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Neck Pain quick look
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This chart rates treatment options according to general effectiveness, ease of use,
side effects and safety.
Active physical (exercise) therapy
(physiotherapy)
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Very good
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Safe and effective. Exercises are effective for reducing pain and improving function. In people with whiplash starting exercises early (within 3 days) is better than resting and using a soft collar. Exercises can be explained by a therapist and performed at home. Many times neck pain heals with no treatment in a few days. In some cases exercises can speed recovery.
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Active physical (exercise) therapy
Active physical therapy (exercise) is more effective than passive therapy (ultrasound, stretching). It is not clear whether therapy is helpful for chronic neck pain.
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Pulsed Electromagnetic Field Therapy
(PEMF)
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Fair
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Some studies show that electromagnetic therapy may be effective in reducing pain. Not widely available. Small home units are very expensive ($3-4,000), and twice daily treatments at an office or hospital are also expensive. Safe. Not to be confused with magnetic necklaces or other magnetic clothing, that have no effect in studies.
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Pulsed Electromagnetic Field Therapy
2 trials of electromagnetic therapy were of good quality and showed that people with neck problems had reduced pain compared to placebo (sham) treatment. It is still considered an experimental treatment, and is not widely available.
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Non-steroidal Anti-inflammatory Drugs
(Motrin/ibuprofen, Aleve/naproxen, aspirin, many others)
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Fair
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Safe and effective for most people.There is little research on anti-inflammatory drugs for neck pain. National guidelines and spine experts recommend these drugs for short term (less than 3 months) treatment of neck pain. Many anti-inflammatories can be bought over the counter. These drugs have side effects such as upset stomach. They can also interact with other medications and should generally not be used in persons with certain medical conditions such as stomach ulcers.
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Non-steroidal Anti-inflammatory Drugs
These drugs have not been studied for long-term treatment of chronic neck pain. Taking them with milk or food, and limiting the strength of the pill may help prevent stomach problems. The benefits of the medications need to be weighed against the potential side effects which can include gastrointestinal bleeding and kidney problems.
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Opioid analgesics
(Narcotic medications)
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Fair
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Effective for pain, but safety is an issue. These drugs are recommended by some experts for short term treatment of severe pain. These drugs should not be used long-term because of their potential for addiction.
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Opioid analgesics
These drugs have not been studied for long-term treatment of chronic neck pain. The benefits of the medications need to be weighed against the potential side effects which include drowsiness, constipation, and addiction.
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Muscle Relaxants
(Soma/carisoprodol, Flexeril/cyclobenzaprine, Robaxin/methocarbamol, Valium/diazepam, many others)
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Fair
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Safe for most people, somewhat effective Muscle relaxants are often recommended for short term treatment of neck pain, particularly when muscle spasm is contributing to the pain.
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Muscle Relaxants
Most research on muscle relaxants involves people with whiplash. Although these drugs are often used for neck pain that is not due to whiplash, it is unclear how well these drugs work in other types of neck pain. Soma, particularly, is often avoided because it has some addictive potential.
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Cervical Collar
(Soft foam neckbrace)
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Poor
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Safe and effective, although inconvenient. Inexpensive. A cervical collar may increase comfort for the first few days, but should not be worn for longer than a few days or while driving, because it can limit movement of the neck. Cervical collars are not effective for chronic neck pain (neck pain that has gone on for weeks or months).
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Cervical Collar
People who were told to gradually increase their usual activities following a neck injury did better than people who were given a collar and told to rest for a few days. Wearing a collar may slow recovery from neck pain if used for too long, but may increase comfort if used soon after an injury. Taking off the collar and doing some exercises seems to be the best compromise.
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Epidural steroid injections
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Good
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Safe in skilled hands. Effective only for some. Expensive and inconvenient. Epidural steroid injections are sometimes used in people with long-standing neck pain who also have nerve involvement in order to avoid or delay surgery. Epidural injections are only performed by specialists (such as an anesthesiologist or surgeon.
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Epidural steroid injections
Epidural steroid injection refers to the injection of steroids into the space around the spinal nerves. People generally feel immediate relief as a result of the anesthetic that is used. Symptoms may worsen the next day as the anesthetic wears off, but then improve on the second or third day after the procedure, as the steroid begin to take effect.
These injections have not been well studied for neck pain without nerve involvement, and the studies that do exist are small and contradictory. For those with nerve involvement some early studies are promising, but long term results are not yet available. There are no good studies comparing injections to surgery.
Two high quality studies have shown that the injections were not effective for chronic neck pain (pain that lasts more than 6 weeks) in those who do not have nerve involvement.
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Surgery
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Fair
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Effective for some people. Expensive. Inconvenient. Has all of the complications associated with surgery and anesthesia, as well as the risk of possible further damage to the nerves involved. Surgery is sometimes recommended for individuals with nerve involvement who have long-standing severe pain and have failed all other treatments. Studies have shown that those who have surgery get better faster than those who just have injections, but that long-term results are no different for patients treated without surgery.
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Surgery
The decision about whether to have surgery is complicated. It needs to be made in consultation with the primary care physician, the neurologist, the surgeon, and the person with pain; and depends on the amount of pain and weakness, on the individual's work and activity level, and the skill and availability of good surgical care.
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Percutaneous Radio-frequency Neurotomy
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Good
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This surgery involves of inserting a needle into the skin overlying the nerves, guided by X-rays, and then burning the nerves that cause chronic neck pain. It has been quite successful in reducing pain and is safe in skilled hands. It is expensive.
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Percutaneous Radio-frequency Neurotomy
This technique has only been well studied in people with chronic neck pain that was caused by whiplash. It is unclear whether this treatment is as helpful for chronic neck pain from causes other than whiplash.
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Manual Treatments
(manipulation or mobilization)
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Not available
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There is not enough evidence from clinical trials to recommend for or against manual therapy for acute neck pain (less than a few weeks). Manual therapy is not recommended for chronic neck pain.
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Manual Treatments
Results of clinical trials comparing manual therapy to exercise and to other conventional treatments for acute neck pain have been inconclusive. There is good evidence that manual treatments are not effective for chronic neck pain.
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Education
(advice, neck school, group instruction)
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Not available
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There is not enough evidence from clinical trials to recommend for or against education as an intervention for neck pain
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Education
Only three clinical trials have studied education. Two were too small to draw any conclusions and the third was of poor quality. More research is needed to see if education for individual with neck pain improves outcomes. Education is helpful for many other longstanding conditions, such as arthritis, and is not harmful, so may be worth trying.
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Acupuncture
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Not available
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There is not enough evidence from clinical trials to recommend for or against acupuncture as a treatment for acute neck pain (lasting less than several weeks). Acupuncture has not been found to be effective for chronic neck pain.
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Acupuncture
Reviews of clinical trials have found inconsistent findings among various trials. Further studies are needed to clarify whether acupuncture provides any benefit for neck pain. There are good studies showing that acupuncture was not helpful for chronic neck pain.
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Massage
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Not available
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There is not enough evidence from clinical trials to recommend for or against massage as a treatment for neck pain
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Massage
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Traction
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Not available
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Based on the studies done thus far, it is unclear as to whether traction is helpful for acute neck pain (lasting less than several weeks). Traction is not helpful for chronic neck pain.
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Traction
Traction may benefit certain types of neck pain (such as pain due to a disc), but the studies done thus far haven't adequately separated and studied different groups of people with neck pain.
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Therapeutic Ultrasound
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Not available
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Studies have not found ultrasound to be helpful for chronic neck pain. There is not enough information to know whether ultrasound is helpful for acute neck pain.
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Therapeutic Ultrasound
Several studies have confirmed that ultrasound is not helpful for chronic neck pain. No studies have been done on ultrasound for acute neck conditions.
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Transcutaneous Electrical Nerve Stimulation
(TENS)
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Not available
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There is not enough research to show whether TENS is helpful for neck pain.
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Transcutaneous Electrical Nerve Stimulation
Two guideline panels have recommended against using TENS for neck pain because there is not enough scientific evidence. TENS may be helpful for certain types of neck pain, but more research is needed.
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Anti-depressant medications
(Prozac/fluoxetine, Celexa/citalopram, Zoloft/sertraline, many others)
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Not available
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These drugs have not been studied specifically in neck pain. There are many studies showing that they are effective for chronic back pain. Some experts do recommend anti-depressants for people with chronic neck pain.
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Anti-depressant medications
There is an association between depression and many types of chronic pain. Antidepressants have been found to relieve many other types of chronic pain.
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Laser Therapy
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Very poor
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Low-Level Laser therapy has not been found to be effective for acute or chronic (lasting more than six weeks) neck pain.
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Laser Therapy
3 clinical trials have not shown any benefit of laser therapy over placebo (sham) treatment.
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Back
Very Good 
Good 
Fair 
Poor 
Not available 
