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National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy

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Abstract

Purpose

To summarise recommendations about 21 selected non-surgical interventions for recent onset (<12 weeks) non-specific neck pain (NP) and cervical radiculopathy (CR) based on two guidelines from the Danish Health Authority.

Methods

Two multidisciplinary working groups formulated recommendations based on the GRADE approach.

Results

Twelve recommendations were based on evidence and nine on consensus. Management should include information about prognosis, warning signs, and advise to remain active. For treatment, guidelines suggest different types of supervised exercise and manual therapy; combinations of exercise and manual therapy before medicine for NP; acupuncture for NP but not CR; traction for CR; and oral NSAID (oral or topical) and Tramadol after careful consideration for NP and CR.

Conclusion

Recommendations are based on low-quality evidence or on consensus, but are well aligned with recommendations from guidelines from North America. The working groups recommend intensifying research relating to all aspects of management of NP and CR.

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Acknowledgements

The authors would like to acknowledge the following members of the project groups and working groups: Karsten Junker, chairman CR working group, research librarians Herdis Foverskov, Kirsten Birkefoss and Conni Skrubbeltrang; lead reviewer Frank Lønberg; members of the working groups Hans Kristian Lauritsen, Jørgen Korsgaard, Peter Kryger-Baggesen, and Anne Gram.

Author information

Authors and Affiliations

  1. Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark

    Per Kjaer, Alice Kongsted, Jan Hartvigsen, Henrik Hein Lauridsen & Inge Ris Hansen

  2. Evidence, Education and Emergency Services, The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark

    Per Kjaer, Alice Kongsted, Bolette Søborg, Christine Marie Bækø Halling, Karsten Juhl Jørgensen, Marie Jakobsen & Tina Myung Povlsen

  3. Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark

    Alice Kongsted & Jan Hartvigsen

  4. Centre for Spine Surgery and Research, Spine Centre of Southern Denmark, Hospital Lillebaelt, Østre Houghvej 55, 5500, Middelfart, Denmark

    Alexander Isenberg-Jørgensen

  5. Spine Centre of Southern Denmark, Hospital Lillebaelt, Østre Houghvej 55, 5500, Middelfart, Denmark

    Berit Schiøttz-Christensen

  6. Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense M, Denmark

    Berit Schiøttz-Christensen

  7. Københavns Fysioterapi I/S, J. E. Ohlsens Gade 2, 1, th, 2100, København Ø, Denmark

    Charlotte Krog

  8. CFR Hospitaler, Hans Bekkevolds Allé 2B, 2900, Hellerup, Denmark

    Christian Martin Møller

  9. KORA, the Danish Institute for Local and Regional Government Research, Købmagergade 22, 1150, Copenhagen K, Denmark

    Christine Marie Bækø Halling & Marie Jakobsen

  10. Centre for Rheumatology and Spine Diseases, Dyrehavevej 29, 3400, Hillerød, Denmark

    Jesper Nørregaard

  11. The Nordic Cochrane Centre, Rigshospitalet, 7811, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark

    Karsten Juhl Jørgensen

  12. Spine Unit, Department of Ortopaedic Surgery, Rigshospitalet, Copenhagen, Denmark

    Lars Valentin Hansen

  13. Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Fyrkildevej 7,1, 9220, Aalborg Ø, Denmark

    Martin Bach Jensen

  14. Aalborg Spine Clinic, Aalborg Rygklinik, Vingaardsgade 9, 9000, Aalborg, Denmark

    Martin Melbye

  15. Neurosurgical Department, Aarhus University Hospital, Nørrebrogade, 8000, Aarhus C, Denmark

    Peter Duel

  16. Department of Health Science and Technology, SMI®, Aalborg University, Aalborg, Denmark

    Steffan W. Christensen

  17. Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark

    Steffan W. Christensen

  18. Research and Test Center for Health Technologies. Rigshospitalet, Nordre Ringvej 57. Opgang 8, 5.sal., 2600, Glostrup, Denmark

    Tina Myung Povlsen

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  1. Per Kjaer
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  2. Alice Kongsted
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  4. Alexander Isenberg-Jørgensen
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Corresponding author

Correspondence to Per Kjaer.

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Funding

Funding was provided by The Danish Finance Act in 2012, and the DHA was commissioned to formulate the national clinical guidelines based on this. A salary was provided to members of the project groups, i.e., lead reviewers (AK, PK, and FL), project managers (BH and CH), methodologists (KJJ, MJ, and TP), search specialists, and chairmen. The funders had no role in the design, collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for public No funding was provided to the working or reference group members.

Conflicts of interest

Potential conflicts of interest have been declared by all involved partners and made publicly available on the DHA webpage (in Danish) [18].

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Kjaer, P., Kongsted, A., Hartvigsen, J. et al. National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. Eur Spine J 26, 2242–2257 (2017). https://doi.org/10.1007/s00586-017-5121-8

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  • DOI: https://doi.org/10.1007/s00586-017-5121-8

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