Stockholm Neck trial (STONE) - A randomized controlled trial of the effect of treatment of disbling neck pain


Around 25% of women and 11% of men have neck pain, many with difficulties to perform activities and work because of neck pain. There is lack of knowledge regarding effective treatment, as well as the course of the condition and cost related aspects. Massage and exercise are treatment modalities that are often recommended but high quality evidence supporting their use is lacking.


To evaluate the effect, adverse reactions and cost-effectiveness of massage, exercise, and massage plus exercise in comparison with advice to stay active, for subacute or persistent disabling neck pain. Additionally, to describe the course of neck pain over one year.


A randomized controlled trial of 619 participants, aged 18-70, with non-specific neck pain that lasted at least 30 days, followed longitudunally over one year. The interventions were massage, exercise, massage plus exercise or advice. The data collection started in 2014 and was completed in  2016. The project is in collaboration with the Center for Disability Prevention and Rehabilitation at Ontario Tech University in Toronto, Canada.


A quarter of the patients showed an unfavorable patterns of trajectories over one year (constant or fluctuating pain of high intensity). Massage and a combined therapy were more effective than advice at reducing pain intensity in the short- but not in the long term. Exercise was more effective in the midterm (at 26 weeks). Those receiving massage, exercise or a combined therapy reported perceived recovery to a higher extent than those in the advice group during one year.

Other research questions that the project answer include:

  • What is the incidence of adverse events due to massage, exercise and a combined therapy and what is their benefit-harm profile?

  • Are these therapies cost-effective in relation to advice to stay active?

  • Are there differences in effect and risk between subgroups of patients?

  • What other factors are of importance for the prognosis?

Research Principle

Karolinska Institutet


The Swedish research council, the Swedish research council for work, health and welfare, Karolinska Institutet and the Swedish Naprapathic Association.


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Eva E. Skillgate

Visiting Professor
Content reviewer:
Anna Frantz