"Spinal manipulation and home exercise are more effective at relieving neck pain in the long term than medications according to new research.  People undergoing spinal manipulation therapy for neck pain also reported greater satisfaction than people receiving medication or doing home exercises.  We found that there are some viable treatment options for neck pain said Gert Bronfort vice president of research at the WolfeHarris Center for Clinical Studies at Northwestern Health Sciences University in Bloomington Minn. What we dont really know yet is how to individualize these treatments for each particular patient. All are probably still viable treatment options but what we dont know is what each particular patient will need Bronfort said adding that its possible a combination of treatments might be helpful too.  Results of the study are published in the Jan.  issue of the Annals of Internal Medicine. Funding for the study was provided by the U.S. National Center for Complementary and Alternative Medicine.  Neck pain is an extremely common problem. About threequarters of adults report having neck pain at some point in their lives according to background information in the study. Neck pain is responsible for millions of health care visits each year and it can have a negative impact on quality of life.  Spinal manipulation is one type of treatment thats offered for neck pain and it can be administered by chiropractors physical therapists osteopaths and other health care providers according to the study.  But there isnt much evidence for treating neck pain with spinal manipulation. There also isnt a great deal of information on how effective medications or home exercise programs are for treating neck pain the researchers noted.  Bronfort and colleagues thought that spinal manipulation might prove to be more effective than medications or home exercise therapy. To test their hypothesis they recruited  people between the ages of  and  who had neck pain. Their neck pain had no known cause such as a trauma or pinched nerve and the patients been experiencing the pain for between two and  weeks when the study began.  The study volunteers were randomly selected for one of three treatment groups. One group received spinal manipulations over a week period. Each individual was allowed to choose the number of spinal manipulations they felt they needed.  The second group received medications both over the counter and prescription depending on their needs. Firstline medications included nonsteroidal antiinflammatory medications or acetaminophen Tylenol. If people didnt get relief from these drugs narcotic pain medications and muscle relaxants were offered.  The third group was assigned two onehour sessions of home exercise. The goal of the homeexercise program was to improve movement in the neck area. Participants were instructed to do the exercises six to eight times per day.  At the th week  percent of people receiving spinal manipulation reported at least a  percent reduction in pain compared with  percent of those on medication and  percent doing home exercises. Also at week  of people receiving spinal manipulation  percent reported feeling a  percent reduction in pain compared with  percent on medications and  percent doing home exercises.  At one year  percent of those receiving spinal manipulation said they felt a  percent reduction in pain versus  percent of those on medications and  percent of those doing home exercises.  For me as an ER doctor this study offers an interesting perspective said Dr. Robert Glatter an attending physician in emergency medicine at Lenox Hill Hospital in New York City. Its a small study but it found that home exercises and spinal manipulation were effective. So should we be referring to physical therapists osteopaths or chiropractors from the ER  This study shows that basically neck pain will get better on its own said Dr. Victor Khabie chief of the departments of surgery and sports medicine at Northern Westchester Hospital in Mount Kisco N.Y. It wouldve been good if they had a notreatment group too he added.  Everyone heals differently. There are different pathways to healing and whether you feel youre better off with chiropractic home exercises or medications this study shows that all three are basically just as effective. Whatever your pathway to healing in about six to eight weeks you should start to feel better said Khabie.  He also noted that its important for anyone receiving spinal manipulation to know that there are rare but serious risks that can occur with neck manipulations. All three experts said anyone experiencing neck pain needs to have it evaluated to make sure there isnt a serious or correctable cause of the pain. This is especially true if youve been in a car accident or if you have any neurological symptoms such as repeatedly dropping things or if you have pain radiating down your arm.  More information Learn more about neck pain its causes and treatment from the U.S. National Library of Medicine http SOURCES Gert Bronfort D.C. Ph.D. vice president and professor research WolfeHarris Center for Clinical Studies Northwestern Health Sciences University Bloomington Minn. Robert Glatter M.D. attending physician emergency medicine Lenox Hill Hospital New York City Victor Khabie M.D. codirector Orthopedic and Spine Institute and chief surgery and chief sports medicine Northern Westchester Hospital Mt. Kisco N.Y. Jan.   Annals of Internal Medicine"