Best evidence synthesis.
OBJECTIVE: 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.