Acupuncture, Alexander Technique Effective in Neck Pain

Janis C. Kelly

November 04, 2015

The first randomized controlled trial to examine the effect of adding acupuncture or Alexander Technique exercises to usual care (medication and physical therapy) for chronic neck pain found promising improvements in pain reduction and self-efficacy, British researchers report in an article published in the November 3 issue of the Annals of Internal Medicine.

"Acupuncture sessions and Alexander Technique lessons both led to significant reductions in neck pain and associated disability compared with usual care at 12 months. Enhanced self-efficacy may partially explain why longer-term benefits were sustained," write Hugh MacPherson, PhD, from the Department of Health Sciences, University of York, United Kingdom.

The researchers recruited patients aged 18 years or older who had consulted their general practitioner in the last 2 years and who had neck pain lasting at least 3 months with a score of 28% or higher on the Northwick Park Questionnaire (NPQ).

They screened 1144 patients from 33 general practices and recruited a total of 517 patients. Most (69%) were female and white (90%), and median duration of prior neck pain was 72 months.

All patients received usual care and were randomly assigned to acupuncture (12 sessions, each 50 minutes long, for 600 minutes total), to Alexander Technique (up to 20 one-on-one sessions, for 600 minutes total), or to usual care only. Usual care included the neck pain–specific treatment routinely provided to primary care patients, such as medications and physical therapy.

The analysis included data for 150 acupuncture patients, 146 Alexander patients, and 146 usual care patients who completed 12 months of follow-up. On average, patients attended 10 of 12 sessions offered for acupuncture, and 14 of 20 offered Alexander lessons. However, 20% of the acupuncture group and 9% of the Alexander group paid privately for additional sessions.

The researchers found statistically and clinically significant 12-month reductions in baseline NPQ sores with acupuncture and with Alexander lessons compared with usual care. They note that the NPQ score reductions of 12.88 percentage points for acupuncture and 12.24 percentage points for Alexander lessons compare favorably with the 8 or 9 percentage point reductions seen with physical and exercise in other studies.

Table 1. NPQ Score Reductions at 12 Months vs Usual Care

Intervention Percentage Points Reduction 95% Confidence P
Acupuncture 3.92 0.97 to 6.87 .009
Alexander 3.79 0.91 to 6.66 .10

There were also significantly larger decreases in pain and disability in the intervention groups at 3 and 6 months and significantly larger improvements in the mental component scores at 12 months in the intervention groups than with usual care.

The authors write, "Over time, each intervention resulted in a greater increase in self-efficacy than did usual care, and these improvements were associated with better NPQ outcomes."

Table 2. Self-Efficacy Improvement at 6 Months

Intervention Percentage Points Reduction 95% Confidence P
Acupuncture 0.8 0.46 to 1.15 .001
Alexander 1.09 0.63 to 1.55 .001

There were no serious adverse events considered to be a result of either intervention.

The researchers conclude that both acupuncture and Alexander Technique were associated with "statistically significant and clinically relevant long-term reductions in neck pain and disability at 12 months," and that further studies are warranted to determine the optimum number of acupuncture sessions and/or Alexander lessons.

The study was supported by the University of York and Arthritis Research UK. One coauthor is a member of the Society of Teachers of the Alexander Technique. The other authors have disclosed no relevant financial relationships.

Ann Intern Med. 2015;163:653-662. Abstract

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