The TAMERE Randomized Controlled Trial: Comparative Effectiveness of Topical Manual Pain Therapy Versus Exercise Therapy in Chronic Nonspecific Neck Pain

OBJECTIVES: We compared topical manual pain therapy (TMPT), a myofascial manual therapy using patient-guided pressure techniques, with exercise training, in adults with chronic nonspecific neck pain. METHODS: In this parallel (1:1) randomized controlled trial, 91 participants (68 women, 23 men) with neck pain ≥3 months were allocated to 3 weeks of TMPT ( n = 51) or exercise training ( n = 40). TMPT included six therapist-guided myofascial massage sessions; exercise training involved resistance-based neck and shoulder exercises. The primary outcome was pain intensity (100-point visual analogue scale) at 6 months. Secondary outcomes included disability, Global Rating of Change, sleep, psychological health, and adverse events. RESULTS: At the primary endpoint (6 months), there was no significant between-group difference in current pain intensity mean difference (MD; MD = 0.05 [−7.80, 7.97], P = .990) between TMPT and exercise. TMPT yielded greater short-term improvements in current pain (MD = 14.58 [−21.18, −7.98]), average pain (MD = 7.67 [−14.43, −0.91]), and disability (MD = 3.4 [−6.54, −0.42]), but these differences did not persist. No between-group differences were observed for maximal pain. Patterns were similar for disability and Global Rating of Change. No serious adverse events occurred. CONCLUSION: TMPT did not offer greater long-term benefits compared to exercise. Although short-term between-group differences favored TMPT, these did not exceed the predefined minimal clinically important difference (15 points on the visual analogue scale) and were not sustained. Future studies should explore blinded delivery, booster sessions, and combined approaches. JOSPT Open 2026;4(1):101-110. Epub 3 December 2025. doi:10.2519/josptopen.2025.0182