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

Abstract

STUDY 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 decisionanalytic 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.

• Authors: Gabrielle 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
• Journal: Journal of manipulative and physiological therapeutics (J Manipulative Physiol Ther) Vol. 32 Issue 2 Suppl Pg. S209-18 (Feb 2009) ISSN: 1532-6586 [Electronic] United States
• PMID: 19251067 (Publication Type: Journal Article)