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Identifying the best treatment among common nonsurgical neck pain treatments: a decision analysis.

AbstractSTUDY DESIGN:
Decision analysis.
OBJECTIVE:
To identify the best treatment for nonspecific neck pain.
SUMMARY OF BACKGROUND DATA:
In Canada and the United States, the most commonly prescribed neck pain treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), exercise, and manual therapy. Deciding which treatment is best is difficult because of the trade-offs between beneficial and harmful effects, and because of the uncertainty of these effects.
METHODS:
(Quality-adjusted) life expectancy associated with standard NSAIDs, Cox-2 NSAIDs, exercise, mobilization, and manipulation were compared in a decision-analytic model. Estimates of the course of neck pain, background risk of adverse events in the general population, treatment effectiveness and risk, and patient-preferences were input into the model. Assuming equal effectiveness, we conducted a baseline analysis using risk of harm only. We assessed the stability of the baseline results by conducting a second analysis that incorporated effectiveness data from a high-quality randomized trial.
RESULTS:
There were no important differences across treatments. The difference between the highest and lowest ranked treatments predicted by the baseline model was 4.5 days of life expectancy and 3.4 quality-adjusted life-days. The difference between the highest and lowest ranked treatments predicted by the second model was 7.3 quality-adjusted life-days.
CONCLUSION:
When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior.
AuthorsGabrielle van der Velde, Sheilah Hogg-Johnson, Ahmed M Bayoumi, J David Cassidy, Pierre Côté, Eleanor Boyle, Hilary Llewellyn-Thomas, Stella Chan, Peter Subrata, Jan Lucas Hoving, Eric Hurwitz, Claire Bombardier, Murray Krahn
JournalSpine (Spine (Phila Pa 1976)) Vol. 33 Issue 4 Suppl Pg. S184-91 (Feb 15 2008) ISSN: 1528-1159 [Electronic] United States
PMID18204391 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Anti-Inflammatory Agents, Non-Steroidal
Topics
  • Anti-Inflammatory Agents, Non-Steroidal (adverse effects, therapeutic use)
  • Cohort Studies
  • Decision Support Techniques
  • Exercise Therapy (adverse effects, standards, statistics & numerical data)
  • Female
  • Humans
  • Iatrogenic Disease (epidemiology)
  • Life Expectancy (trends)
  • Male
  • Manipulation, Spinal (adverse effects, standards, statistics & numerical data)
  • Middle Aged
  • Models, Statistical
  • Neck Pain (physiopathology, therapy)
  • Patient Satisfaction (statistics & numerical data)
  • Quality of Life
  • Randomized Controlled Trials as Topic (statistics & numerical data)
  • Risk Assessment
  • Treatment Outcome
  • Vertebrobasilar Insufficiency (epidemiology, physiopathology)

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