Ketorolac tromethamine injected intramuscularly (IM) has been shown to be an effective analgesic in treating patients with acute musculoskeletal pain in the emer- gency department (ED). The authors compare the efficacy of a single dose of IM ketorolac to osteopathic manipula- tive treatment (OMT) as delivered in the ED for the man- agement of acute neck pain. A randomized clinical trial was conducted in three EDs.