Combined Chiropractic Care and Tai Chi for Chronic Non-Specific Neck Pain

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Chronic nonspecific neck pain (CNNP), which is not due to organic pathology, is responsible for significant direct health care costs, health care provider visits, and work-related productivity loss. Though one of the top five chronic pain conditions in terms of prevalence and years lost to disability, to date, neck pain has received only a small fraction of the research funding given to low back pain. Consequently, there is a limited evidence base to guide management. Both pharmacological and non-pharmacological interventions are widely used to manage CNNP, but effect sizes are, at best, low to moderate, and no one therapy stands out as superior. CNNP is best understood from a biopsychosocial framework that recognizes etiology, severity, and outcomes as a complex and interrelated array of biological, psychological and social factors and points to the promise of complementary and integrative health approaches for successful disease management and treatment. Accordingly, this application explores the feasibility of pragmatically delivering and clinically evaluating the combined impact of two widely available approaches for managing CNNP––chiropractic care and Tai Chi (TC). These specific modalities were chosen because both individually show promise in managing CNNP, and based on their complementary approaches, strengths, and therapeutic components, there is a strong likelihood of additive or synergist effects when the two are delivered in a coordinated manner. Our long-term goal is to conduct a multi-site fully powered trial evaluating the effectiveness of chiropractic care combined with TC training to reduce pain and disability in adults with CNNP. As a first step, we propose to conduct a three-arm, mixed-methods pilot study. We will recruit and randomize (1:1:1) 48 adults with CNNP to receive: 1) 10 chiropractic treatments (delivered over 16 weeks) with concurrent TC training (16 weeks of in- person group training) plus enhanced usual care (EUC; usual care (UC) with CNNP educational materials); 2) chiropractic care plus EUC; or 3) EUC alone. Individuals will be followed for 8 weeks after the end of their intervention period to assess longer-term outcomes. Aim 1 will evaluate our ability to recruit a network of chiropractors and Tai Chi instructors, refine our interventions, and assess fidelity of intervention protocols. Aim 2 will assess the feasibility of recruiting, retaining and monitoring the safety of adults with CNNP into our trial. Aim 3 will refine data collection procedures and evaluate outcomes for future trials. Given the widespread availability of chiropractic and TC nationally, if proven effective, this multimodal approach for treating CNNP could represent a practical strategy with immediate public health impact. This application aligns with NCCIH’s 2021-2025 Strategic Plan, including advancing research on the whole person and investigating non-pharmacological pain management strategies that can improve first-line chronic pain management.