A new study says doctors often bypass effective treatments for chronic neck pain – like therapeutic exercise – and instead prescribe strong medicine and conduct diagnostic tests that may be unnecessary.

“It’s a problem from the standpoint that some folks may not be utilizing highly effective treatments and some folks may be continuing to use ineffective treatments. We are trying to make evidence more aware to patients and providers,” explains Adam Goode, an assistant professor of physical therapy at Duke University in Durham, N.C.

In the November issue of Arthritis Care & Research, Goode and his colleagues from Duke University and the University of North Carolina sorted through data from a 2006 telephone survey of more than 5,000 homes in North Carolina. They identified 140 people who had been experiencing chronic neck pain for nearly seven years. The patients’ search for relief involved, on average, about 21 visits with five different kinds of health care providers, 1.6 diagnostic tests and more than three different types of treatment.

More than 56 percent of participants said they had used over the counter medications to relieve their neck pain, 29 percent had taken strong opioid painkillers, such as oxycodone, and 23 percent had used weaker opioids, such as codeine – but their pain persisted. Researchers say that’s not surprising: A review of scientific literature in The Cochrane Library and The Bone and Joint Decade 2000-2010 shows medicine has limited effectiveness in treating chronic neck pain.

“I think it indicates there’s a disconnect between what we know to be effective and what people are using in the population. But why that is occurring we can’t answer in the study,” Goode says.

Forty-five percent of participants had spinal radiographs, 30 percent had MRIs and 24 percent had CT scans. But just more than half the participants were prescribed therapeutic exercise, which generally involves physical therapy for muscles that support a painful area. Studies have shown physical therapy, as well as acupuncture, are effective at reducing chronic neck pain.

“For the most part, a lot of things that have limited effectiveness are being overused and things with high effectiveness like therapeutic exercise are being underused. It gives us an idea of what’s going on. This is the first type of study that’s looked at that,” Goode explains.

While the study doesn’t answer the question of why medicine is often used instead of therapeutic exercise to treat this condition, Goode says that would be a good focus for future research.

Daniel Berland, MD, an assistant professor of medicine and anesthesiology at the University of Michigan in Ann Arbor, specializes in acute and chronic pain management. He says he believes a variety of factors are at play.

“It’s our instant-gratification society that wants to do nothing more than take a pill to be fixed, and doctors who have been incorrectly trained and don’t have time to do a full assessment,” he says. “There’s no question that doctors’ physical exam skills have waned over time and there’s an over reliance on testing and of course there’s patient demand for tests.”

Dr. Berland says while pain medicines work well in acute situations, over time patients can build up a tolerance or addiction. He believes most patients will find longer-lasting relief through other options.

“There is not a single study in the medical literature that shows there’s a benefit in improving functional outcomes – in terms of making people live their lives better – for any opioid treatment greater than 100 days,” Dr. Berland says. “The more exercise they get the better. The more they make friends with their heating pad the better.”

He says sometimes it’s not possible to eliminate pain altogether, but he believes patients are best served by regular consultations with qualified pain experts who can teach them to manage their symptoms and their expectations.

“If people walk in saying I want to have no pain they probably aren’t being realistic. They need to learn not to fight their pain but learn to live with some pain,” Dr. Berland says. “That’s the message that’s truth and once people do it they live a lot better.”