Acupuncture for Chronic Neck Pain

Chronic neck pain is a prevalent problem in general practice and conventional treatments have limited success. Patients are seeking acupuncture outside the NHS in increasing numbers, yet the current evidence on acupuncture for chronic neck pain is inconclusive. As a result, there is a growing public interest in knowing whether acupuncture is worth offering as a referral option in primary care.

We have conducted an open pragmatic randomised controlled trial of acupuncture for patients with neck pain to evaluate the clinical and economic impact when provided as an adjunct to normal GP management. As well as informing decisions made by patients and general practitioners, the knowledge gained on cost-effectiveness contributes to policy decisions on access to acupuncture within primary care. 

We first conducted a pilot project, led by Gemma Salter, an Medical Research Council funded MSc student at the University of York. For the pilot we recruited 24 patients and provided those randomised to acupuncture with 10 sessions of acupuncture. A paper outlining the findings in the context of designing and conducting a large scale trial has been published.(Salter et al 2006)[Free full text]

On the back of our pilot research, we were funded by Arthritis Research UK to investigate the effectiveness of acupuncture and Alexander Technique lessons in alleviating chronic neck pain. Although acupuncture and Alexander Technique lessons are frequently used by people with chronic neck pain, neither is widely available on the NHS.

In this trial, 517 people with chronic neck pain were recruited from 33 GP practices in York, Sheffield, Leeds and Manchester and their progress was followed over a 12 month-period. At all time points we found both acupuncture and Alexander Technique to be associated with statistically significantly reduced pain when compared to conventional medical care. In part this was explained by improved self-efficacy, a measure of the use made of strategies learned by patients and used to reduce pain levels without resorting to medication. This project was funded by a grant of £719,000 from Arthritis Research UK. For further details, see [Abstract] [Arthritis Today].

A number of sub-studies have been published (see right hand panel). Health economic data collected shows acupuncture to be cost-effectiveness.(Essex et al 2017)[Open Access] We published details of the acupuncture and the theory-related related life-style advice delivered and its impact on outcvome.(MacPherson et al 2017) In a parallel paper we present results on the self-efficacy and self-care-related outcomes following Alexander Technique lessons.(Woodman et al 2018) And in a longitudunal qualitative sub-study, we excplored the role of self-efficacy and embodiment associated with Alexander Technique lessons and with acupuncture sessions.(Wenham et al 2018)

In a separate study, we reported on a national survey of practice that we conducted involving teachers of the Alexander Technique (Eldred et al 2015).[Abstract]

Key publication

MacPherson H, Tilbrook H, Richmond S, Woodman J, Ballard K, Atkin K, Bland M, Eldred J, Essex H, Hewitt C, Hopton A, Keding A, Lansdown H, Parrott S, Torgerson D, Wenham A, Watt I. Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial. Ann Intern Med. 2015 Nov 3;163(9):653-62. doi: 10.7326/M15-0667.[Abstract]

Other publications:

Wenham A, Atkin K, Woodman J, Ballard K, MacPherson H. Self-efficacy and embodiment associated with Alexander Technique lessons or with acupuncture sessions: A longitudinal qualitative sub-study within the ATLAS trial. Complement Ther Clin Pract. 2018 May 1;31:308–14.[Open Access] 

Woodman J, Ballard K, Hewitt C, MacPherson H. Self-efficacy and self-care-related outcomes following Alexander Technique lessons for people with chronic neck pain in the ATLAS randomised, controlled trial. Eur J Integr Med. 2018 Jan 1;17(Supplement C):64–71.[Open Access]

Essex H, Parrott S, Atkin K, Ballard K, Bland M, Eldred J, et al. An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS). PloS One. 2017;12(12):e0178918.[Open Access]
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​MacPherson H, Elliot B, Hopton A, Lansdown H, Birch S, Hewitt C. Lifestyle Advice and Self-Care Integral to Acupuncture Treatment for Patients with Chronic Neck Pain: Secondary Analysis of Outcomes Within a Randomized Controlled Trial. J Altern Complement Med N Y N. 2017 Mar;23(3):180–7.[Open Access]

Eldred J, Hopton A, Donnison E, Woodman J, MacPherson H. Teachers of the Alexander Technique in the UK and the people who take their lessons: A national cross-sectional survey. Complement Ther Med. 2015 Jun;23(3):451–61.[Abstract]

MacPherson H, Tilbrook HE, Richmond SJ, Atkin K, Ballard K,  Bland M, et al. Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain (ATLAS): study protocol for a randomised  controlled trial. Trials. 2013 Jul 10;14(1):209.[Free full text]
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Salter G, Roman M, MacPherson H. Acupuncture for chronic neck pain: a pilot for a randomised controlled trial.   BMC Musculoskeletal Disorders. 2006. 7(1):99. [Free full text]