JMIR Publications

ABSTRACT

Background:

Neck pain poses a significant and growing public health challenge, with rising prevalence among younger populations and negative impacts on both quality of life and socioeconomic costs. Clinical manifestations are diverse, including restricted movement, muscle spasms, headaches, and upper limb numbness. Although drug therapy is widely used, its long-term use is limited by adverse effects. Traditional Chinese Medicine (TCM) exercises offer a promising alternative, but high-quality evidence directly comparing their efficacy and safety to oral medications is currently lacking.

Objective:

This study aims to compare the efficacy and safety of traditional Chinese medicine exercises and oral medication in treating neck pain.

Methods:

Relevant RCTs will be identified through a systematic search of multiple databases (including PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, CBM, VIP, and Wanfang) from inception through September 2025. Study quality will be assessed using the Cochrane RoB2 tool, and the overall evidence will be graded via the GRADE approach. For heterogeneity, the I² statistic and Cochran's Q test will be applied. A fixed-effect model is adopted if I² < 50% and P ≥ 0.1; otherwise, subgroup analysis will be performed. Should heterogeneity persist, sensitivity analysis or a random-effects model will be employed, leading to a reduction in the GRADE rating.

Results:

As of September 2025, 562 studies have undergone preliminary screening. Full-text screening is expected to conclude by December 2025, with data analysis completed in May 2026. The included studies are predominantly from Asia and mostly published after 2010.Outcomes were structured around core indicators: changes in the Visual Analogue Scale (VAS) served as the primary measure, while secondary measures included the Neck Disability Index (NDI), Self-Rating Anxiety Scale (SAS) score, mean vertebral artery blood flow velocity (Vm), and Cobb angle. Combined effect sizes with 95% confidence intervals were calculated for relevant outcomes, and adverse events were systematically summarized.

Conclusions:

If this study confirms the superiority of traditional Chinese medicine exercise therapy in managing neck pain, it will offer high-level evidence to guide clinical decision-making, support treatment optimization, and promote the standardization of such interventions. These contributions would ultimately improve neck pain prevention and rehabilitation outcomes at the public health level. However, existing studies exhibit several limitations, including insufficient standardization of exercise protocols, challenges in blinding, and notable heterogeneity due to variations in interventions and patients' cultural backgrounds. Moreover, the small number of available randomized controlled trials and their limited geographic distribution constrain the generalizability of current findings. Future high-quality, multicenter studies are needed to refine intervention protocols and expand the evidence base, thereby strengthening the reliability of conclusions in this field. Clinical Trial: CRD 420251156106