What non-pharmacological interventions are effective for managing chronic neck pain in primary care?

Effective non-pharmacological interventions for managing chronic neck pain in primary care include supervised strengthening exercises combined with structured patient education, which may be considered especially for Grade III neck pain of 3 months duration or less. Exercise interventions should be multimodal and tailored to patient preference and availability, as no single physical exercise strategy has proven superior. Referral to occupational health is reasonable when occupational factors contribute to the pain. Psychological interventions such as cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT) should be considered for patients with persistent neck pain or psychological risk factors. For chronic neck pain lasting more than 12 weeks and unresponsive to primary care management, referral to a multidisciplinary pain management programme or pain clinic is appropriate. Additionally, advice and education about maintaining physical activity and correcting postural aspects in daily activities are recommended. Manual therapy, including spinal manipulation or mobilization combined with exercise, is also supported as part of a multimodal approach. Acupuncture may be considered as a single course delivered by trained healthcare professionals in community settings. Electrical physical modalities such as TENS, ultrasound, or interferential therapy are not recommended due to lack of evidence of benefit.