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

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2008-02, Vol.33 (4 Suppl), p.S184-S191
• Main Authors: van der Velde, Gabrielle, Hogg-Johnson, Sheilah, Bayoumi, Ahmed M, Cassidy, J David, Côté, Pierre, Boyle, Eleanor, Llewellyn-Thomas, Hilary, Chan, Stella, Subrata, Peter, Hoving, Jan Lucas, Hurwitz, Eric, Bombardier, Claire, Krahn, Murray
• Format: Article
• Language: English
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Cohort Studies; Decision Support Techniques; Exercise Therapy - adverse effects; Exercise Therapy - standards; Exercise Therapy - statistics & numerical data; Female; Humans; Iatrogenic Disease - epidemiology; Life Expectancy - trends; Male; Manipulation, Spinal - adverse effects; Manipulation, Spinal - standards; Manipulation, Spinal - statistics & numerical data; Middle Aged; Models, Statistical; Neck Pain - physiopathology; Neck Pain - therapy; Patient Satisfaction - statistics & numerical data; Quality of Life; Randomized Controlled Trials as Topic - statistics & numerical data; Risk Assessment; Treatment Outcome; Vertebrobasilar Insufficiency - epidemiology; Vertebrobasilar Insufficiency - physiopathology
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e31816454f8

Decision analysis. To identify the best treatment for nonspecific neck pain. 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. (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. 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. When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior.