~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The Raelian Movement for those who are not afraid of the future : http://www.rael.org ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Selected by Marc Rivard, raelian bishop and MD Source: email Chiropractic care = intense exercise advice for neck pain; both better than meds Clinical question Is chiropractic manipulation more effective than medical treatment or home exercise education for patients with neck pain? Bottom line Both chiropractic spinal manipulation and extensive education about home exercise (two 1-hour sessions of instruction) were more effective than standard treatment with medication to decrease symptoms in patients with mechanical neck pain. The number of dropouts was much higher in the group treated medically. (LOE = 1b-) Reference Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain. A randomized trial. Ann Intern Med 2012;156 (1 Pt 1):1-10. [PubMedÂabstract | Free full-text Ann Intern Med article PDF] Study design: Randomized controlled trial (single-blinded) Funding source: Government Allocation: Concealed Setting: Outpatient (primary care) Synopsis These investigators enrolled 272 adults who had nonspecific neck pain for an average 7 weeks. The patients were recruited by mailings and advertisements. They excluded patients with cervical spine instability or fracture, cardiac disease, or previous spine surgery, and any women who were pregnant or breastfeeding. After 2 screening appointments, the patients were randomized, using concealed allocation, into 1 of 3 groups. Spinal manipulation was performed by experienced chiropractors who determined the treatment method, frequency, and duration, an average of 15 visits over 3 months. The medication group was treated with nonsteroidal anti-inflammatory drugs, acetaminophen, or both, progressing as necessary to narcotic analgesia and muscle relaxant, again at the discretion of the treating physician (an average of 5 visits). Most patients in this group received all 3 classes of medicine. The third group consisted of 2 hours of extensive education on home exercise with instructions to complete 5 to 10 repetitions of each exercise up to 8 times per day. Pain scores were significantly better with chiropractic care or exercise than with medical treatment, both in terms of average pain scores, as well as the percent of people with at least a 50% reduction in pain. Participants dropped out of all 3 groups, though at a higher rate in the medication-treated group. There is currently no standard definition of a meaningful difference in pain, so it's hard to decide how relevant these differences are. Of note, range of motion, evaluated by an investigator who was masked to treatment group, improved most with exercise. Allen F. Shaughnessy, PharmD Professor of Family Medicine Tufts University Boston, MA Copyright Â
2012 John Wiley & Sons, Inc. www.essentialevidence.com The above message comes from "InfoPOEMs", who is solely responsible for its content. You have received this email because you requested follow-up information to an Epocrates DocAlertÂ
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