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.

Background: 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. Objective: This study aims to compare the efficacy and safety of TCM exercises and oral medication in treating neck pain. Methods: 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 I² statistic and Cochran Q test will be applied. A fixed-effect model will be adopted if I²<50% and P≥.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. Results: 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. Conclusions: 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.