Neck pain – whats the most cost effective treatment?

One question we’re often asked is “is chiropractic cost effective?” – it’s a fair question because compared with taking some cheap painkillers and ignoring the pain, getting professional chiropractic care is definitely more expensive. The problem with this approach to the question is that it ignores the real costs of pain – the reduced quality of life, lost time at work, and overall lower productivity. What’s worse is the longer the pain is ignored, the worse it (and its impact on your life!) tends to get.


Chronic pain is an epidemic!

Chronic pain is one of the most common conditions faced today, this is true in the UK and worldwide. One recent study suggested that chronic pain affects more U.S. adults than heart disease, diabetes, and cancer combined.[1]  It’s probably back pain, and especially lower back pain which we focus on the most when we talk about chronic pain – but neck pain is also a substantial problem which is sometimes overlooked. Indeed, similar researched showed that Neck pain is the third most common chronic pain condition in the U.S.[2] and the fourth leading cause of disability worldwide.[3] Up to 22% of older adults experience neck pain, which is associated with diminished physical function and overall health.[4]


How do we treat neck pain?

There are two main approaches to treating neck pain – these are Manipulative therapies (such as chiropractic) and what is broadly termed “therapy and exercise” – this subset of treatment encompasses specialist therapy, such as sports therapy, as well as home-based exercise for self-management of neck pain.[5]  There is still research going on to determine the most effective way to treat neck pain, but there is now evidence to suggest that a combination of spinal manipulative therapy with home exercise results in less neck pain compared to home exercise alone.[6]

What has been far less clear, however, is which of these common treatments is the most cost-effective option for neck pain sufferers.


Treating neck pain – what’s the most cost-effective approach?

A 2016 study[7] worked to fill this gap and gave us out first indication of which treatment was, in essence, the best value for money. The study focused in particular on Older adults (≥65 years old) with chronic mechanical neck pain (≥3 months duration), but who did not have any other unstable medical conditions.

The clinical trial was conducted within a University-based outpatient research clinic in the Minneapolis, Minnesota metropolitan area from 2004 to 2008. Participants were recruited from the general public using newspaper advertisements, direct mailings, and community posters.

As part of the study, participants were randomly assigned to 12 weeks of treatment with one of three common approaches – these were:

Home Exercise and Advice (HEA):   Participants in the HEA group received four, one hour sessions with an exercise therapist or chiropractor who provided appropriate neck and shoulder exercises to do at home. In addition to the home exercise instruction, general information regarding neck pain and advice on self-management (e.g. ice, heat, ergonomics) was provided.

Chiropractic care (Spinal Manipulative Therapy (SMT)) + HEA:   Participants in the SMT+HEA group received the same four, one-hour sessions of exercise instruction and advice, but also benefited from a maximum of 20 sessions of chiropractic adjustment with a chiropractor. The number and frequency of treatments were determined by the chiropractor, in line with best practice.

Supervised Rehabilitative Exercise (SRE) + HEA:   Participants in the SRE+HEA group received four, one-hour sessions of home exercise advice in addition to 20 one-on-one supervised one hour sessions of supervised specialist exercise provided by exercise therapists. The exercises consisted of neck and upper body strengthening using rubber tubing in addition to stretching, balance, and coordination exercises. Emphasis was placed on high repetitions and progressively increased resistance. Exercises were preceded by a light aerobic warm-up.

The study investigators also took into account the cost of treatment (which was averaged across the participating regions) as well as the indirect cost to patients, such as travel.

After factoring for the cost of lost time at work, the cost and frequency of treatment, and other additional costs associated with treatment, the investigators concluded that Chiropractic care, coupled with home exercise advice resulted in the lowest mean costs ($2,198) followed by HEA alone ($2,305) and SRE+HEA ($4,129) in last place.

Not only was chiropractic plus home exercise the cheapest approach, when all factors were considered, on average, SMT+HEA also resulted in better clinical outcomes for patients – a clear winner!


Neck pain treatment at Complete Chiropractic

At Complete Chiropractic we have always preferred the combination of chiropractic care and home-based exercise advice as the best way to treat neck pain. The study results discussed in this blog only goes to confirm what we have along believed!

If neck pain is slowing you down, why not try the most cost effective solution at an even better price with our new patient special!







[1] Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research Washington (DC): National Academies Press; 2011.

[2] Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH.

The prevalence of chronic pain in United States adults: results of an Internet-based survey. The journal of pain : official journal of the American Pain Society. 2010;11(11):1230–9

[3] Hoy D, March L, Woolf A, et al. The Global Burden of Neck Pain: Estimates From the Global Burden of Disease 2010 Study Ann Rheum Dis. 2014 (Jul); 73 (7): 1309–1315

[4] Hartvigsen J, Christensen K, Frederiksen H.  Back and neck pain exhibit many common features in old age: a population-based study of 4,486  Danish twins 70–102 years of age.
Spine (Phila Pa 1976) 2004;29(5):576–80 Patel KV, Guralnik JM, Dansie EJ, Turk DC.  Prevalence and impact of pain among older adults in the United States:  findings from the 2011 National Health and Aging Trends Study.  Pain. 2013;154(12):2649–57

[5] Hurwitz EL. Epidemiology: Spinal Manipulation Utilization J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 648–654

Freburger JK, Carey TS, Holmes GM, et al. Exercise prescription for chronic back or neck pain: who prescribes it? who gets it?

What is prescribed? Arthritis Rheum. 2009;61(2):192–200

[6] Maiers M, Bronfort G, Evans R, et al. Spinal Manipulative Therapy and Exercise For Seniors with Chronic Neck Pain Spine J. 2014 (Sep 1); 14 (9): 1879–1889

Maiers M, Evans R, Hartvigsen J, Schulz C, Bronfort G. Adverse Events Among Seniors Receiving Spinal Manipulation and Exercise in a Randomized Clinical Trial Manual Therapy 2015 (Apr); 20 (2): 335–341

[7] Brent Leininger et al. Cost-effectiveness of Spinal Manipulative Therapy, Supervised Exercise, and Home Exercise for Older Adults with Chronic Neck Pain Spine J. 2016 (Nov); 16 (11):  1292–1304

Blog by / March 1, 2019 / Blog

Dr. Paul Irvine is a doctor of chiropractic who graduated in 1994 with a Bachelor of Science degree from the University of NSW and in 1996, attained his Master of Chiropractic degree from Macquarie University in Australia. He practised in North Sydney for 5 years before he left Australia to travel and practise in the UK. He joined Complete Chiropractic in 2003 (est 1999) and took over the clinic in 2007