16. Traditional Chinese Medicine for Chronic Neck Pain

Compiled by Joseph Brady MSTCM, L.Ac., Dipl. OM

Contact: taichiproj@earthlink.net | joe.brady@faculty.ccmu.edu

1529 York Street, Denver, CO 80206

Acknowledgements

Special thanks to Cheryl Wheeler and Jacqui Shumway for their invaluable assistance in verifying and formatting references. Each review is a snapshot of the best available evidence at the time of publication and will be updated regularly to reflect new research.

Author’s Note on AI Use

Artificial intelligence was used to assist with formatting, reference management, and language refinement in the preparation of this manuscript. All content, including interpretation of data and conclusions, was reviewed and verified by the author to ensure accuracy and scholarly integrity.

Introduction

Chronic neck pain (CNP) is one of the most prevalent musculoskeletal disorders, affecting up to 70% of individuals during their lifetime and contributing to substantial disability worldwide. Traditional Chinese Medicine (TCM) offers a multifaceted approach—including acupuncture, herbal medicine, traditional Chinese exercises (TCEs), and manual therapies—emphasizing individualized treatment and systemic balance. This review synthesizes the highest-quality systematic reviews, meta-analyses, and randomized controlled trials (RCTs) evaluating TCM for CNP.

Acupuncture

Acupuncture is the most extensively researched TCM modality for neck pain. A systematic review and meta-analysis by Fang et al. (2024) found significant improvements in functional impairment, with effects lasting at least three months after treatment, though pain reduction did not differ significantly from sham acupuncture at follow-up. Mechanistic studies support analgesic effects via endogenous opioid modulation and activation of descending pain inhibitory pathways (Luiz et al., 2012; Vickers et al., 2012).

Large multicenter RCTs confirm acupuncture’s safety, with adverse events rare and mild (Zhao et al., 2011). While methodological heterogeneity persists—particularly in point selection—individualized protocols reflect TCM’s pattern-based diagnostic approach. Costa and Ferreira (2022) note over 325 studies in the past two decades, highlighting the need for more high-certainty RCTs with standardized protocols.

Traditional Chinese Exercises

Evidence for TCEs such as Tai Chi, Qigong, Baduanjin, and Yijinjing is mixed but promising. A systematic review of 21 studies reported positive complementary effects on pain relief (SMD = 1.12, 95% CI [0.78, 1.45], p < .00001), with Baduanjin yielding improvements in neck flexion (SMD = 0.65, p = .0006) and extension (SMD = 0.66, p = .02) (Kong et al., 2022).

However, another meta-analysis of six RCTs (n = 716) found no significant advantage of TCEs over controls for pain intensity, functional mobility, or quality of life (Xie et al., 2021). A study combining Qigong with Tuina massage outperformed conventional neck exercise in symptom relief and recurrence reduction (Yang et al., 2023).

Herbal Medicine

High-quality evidence for herbal medicine in CNP is limited. Some traditional formulations—such as combinations of dipsacus root, eucommia, astragalus, hawthorn, and salvia—are described in patents and small trials, but robust RCT data are lacking. Veterinary studies show potential efficacy of acupuncture combined with herbal medicine for cervical conditions (Zhao, 2022), warranting human trials.

Integration with Conventional Care

Multimodal TCM health management, including acupuncture plus lifestyle and self-care strategies, achieved higher Goal Attainment Scaling scores than acupuncture alone (Qiu et al., 2022). Such approaches align with biopsychosocial models of chronic pain and may enhance patient engagement and functional recovery.

Safety

Across modalities, TCM interventions for CNP show favorable safety profiles. Adverse events are infrequent and mild when delivered by qualified practitioners. Safety data are stronger for acupuncture and TCEs than for herbal formulations, which require quality control and monitoring.

Conclusion

Current evidence supports acupuncture—particularly when integrated with broader TCM strategies—as a safe and moderately effective complementary therapy for CNP, especially for improving function. Baduanjin and other TCEs offer additional benefits, though findings are inconsistent. High-quality, standardized RCTs are needed to confirm optimal protocols, clarify the role of herbal medicine, and evaluate long-term, multimodal TCM strategies for neck pain management.

Key References (GRADE-ordered)

High quality

Fang, J., Shi, H., Wang, W., Chen, H., Yang, M., Gao, S., Yao, H., Zhu, L., Yan, Y., & Liu, Z. (2024). Durable effect of acupuncture for chronic neck pain: A systematic review and meta-analysis. Current Pain and Headache Reports, 28(9), 957–969. https://doi.org/10.1007/s11916-024-01267-x

Kong, L. J., Ren, J., Fang, S., He, T., Zhou, X., & Fang, M. (2022). Traditional Chinese exercises on pain and disability in middle-aged and elderly patients with neck pain: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Aging Neuroscience, 14, 912945. https://doi.org/10.3389/fnagi.2022.912945

Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Witt, C. M., & Linde, K. (2012). Acupuncture for chronic pain: Individual patient data meta-analysis. Archives of Internal Medicine, 172(19), 1444–1453. https://doi.org/10.1001/archinternmed.2012.3654

Moderate quality

Xie, Y. H., Liao, M. X., Wang, M. Y., Fernando, W. C. H. A., Gu, Y. M., Wang, X. Q., & Liao, L. R. (2021). Traditional Chinese mind and body exercises for neck pain: A meta-analysis of randomized controlled trials. Pain Research & Management, 2021, 5426595. https://doi.org/10.1155/2021/5426595

Costa, S., & Ferreira, A. S. (2022). Acupuncture for neck pain: Current evidence and challenges. Longhua Chinese Medicine, 5. https://doi.org/10.21037/lcm-22-8

Yang, X., Sheng, F., Weng, Z., Cheng, L., & Gong, C. (2023). Traditional Qigong exercise combined with Tuina manipulations in treating lower cervical disc herniation: Efficacy observation. Journal of Acupuncture and Tuina Science, 21(3). https://doi.org/10.1007/s11726-023-1377-1

Low quality / preliminary

Zhao, Q. (2022). Acupuncture and Chinese herbal medicine treatment for neck pain and cervical disc disease: A retrospective study in 42 dogs. American Journal of Traditional Chinese Veterinary Medicine, 17(2). https://doi.org/10.59565/001c.81914

Qiu, X., Ren, J., He, M., Ren, L., Cao, Q., Wang, J., & Wang, W. (2022). Traditional Chinese medicine health management for community-dwelling individuals with chronic neck and shoulder pain: Effectiveness assessed using Goal Attainment Scaling and associated factors. Chinese General Practice. https://www.chinagp.net/EN/Y2022/V25/I34/4292

Zhao, L., Zhang, F. W., Li, Y., et al. (2011). Adverse events associated with acupuncture: Three multicenter randomized controlled trials of 1968 cases in China. Trials, 12, 87. https://doi.org/10.1186/1745-6215-12-87

Luiz, A. B., Babinski, M. A., & Ferreira, A. S. (2012). Neurobiologia da analgesia induzida por acupuntura manual e eletroacupuntura: Revisão de literatura. Cadernos de Naturologia e Terapias Complementares, 1, 71–84. https://www.academia.edu/20990667

Yang, X., Sheng, F., Weng, Z., Cheng, L., & Gong, C. (2023). Observation on the efficacy of traditional Qigong exercise combined with Tuina manipulations in treating lower cervical disc herniation. Special Topic Study, Volume 21,pages 203–209 . doi: 10.1007/s11726-023-1377-1