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Naprapathic Manual Therapy or Evidence-based Care for Back and Neck Pain: A Randomized, Controlled Trial

Skillgate, Eva DN* †; Vingård, Eva MD, PhD; Alfredsson, Lars PhD* §

The Clinical Journal of Pain: June 2007 - Volume 23 - Issue 5 - p 431-439
doi: 10.1097/AJP.0b013e31805593d8
Original Articles

Objectives To compare naprapathic manual therapy with evidence-based care for back or neck pain regarding pain, disability, and perceived recovery. Naprapathy that is common in the Nordic countries and in some states in the United States is characterized by manual manipulations with a focus on soft and connective tissues, aiming to decrease pain and disability in the musculoskeletal system.

Methods Four hundred and nine patients with pain and disability in the back or neck lasting for at least 2 weeks, recruited at 2 large public companies in Sweden in 2005, were included in this randomized controlled trial. The 2 interventions were naprapathy, including spinal manipulation/mobilization, massage, and stretching (Index Group) and support and advice to stay active and how to cope with pain, according to the best scientific evidence available, provided by a physician (Control Group). Pain, disability, and perceived recovery were measured by questionnaires at baseline and after 3, 7, and 12 weeks.

Results At 7-week and 12-week follow-ups, statistically significant differences between the groups were found in all outcomes favoring the Index Group. At 12-week follow-up, a higher proportion in the naprapathy group had improved regarding pain [risk difference (RD)=27%, 95% confidence interval (CI): 17-37], disability (RD=18%, 95% CI: 7-28), and perceived recovery (RD=44%, 95% CI: 35-53). Separate analysis of neck pain and back pain patients showed similar results.

Discussion This trial suggests that combined manual therapy, like naprapathy, might be an alternative to consider for back and neck pain patients.

*Institute of Environmental Medicine, Karolinska Institutet

Skandinaviska Naprapathögskolan (Scandinavian College of Naprapathic Manual Medicine)

§Stockholm Centre for Public Health, Stockholm County Council, Stockholm

Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala Universitet, Uppsala, Sweden

Grant Support: This study was financially supported by the Swedish Research Council (K2005-27VK-15355-01A), the Stockholm County Council (20050585), the Uppsala County Council, Capio (626), the Swedish Naprapathic Association and Health Care Science Post-Graduate School at Karolinska Institutet.

Reprints: Eva Skillgate, DN, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden (e-mail:

Received for publication November 28, 2006; revised February 9, 2007; accepted February 28, 2007

© 2007 Lippincott Williams & Wilkins, Inc.