Report took 4 years to complete. The scientific basis for more than 30 different treatments was systematically reviewed. For the majority of these thare are either no evidence or limited evidence in favor of treatment. For some modalities there is strong or moderate evidence against their effectiveness, eg, by traction, aerobics, stretching, and bed rest. For a minority of treatments there isstrong evidence of effectiveness, eg, for antiinflammatory and muscle relaxant drugs, manual treatment, manipulation, exercise, multidisciplinary treatment, spa treatment, and continuation of normal activities.
Radiographic studies are of limited value.
For neck pain, the evidence is sparse. Psychological and social factors may have a strong influence on back and neck pain. Healing is promoted by staying active, returning to work, and exercising at an appropriate intensity. A thorough anamnesis and physical examination is important for relieving anxiety about the consequences of pain and sufficient for identifying those who should be referred to a specialist. For most patients with back pain, the interventions that can be offered in primary care are the only ones needed.