Volume 32, Issue 2, Supplement , Pages S209-S218, February 2009
Identifying the Best Treatment Among Common Nonsurgical Neck Pain Treatments:
A Decision Analysis
Abstract
Study Design
Decision analysis.
Objective
To identify the best treatment for nonspecific neck pain.
Summary of Background Data
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.
Methods
(Quality-adjusted) life expectancy associated with standard NSAIDs, Cox-2 NSAIDs, exercise, mobilization, and manipulation were compared in a decisionanalytic 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.
Results
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.
Conclusion
When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior.
Key words: decision analysis, exercise, quality-of-life, neck pain, nonsteroidal anti-inflammatory drug, manual therapy, effectiveness, treatment risk
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The manuscript submitted does not contain information about medical device(s)/drug(s).
Provincial funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Supported by the Canadian Institutes of Health Research through a Fellowship Award (to G.v.d.V.), Canadian Institutes of Health Research through a New Investigator Award (to P.C.), Canada Research Chair in Knowledge Transfer for Musculoskeletal Care (to C.B.), and F. Norman Hughes Chair in Pharmacoeconomics (to M.K.). The views expressed in this publication are the views of the authors and do not necessarily reflect the views of the Ontario Ministry of Health and Long-term Care.
Ethics Approval: University of Toronto Ethics Review Board Protocol Reference 18807.
Reprinted from van der Velde G et al. Indentifying the best treatment among common nonsurgical neck pain treatment: a decision analysis. Spine 2008:33:S184-S191. Reprinted with permission from Lippincott Williams & Wilkins.
PII: S0161-4754(08)00348-5
doi:10.1016/j.jmpt.2008.11.021
© 2008 Lippincott Williams & Wilkins. Published by Elsevier Inc. All rights reserved.
Volume 32, Issue 2, Supplement , Pages S209-S218, February 2009
