The most frequent pain outcome used was a numeric scale (n = 29). One trial reported pain outcomes using the von Korff scale ( von Korff et al 1990), and one trial reported the number of

participants who experienced improvement in neck pain. Disability outcomes were reported by 18 of the 33 eligible trials. The disability measures used included the Neck Disability Index ( Vernon and Moir 1991, n = 8), Northwick Park Neck Pain Questionnaire ( Leak et al 1994, n = 3), Million Scale ( Million et al 1982, n = 2), Neck Pain and Disability Index ( Wheeler et al 1999, n = 2), Modified Whiplash Disability Questionnaire ( Skillgate et al 2007, n = 1), and single- and multiple-item numerical scales (n = 2) ( Petrie and Hazleman 1986, Viljanen et al 2003). Selleckchem Autophagy inhibitor For all interventions, pain outcomes at the conclusion of treatment are presented in Figure 2 and at medium-and longterm follow-up in Figure 3. For all interventions, disability outcomes at the conclusion of treatment

are presented in Figure 4 and at medium-and long-term follow-up in Figure 5. (See also Tables 3 to 6 on the eAddenda for detailed data.) Medication: Two trials were identified that compared the short-term analgesic effects of medications with placebo. One trial ( Hoivik and Moe 1983) found more effective pain relief from an 8-day course of Norgesic (ie, combination orphenadrine 35mg and paracetamol 450mg) than placebo (MD –17, 95% CI –32 to –2). One trial ( Thomas et al 1991) found no significant difference in immediate pain relief between single doses LY294002 chemical structure of

diazepam (5mg) and placebo (MD –1, 95% CI –5 to 3). Neither trial reported medium- or longterm outcomes. Relaxation: One trial investigated relaxation ( Viljanen et al 2003). This three-arm trial compared intensive relaxation training with dynamic strengthening exercise and with minimal intervention in women with chronic neck pain. There was no significant difference in pain outcomes between relaxation training and minimal intervention at the conclusion of treatment (MD 2, 95% CI –4 to 8) or at medium- (MD 1, 95% CI –6 to 8), Parvulin or long-term (MD 1, 95% CI –6 to 8) follow-up. In addition, there was no significant difference in disability outcomes between relaxation training and minimal intervention at the conclusion of treatment (MD 0, 95% CI –4 to 4), medium- (MD 1, 95% CI –3 to 6), or long-term (MD 3, 95% CI –2 to 7) follow-up. Acupuncture: Five trials compared acupuncture with sham intervention. The shams used in these trials included needling procedures without skin penetration ( Itoh et al 2007, Nabeta and Kawakita 2002) and deactivated electrotherapy devices ( Petrie and Hazleman 1986, Vas et al 2006, White et al 2004). One trial compared acupuncture with minimal treatment ( Witt et al 2006).