Jaime Guzman MD, MSc, FRCPC(C), Scott Haldeman DC, MD, PhD, Linda J. Carroll PhD, Eugene J. Carragee MD, FACS, Eric L. Hurwitz DC, PhD, Paul Peloso MD, MSc, FRCP(C), Margareta Nordin PT, Dr Med Sc, J. David Cassidy DC, PhD, Dr Med Sc, Lena W. Holm Dr Med Sc, Pierre Côté Dr Med Sc, Gabrielle van der Velde DC, Sheilah Hogg-Johnson PhD


March 2008, Volume 17, Issue 1, pp 199 - 213 Implications Read Full Article 10.1007/s00586-008-0637-6

First Online: 29 February 2008

Study Design

Best evidence synthesis.

Objective

To provide evidence-based guidance to primary care clinicians about how to best assess and treat patients with neck pain.

Summary of Background Data

There is a need to translate the results of clinical and epidemiologic studies into meaningful and practical information for clinicians.

Methods

Based on best evidence syntheses of published studies on the risk, prognosis, assessment, and management of people with neck pain and its associated disorders, plus additional research projects and focused literature reviews reported in this supplement, the 12member multidisciplinary Scientific Secretariat of the Neck Pain Task Force followed a 4-step approach to develop practical guidance for clinicians.

Results

The Neck Pain Task Force recommends that people seeking care for neck pain should be triaged into 4 groups: Grade I neck pain with no signs of major pathology and no or little interference with daily activities; Grade II neck pain with no signs of major pathology, but interference with daily activities; Grade III neck pain with neurologic signs of nerve compression; Grade IV neck pain with signs of major pathology. In the emergency room after blunt trauma to the neck, triage should be based on the NEXUS criteria or the Canadian C-spine rule. Those with a high risk of fracture should be further investigated with plain radiographs and/or CT-scan. In ambulatory primary care, triage should be based on history and physical examination alone, including screening for red flags and neurologic examination for signs of radiculopathy. Exercises and mobilization have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain after a motor vehicle collision. Exercises, mobilization, manipulation, analgesics, acupuncture, and low-level laser have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain without trauma. Those with confirmed Grade III and severe persistent radicular symptoms might benefit from corticosteroid injections or surgery. Those with confirmed Grade IV neck pain require management specific to the diagnosed pathology.

Conclusion

The best available evidence suggests initial assessment for neck pain should focus on triage into 4grades, and those with common neck pain (Grade I and Grade II) might be offered the listed noninvasive treatments if short-term relief is desired.


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