This open-label randomised controlled trial was designed to investigate spinal manipulation therapy (SMT), drug therapy, and home exercise with advice (HEA) as therapies for acute and subacute neck pain in both the short and long term.

A total of 272 subjects aged 18 to 65 years who had nonspecific neck pain for two to twelve weeks were enrolled from a university research center and a pain management clinic in Minnesota.

Subjects were randomised to twelve weeks of SMT (chiropractic manipulation with light soft-tissue massage, assisted stretching, and hot and cold packs), drug therapy (first-line therapy with nonsteroidal anti-inflammatory drugs, paracetamol, or both followed by narcotic medication or muscle relaxants), or HEA (simple self mobilisation exercises).

The primary outcome measure was participant-rated pain, measured by questionnaires at 2, 4, 8, 12, 26, and 52 weeks after randomisation. Blinded evaluation of neck motion was performed at 4 and 12 weeks.

The researchers reported that for pain, SMT had a statistically significant advantage over drug therapy after 8, 12, 26, and 52 weeks (P ≤ 0.010), and HEA was superior to drug therapy at 26 weeks (P = 0.02). No important differences in pain were found between SMT and HEA at any time point.

The researchers concluded that for participants with acute and subacute neck pain, SMT was more effective than drug therapy in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points.