Evaluation of cervical pain interventions: Systematic review and meta-analysis of physical therapy, exercise, and medications

Introduction: Cervical discomfort, or neck pain, is a significant global health issue and a leading cause of disability. This systematic review and meta-analysis evaluate the effectiveness of non-surgical interventions, including physiotherapy, exercise, manual therapy, and muscle energy techniques, in reducing pain and improving function. Methods: A comprehensive search of PubMed, the Cochrane Library, and Scopus up to September 2024 identified 17 randomized controlled trials (RCTs) involving 3,286 participants. Studies comparing these interventions to placebo or other treatments were included. Exclusions applied to cases involving cancer, infections, fractures, radiculopathy, prior cervical surgery, or high-risk bias studies. Results: All interventions significantly reduced pain and improved function. Manual therapy was superior to physical therapy for pain relief (SMD -0.30), while exercise outperformed usual care for pain (SMD -0.68) and function (SMD -0.49). NSAIDs showed moderate pain relief (SMD -0.31). Conclusion: Non-surgical interventions effectively treat cervical pain, but further research is necessary to optimize strategies.