Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis

Review written by Dr Julia Treleaven info

Key Points

  1. A combination of active and/or passive multimodal non-pharmacological treatments (e.g. exercise and manual therapy) may be most effective for chronic non-specific neck pain.
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Several conservative interventions are recommended for the management of chronic non-specific neck pain (CNSNP) (1). Often a multimodal approach consisting of manual therapy and exercise is recommended (1) but education, acupuncture, taping, mind-body practices and medications can also be included in the multimodal approach. Previous systematic reviews have usually considered pairwise comparison of different treatments and haven’t considered the full scope of conservative interventions (2,3).

This article was a systematic review and meta-analysis of the literature to determine the most effective conservative management for pain intensity and disability in those with CNSNP. The study included all pharmacological and non-pharmacological interventions and to consider both benefits and harms, they also considered adverse events in association with these treatments.

A multimodal approach consisting of manual therapy and exercise is recommended for chronic non-specific neck pain.
This study endorses a multimodal approach for chronic non-specific neck pain that includes both exercise and manual therapy.


  • Studies were only considered if they were a randomized controlled trial (RCT) of one or no more than two combined conservative interventions compared to inert treatment including no treatment, placebo and sham treatments.
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