Implications and Recommendations From the Neck Pain Task Force
Clinical Practice Implications of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: From Concepts and Findings to Recommendations

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Abstract

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 12-member 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 4 grades, and those with common neck pain (Grade I and Grade II) might be offered the listed noninvasive treatments if short-term relief is desired.

Section snippets

Development of Concepts

The Neck Pain Task Force Conceptual Model for the onset, course, and care of Neck Pain was developed via an iterative process that spanned almost the full duration of the Neck Pain Task Force. The conceptual model, which is described in detail in Guzman et al, provided the framework for the formulation of the clinical practice summary statements and recommendations, and includes a classification system for neck pain case definitions.1

Synthesis of the Evidence

The methodology chosen by the Neck Pain Task Force to

Concepts

At times neck pain may be inconsequential to the point that the pain is noticed only with prompting; or the individual rapidly forgets having experienced the episode. Other times, neck pain severity or circumstances may prompt people to seek care, reduce activities and/or file a claim to access financial benefits or compensation.1

Neck pain is a ubiquitous symptom, and only a minority of people with neck pain seek healthcare. Who seeks clinical care is likely determined by multiple factors,

Discussion

The key concepts, findings, and recommendations described in this article are the result of over 6 years of literature review, research, and discussion by a 12-member multidisciplinary Scientific Secretariat of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders, supported by a 17-member international and multidisciplinary Advisory Committee.11 The detailed results and findings are reported in multiple articles in this supplement.2, 3, 4, 5, 6, 7, 8, 9, 10,

Acknowledgment

The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders was supported by grants from the following: National Chiropractic Mutual Insurance Company (USA); Canadian Chiropractic Protective Association (Canada); State Farm Insurance Company (USA); Insurance Bureau of Canada; Länsförsäkringar (Sweden); The Swedish Whiplash Commission; Jalan Pacific Inc. (Brazil); Amgen (USA). All funds received were unrestricted grants. Funders had no control in planning, research

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    The manuscript submitted does not contain information about medical device(s)/drug(s).

    Corporate/Industry, Foundation, and Professional Organizational funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

    Reprinted from Guzman J et al. Clinical practice implications of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. From Concepts and Findings to Recommendations. Spine 2008;33:S199-S213. Reprinted with permission from Lippincott Williams & Wilkins

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