Qigong versus Exercise versus No Therapy for Patients with Chronic Neck Pain

A Randomized Controlled Trial

Daniel Rendant, MD; Daniel Pach, MD; Rainer Lüdtke, MSc; Anett Reisshauer, MD; Anna Mietzner, MD; Stefan Willich, N. MD, MBA, MPH; Claudia Witt, M. MD, MBA

Disclosures

Spine. 2011;36(6):419-427. 

In This Article

Abstract and Introduction

Abstract

Study Design. Randomized controlled trial.
Objective. To evaluate whether qigong is more effective than no treatment and not inferior to exercise therapy.
Summary of Background Data. Lifetime prevalence of chronic neck pain is close to 50%. Qigong is often used by patients, although, the evidence is still unclear.
Methods. Patients (aged 20–60 years) with chronic neck pain (visual analog scale, VAS ≥40 mm) were randomized to 1) qigong or 2) exercise therapy (18 sessions over 6 months) or 3) waiting list (no treatment). At baseline and after 3 and 6 months, patients completed standardized questionnaires assessing neck pain (VAS), neck pain and disability, and quality of life (Short Form SF-36 questionnaire, SF-36). The primary endpoint was average pain in the last 7 days on VAS at 6-month follow-up. Statistical analysis included generalized estimation equation models adjusted for baseline values and patient expectation.
Results. A total of 123 patients (aged 46 ± 11 years, 88% women) suffering from chronic neck pain for 3.2 (SD ± 1.6) years were included. After 6 months, a significant difference was seen between the qigong and waiting list control groups (VAS mean difference: −14 mm [95% CI = −23.1 to −5.4], P = 0.002). Mean improvements in the exercise group were comparable to those in the qigong group (difference between groups −0.7 mm [CI = −9.1 to 7.7]) but failed to show statistical significance (P = 0.092). Neck pain and disability, and SF-36 results also yielded superiority of qigong over no treatment and similar results in the qigong and exercise therapy groups.
Conclusion. Qigong was more effective than no treatment in patients with chronic neck pain. Further studies could be designed without waiting list control and should use a larger sample to clarify the value of qigong compared to exercise therapy.

Introduction

Chronic neck pain is a common complaint in the general population. Recent studies have reported the point prevalence of between 5.9% and 22% and the lifetime prevalence of up to 48.5%, increasing with age. The complaint is more common among women than men.[1–4]

Not only does neck pain entail personal suffering but it also leads to high costs in the national health care systems. In the Netherlands alone, costs reached up to 1% of their total health care expenditure and 0.1% of the gross domestic product in 1996.[5,6]

There are different treatments available for chronic neck pain. Besides invasive interventions like trigger point injections or acupuncture, noninvasive treatments such as transcutaneous electrical nerve stimulation, physiotherapy or pain medication are used.

The emphasis on exercise varies from massage, strengthening exercises, isometric and dynamic muscle strengthening, and endurance training to proprioceptive exercises.[7,8] It seems these exercises reduce pain by increasing cervical spine flexibility and by improving the spine's perfusion.[9] Although there are a large number of studies evaluating the effectiveness of exercise therapy, evidence is still only moderate.[7,10–14]

The utilization of complementary and alternative medicine is growing continuously.[15,16] Qigong, a component of Chinese medicine is used in Europe. It involves meditation, controlled breathing, and movement exercises,[17] with the goal of ensuring the smooth flow of the qi to activate self-healing capacities. Literally translated qi means breath, steam, or mist.[17–19] To equate the term qi with the European concept of energy is highly controversial.[20,21]

Qigong has a long tradition. There are Chinese sources from the second century BC, which explain the breathing and movement exercises, which influence the qi. From this a tradition of qigong-exercises was developed and is practiced by many Chinese in public today.[20] Numerous qigong classes are now offered in Germany.

In recent years, there have been some studies evaluating the effect of qigong on pain. Nevertheless the evidence is still scarce.

One review of five randomized controlled trials evaluating the effect of qigong on pain in general, found a statistically positive effect compared to control treatments such as waiting list, usual care, and sham external qigong.[22]

To our knowledge, only two trials have evaluated the effectiveness of qigong for neck pain. One randomized controlled trial compared 122 patients who received qigong or exercise therapy. Both groups had significantly reduced neck pain and disability after an intervention of 3 months (12 treatments), but no differences were found between the qigong and exercise therapy.[23]

In contrast, a study in elderly patients by our group[24] evaluated the effect of qigong and exercise therapy in comparison to no treatment and found no significant differences.

The aim of this study is to compare the effectiveness of qigong versus no treatment and versus exercise therapy in adults under the age of 60 years with chronic neck pain.

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