European Spine Journal

, Volume 17, Supplement 1, pp 199–213

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

Authors

    • Department of MedicineUniversity of British Columbia
    • Occupational Health and Safety Agency for Healthcare
  • Scott Haldeman
    • Department of NeurologyUniversity of California
    • Department of Epidemiology, School of Public HealthUniversity of California
  • Linda J. Carroll
    • Department of Public Health Sciences, and the Alberta Centre for Injury Control and Research, School of Public HealthUniversity of Alberta
  • Eugene J. Carragee
    • Department of Orthopaedic SurgeryStanford University School of Medicine
    • Orthopaedic Spine Center and Spinal Surgery ServiceStanford University Hospital and Clinics
  • Eric L. Hurwitz
    • Department of Public Health Sciences, John A. Burns School of MedicineUniversity of Hawaii at Ma.noa
  • Paul Peloso
    • Endocrinology, Analgesia and InflammationMerck & Co
  • Margareta Nordin
    • Departments of Orthopedics, School of Medicine and Graduate School of Arts and ScienceNY University
    • Departments of Environmental Medicine and Program of Ergonomics and Biomechanics, School of Medicine and Graduate School of Arts and ScienceNY University
    • Occupational and Industrial Orthopaedic Center (OIOC)NY University Medical Center
  • J. David Cassidy
    • Centre of Research Expertise in Improved Disability Outcomes(CREIDO)University Health Network Rehabilitation Solutions
    • Division of Health Care and Outcomes ResearchToronto Western Research Institute
    • Departments of Public Health Sciences and Health Policy, Management and EvaluationUniversity of Toronto
  • Lena W. Holm
    • Institute of Environmental MedicineKarolinska Institutet
  • Pierre Côté
    • Centre of Research Expertise in Improved Disability Outcomes(CREIDO)University Health Network Rehabilitation Solutions
    • Departments of Public Health Sciences and Health Policy, Management and EvaluationUniversity of Toronto
    • Division of Health Care and Outcomes ResearchToronto Western Research Institute
    • Institute for Work & Health
  • Gabrielle van der Velde
    • Centre of Research Expertise in Improved Disability Outcomes(CREIDO)University Health Network Rehabilitation Solutions
    • Departments of Public Health Sciences and Health Policy, Management and EvaluationUniversity of Toronto
    • Division of Health Care and Outcomes ResearchToronto Western Research Institute
    • Institute for Work & Health
  • Sheilah Hogg-Johnson
    • Institute for Work & Health
    • Department of Public Health SciencesUniversity of Toronto
Implications

DOI: 10.1007/s00586-008-0637-6

Cite this article as:
Guzman, J., Haldeman, S., Carroll, L.J. et al. Eur Spine J (2008) 17: 199. doi:10.1007/s00586-008-0637-6

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.

Keywords

neck paintherapypractice guidelinesdiagnosismanagement

Copyright information

© Springer-Verlag 2008