{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:48:09Z","timestamp":1782841689877,"version":"3.54.5"},"reference-count":36,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to compare the efficacy and safety of TCM exercises and oral medication in treating neck pain.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We will identify relevant randomized controlled trials (RCTs) through a systematic search of multiple databases (including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure [CNKI], Chinese Biomedical Literature Database [CBM], VIP, and Wanfang) from inception through September 2025. Only RCTs directly comparing TCM exercise to oral medication will be included. Study quality will be assessed using the Cochrane RoB2 tool, and the overall evidence will be graded via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. For heterogeneity, the\n I<\/jats:italic>\n \u00b2 statistic and Cochran Q test will be applied. A fixed-effect model will be adopted if\n I<\/jats:italic>\n \u00b2<50% and\n P<\/jats:italic>\n \u2265.10; 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.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n This is a study protocol; therefore, no results are available at this stage. The systematic review is scheduled to commence in August 2025, with the literature search from August to September 2025, study screening from September to December 2025, data extraction and analysis from January to May 2026, and manuscript submission by June 2026.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This protocol outlines a systematic review and meta-analysis designed to compare the efficacy and safety of TCM exercises versus oral medications for neck pain. The completed review aims to synthesize the available evidence and clarify whether TCM exercises offer a comparable or superior alternative to pharmacotherapy. By systematically evaluating direct head-to-head RCTs, this study seeks to provide evidence-based insights to inform clinical decision-making. Potential limitations of the forthcoming review may include heterogeneity in exercise protocols, challenges in blinding, and a possible limited number or geographic concentration of available trials, which could affect the generalizability of the findings. These limitations will be considered when interpreting the results.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/86168","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T07:45:05Z","timestamp":1773647105000},"page":"e86168-e86168","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Traditional Chinese Medicine Exercise Versus Oral Medication in the Treatment of Neck Pain: Study Protocol for a Systematic Review and Meta-Analysis"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0078-0377","authenticated-orcid":false,"given":"Guancheng","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4283-0807","authenticated-orcid":false,"given":"Yuanming","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5731-191X","authenticated-orcid":false,"given":"Shichang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2764-7140","authenticated-orcid":false,"given":"Haoran","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4053-4316","authenticated-orcid":false,"given":"Jie","family":"Si","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6202-5109","authenticated-orcid":false,"given":"Yan","family":"Long","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9380-5259","authenticated-orcid":false,"given":"Jinyu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2025.10.017","article-title":"Trends in global musculoskeletal rehabilitation needs from 1990 to 2050: a systematic analysis of the Global Burden of Disease Study 2021","author":"Li","journal-title":"Arch Phys Med Rehabil"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m791","article-title":"Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017","volume":"368","author":"Safiri","journal-title":"BMJ"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-021-04957-4","article-title":"Neck pain: global epidemiology, trends and risk factors","volume":"23","author":"Kazeminasab","journal-title":"BMC Musculoskelet Disord"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2025.103290","article-title":"The occurrence of cervicogenic headache: a mapping review","volume":"77","author":"Mingels","journal-title":"Musculoskelet Sci Pract"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2017.11.007","article-title":"Identifying risk factors for first-episode neck pain: A systematic review","volume":"33","author":"Kim","journal-title":"Musculoskelet Sci Pract"},{"issue":"7592","key":"R6","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1136\/bmj.39127.608299.80","article-title":"Cervical spondylosis and neck pain","volume":"334","author":"Binder","journal-title":"BMJ"},{"issue":"4 Suppl","key":"R7","doi-asserted-by":"publisher","first-page":"S39","DOI":"10.1097\/BRS.0b013e31816454c8","article-title":"The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders","volume":"33","author":"Hogg-Johnson","journal-title":"Spine (Phila Pa 1976)"},{"issue":"9","key":"R8","doi-asserted-by":"publisher","first-page":"2242","DOI":"10.1007\/s00586-017-5121-8","article-title":"National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy","volume":"26","author":"Kjaer","journal-title":"Eur Spine J"},{"issue":"21","key":"R9","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.1136\/bjsports-2020-102664","article-title":"Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials","author":"de Zoete","journal-title":"Br J Sports Med"},{"issue":"6","key":"R10","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1007\/s11916-024-01218-6","article-title":"Comparative efficacy of mind-body exercise for treating chronic non-specific neck pain: a systematic review and network meta-analysis","volume":"28","author":"Gao","journal-title":"Curr Pain Headache Rep"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000319.pub4","article-title":"Medicinal and injection therapies for mechanical neck disorders","author":"Peloso","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"R12","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1007\/s10787-023-01405-8","article-title":"Effect of use of NSAIDs or steroids during the acute phase of pain on the incidence of chronic pain: a systematic review and meta-analysis of randomised trials","volume":"32","author":"Huo","journal-title":"Inflammopharmacology"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","first-page":"143","DOI":"10.14336\/AD.2017.0306","article-title":"A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly","volume":"9","author":"Wongrakpanich","journal-title":"Aging Dis"},{"issue":"2","key":"R14","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1007\/s40122-020-00193-1","article-title":"Real-world evidence in prescription medication use among U.S. adults with neck pain","volume":"9","author":"Huang","journal-title":"Pain Ther"},{"issue":"16","key":"R15","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1097\/BRS.0000000000002078","article-title":"Does postural awareness contribute to exercise-induced improvements in neck pain intensity? A secondary analysis of a randomized controlled trial evaluating Tai Chi and neck exercises","volume":"42","author":"Lauche","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"R16","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.jphys.2022.09.007","article-title":"Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis","volume":"68","author":"Castellini","journal-title":"J Physiother"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S482424","article-title":"Traditional Chinese Rehabilitation Exercise (TCRE) for myofascial pain: current evidence and further challenges","volume":"17","author":"Liu","journal-title":"J Pain Res"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2022.912945","article-title":"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","volume":"14","author":"Kong","journal-title":"Front Aging Neurosci"},{"issue":"9","key":"R19","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1016\/j.jpain.2016.06.004","article-title":"The effects of Tai Chi and neck exercises in the treatment of chronic nonspecific neck pain: a randomized controlled trial","volume":"17","author":"Lauche","journal-title":"J Pain"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1455679","article-title":"Effect of traditional Chinese exercises on the physical and mental health of stroke patients: a meta-analysis","volume":"15","author":"Shao","journal-title":"Front Neurol"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctcp.2022.101679","article-title":"Effectiveness of mind-body exercise via Baduanjin on physical and psychological outcomes in patients with pulmonary ground-glass nodules: a non-randomized controlled pilot study","volume":"50","author":"Lu","journal-title":"Complement Ther Clin Pract"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-024-07194-7","article-title":"Effects of traditional Chinese exercise therapy on pain scores, sleep quality, and anxiety-depression symptoms in fibromyalgia patients: a systematic review and meta-analysis","volume":"25","author":"Wang","journal-title":"BMC Musculoskelet Disord"},{"issue":"10","key":"R23","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1097\/PHM.0b013e31825f1a67","article-title":"Tai chi treatment for depression in Chinese Americans: a pilot study","volume":"91","author":"Yeung","journal-title":"Am J Phys Med Rehabil"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1347201","article-title":"Evidence map of traditional Chinese exercises","volume":"12","author":"Yu","journal-title":"Front Public Health"},{"issue":"2","key":"R25","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/j.mayocp.2014.09.008","article-title":"Epidemiology, diagnosis, and treatment of neck pain","volume":"90","author":"Cohen","journal-title":"Mayo Clin Proc"},{"issue":"2","key":"R26","doi-asserted-by":"publisher","first-page":"514","DOI":"10.5114\/aoms\/190029","article-title":"Temporal trends in neck pain prevalence among adolescents and young adults aged 10-24 from 1990 to 2019","volume":"21","author":"Fu","journal-title":"Arch Med Sci"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.14.04066","article-title":"Burden of neck pain in general population of China, 1990-2019: an analysis for the Global Burden of Disease Study 2019","volume":"14","author":"Xia","journal-title":"J Glob Health"},{"issue":"7","key":"R28","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1136\/annrheumdis-2013-204431","article-title":"The global burden of neck pain: estimates from the global burden of disease 2010 study","volume":"73","author":"Hoy","journal-title":"Ann Rheum Dis"},{"issue":"2","key":"R29","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1002\/ejp.1679","article-title":"Evidence-based treatment recommendations for neck and low back pain across Europe: a systematic review of guidelines","volume":"25","author":"Corp","journal-title":"Eur J Pain"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2023.1290471","article-title":"Exploring the efficacy of traditional Chinese medicine exercise in alleviating anxiety and depression in older adults: a comprehensive study with randomized controlled trial and network meta-analysis","volume":"14","author":"Dong","journal-title":"Front Psychol"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-024-02737-4","article-title":"Comparative effectiveness of manual therapy, pharmacological treatment, exercise therapy, and education for neck pain (COMPETE study): protocol of a systematic review with network meta-analysis","volume":"14","author":"de Oliveira-Souza","journal-title":"Syst Rev"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1139483","article-title":"Effects of traditional Chinese exercises on the rehabilitation of patients with chronic heart failure: a meta-analysis","volume":"11","author":"Dai","journal-title":"Front Public Health"},{"issue":"1","key":"R33","doi-asserted-by":"publisher","DOI":"10.1186\/s13020-018-0165-1","article-title":"SWOT analysis and revelation in traditional Chinese medicine internationalization","volume":"13","author":"Tang","journal-title":"Chin Med"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2025.103774","article-title":"Global research on the treatment of cancer patients during the COVID-19 pandemic: visualisation and bibliometric analysis","volume":"40","author":"Chen","journal-title":"Clin Oncol (R Coll Radiol)"},{"issue":"1","key":"R35","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1037\/1099-9809.14.1.10","article-title":"Stigma and beliefs of efficacy towards traditional Chinese medicine and Western psychiatric treatment among Chinese-Americans","volume":"14","author":"Yang","journal-title":"Cultur Divers Ethnic Minor Psychol"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctim.2025.103127","article-title":"The efficacy and safety of Baduanjin exercise as complementary therapy for pain reduction and functional improvement in knee osteoarthritis: a meta-analysis of randomized controlled trials","volume":"88","author":"Tian","journal-title":"Complement Ther Med"}],"container-title":["JMIR Research Protocols"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e86168","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:14:10Z","timestamp":1782839650000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e86168"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":36,"URL":"https:\/\/doi.org\/10.2196\/86168","relation":{},"ISSN":["1929-0748"],"issn-type":[{"value":"1929-0748","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]},"article-number":"v15i1e86168"}}