Background: One of the main causes of disability in working age is chronic neck pain (CNP). Although there were many different therapy approaches used to treat CNP, each had advantages and disadvantages.
Objectives: Comparison of the outcomes of the greater occipital nerve block (GONB) versus digital manual therapy (DMT) for patients with chronic neck pain (CNP) as regards pain, disability and quality of life (QOL).
Patients: 159 CNP patients were randomly divided into GMT (N=81) and GONB (n=78) groups. DMT was performed as two weekly sessions of 15-min each and 48-h apart for month. Distal and proximal GONB was done using lidocaine (2%) and bupivacaine (0.5%) mixture; 1:1 by volume.  At 1-m, 3-m and 6-m after the intervention outcomes were evaluated using the Numeric Ratting Scale (NRS) and the Oswestry Disability Index (ODI) to assess pain and disability. The change in type and frequency of pain medication was recorded and the extent of change in QOL was evaluated using a self-administered questionnaire.
Results: During follow-up, pain scores were significantly lower than baseline scores. However, all DMT patients had recurrent pain and 63 patients had two DMT sessions. Patients of GONB group had significantly lower pain scores than patients. The frequency of patients had minimal disability was significantly higher and that of patients receiving opioids was decreased significantly than baseline frequency especially with GONB. QOL of all patients was improved but improvement was more pronounced in GONB patients who showed significantly higher extent of change in QOL status.      
Conclusion: GONB is feasible, safe and effective therapeutic modality for CNP and provides extended pain relief with improvement of QOL. DMT could provide temporary pain relief with improved QOL especially for patients refusing GONB.