’ Geoffrey Maitland was a giant; we mourn his passing, C59 in vitro but celebrate his life and contribution. “
“Neck pain affects up to two-thirds of people at some point during their life (Cote et al 1998). It remains one of the most common musculoskeletal complaints in primary care (Rekola et al 1993), yet many of those affected do not seek health care (Badcock et al 2003). Neck pain may be associated with specific conditions such as fracture, inflammatory disease, vascular disorders, or neurological compromise. However, for the majority of cases of neck pain, a specific cause cannot be identified
and the classification non-specific neck pain is used ( Hoving et al 2001). The efficacy of interventions for non-specific neck pain has not been well established. Although many interventions have been investigated, previous systematic reviews (Binder 2005, Gross et al 2007, Hurwitz et al 2008) have investigated a diverse group of conditions additional to non-specific neck pain including radiculopathy, whiplash, and conditions that Proteasome inhibitor commonly, though not necessarily, have concomitant neck pain (eg headache, dizziness, brachialgia, back pain, and shoulder pain). These conditions are not homogeneous in that they have different clinical presentations and they are also believed to have different mechanisms.
Better estimates of the effects of interventions for non-specific neck pain are likely to be found in trials in which all participants have non-specific neck pain. Another factor that limits understanding of the effects of interventions for non-specific neck pain is that many of the available trials compare two or more active interventions without a no-intervention control. This
type of trial is appropriate in circumstances where the efficacy of one of the interventions has been well established, or where the use of a no-intervention control might be unethical (Saunders 2003). However, in instances where the efficacy of the comparison intervention is simply presumed, there is no way of knowing whether either intervention is beneficial, ineffective, or even L-NAME HCl harmful. The use of a placebo or no intervention as a control provides a clearer answer about the efficacy of an intervention. Therefore, the research question for this review was: Which interventions for non-specific neck pain are more effective than placebo, sham, minimal intervention, or no intervention in reducing pain and disability? The databases MEDLINE, CINAHL, EMBASE, PEDro, and the Cochrane Register of Clinical Trials were searched from inception to February 2008 using a sensitive search strategy described by van Tulder et al (2003). (See Appendix 1 on the eAddenda for the full search strategy.