placebo control (sham cupping), however, it is not possible know whether the cupping itself led to beneficial effect in this pilot study.
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2. Gross A, Kay T, Hondras M, et al. Manual therapy for mechanical neck disorders: a systematic review. Man Ther. 2002;7:131.
3. Nelson CF, Bronfort G, Evans R, et al. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther. 1998;21:511–519.
4. White AR, Ernst E. A systematic review of randomized controlled trials of acupuncture for neck pain. Rheumatology (Oxford). 1999;38:143–147.
5. Irnich D, Behrens N, Molzen H, et al. Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain. BMJ. 2001;322:1–6.
6. Sarig-Bahat H. Evidence for exercise therapy in mechanical neck disorders. Man Ther. 2003;8:10–20.
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8. Nabeta T, Kawakita K. Relief of chronic neck and shoulder pain by manual acupuncture to tender points-a sham-controlled randomized trial. Complement Ther Med. 2003;10:217–222.
9. Dziedzic K, Hill J, Lewis M et al. Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: A pragmatic randomized controlled trial in physical therapy clinics. Arthritis Rheum. 2005 Apr 7 [Epub ahead of print].
10. Verhagen A, Scholten-Peeters G, Bie R, et al. Conservative treatments for whiplash. Cochrane Database Syst Rev. 2004;1:CD003338.
11. Haneline MT. Chiropractic manipulation and acute neck pain: a review of the evidence. J Manipulative Physiol Ther. 2005;28:520-5.
12. Gross AR, Hoving JL, Haines TA, et al. Manipulation and Mobilisation for Mechanical Neck Disorders. Cochrane Database Syst Rev. 2004;1:CD004249.
13. White P, Lewith G, Prescott P et al. Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial. Ann Intern Med. 2004;141:911-9.
14. Gross AR, Hoving JL, Haines TA, et al. Manipulation and Mobilisation for Mechanical Neck Disorders. Cochrane Database Syst Rev. 2004;1:CD004249.
15. Aigner N, Fialka C, Radda C et al. Adjuvant laser acupuncture in the treatment of whiplash injuries: a prospective, randomized placebo-controlled trial. Wien Klin Wochenschr. 2006;118:95-99.
16. Ventegodt S, Merrick J, Andersen NJ et al. A Combination of Gestalt Therapy, Rosen Body Work, and Cranio Sacral Therapy did not help in Chronic Whiplash-Associated Disorders (WAD) - Results of a Randomized Clinical Trial. Scientific World Journal. 2005;4:1055-68.
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19. Martinez-Segura R, Fernandez-de-Las-Penas C, Ruiz-Saez M et al. Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial. J Manipulative Physiol Ther. 2006;29:511-7.
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22. Lansinger B, Larsson E, Persson LC, et al. Qigong and exercise therapy in patients with long-term neck pain: a prospective randomized trial. Spine. 2007;32:2415-2422.
23. Franca DL, Senna-Fernandes V, Cortez CM, et al. Tension neck syndrome treated by acupuncture combined with physiotherapy: A comparative clinical trial (pilot study). Complement Ther Med. 2008;16:268-277.
24. Miller J, Gross A, D'Sylva J, et al. Manual therapy and exercise for neck pain: a systematic review. Man Ther. 2010;15(4):334-354.
25. Martel J, Dugas C, Dubois JD, Descarreaux M. A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain. BMC Musculoskelet Disord. 2011;12:41.
26. Sun MY, Hsieh CL, Cheng YY, et al. The therapeutic effects of acupuncture on patients with chronic neck myofascial pain syndrome: a single-blind randomized controlled trial. Am J Chin Med. 2010;38(5):849-859.
27. Cameron ID, Wang E, Sindhusake D. A Randomized trial comparing acupuncture and simulated acupuncture, for sub-acute and chronic whiplash. Spine. 2011 Apr 7.
28. Liang Z, Zhu X, Yang X, Fu W, Lu A. Assessment of a traditional acupuncture therapy for chronic neck pain: a pilot randomised controlled study. Complement Ther Med. 2011;19 Suppl 1:S26-32.
29. Lauche R, Cramer H, Choi KE, et al. The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain--a randomised controlled pilot study. BMC Complement Altern Med. 2011;11:63.
30. Gross A, Kay TM, Paquin JP, et al. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2015;1:CD004250.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 12/15/2015
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