Non-specific neck pain: diagnosis and treatment - KCE

vi non-specific neck pain KCE reports 119C
The experts and authors evaluated the diagnostic procedures and therapeutic
interventions according to the GRADE system (see Table). When the desirable effects
of an intervention clearly did (not) outweigh the undesirable effects, the panel
considered it to be strongly indicated to use (or use not) the intervention. The panel
considered the intervention to be only weakly indicated when the expected effect of the
proposed interventions was less certain - either because of evidence of low quality or
because of an uncertain balance between desirable and undesirable effects. In this case,
clinicians should carefully consider the benefits, risks, and burdens for the individual
patient.
KEY MESSAGES
The following points should be taken into account when evaluating patients with neck
pain:
• Importance of history taking and clinical evaluation;
• Exclusion of “red flags”;
• Diagnostic procedures:
o No evidence exists in the scientific literature that supports the use of
diagnostic imaging for non-specific neck pain. Moreover, pathologic
radiological findings are not associated with worse prognosis (low level of
evidence);
o Specific provocative tests (manoeuvres) can be used (low level of
evidence).
For the treatment of patients with chronic non-specific neck pain, only one treatment
with a high level of evidence exists in the scientific literature: a multimodal approach (at
least 2 treatment modalities) including exercises (under supervision) combined with
mobilizations or manipulations.
For all other treatment modalities the level of evidence in the literature is low and/or
does not support a recommendation based on a high level of evidence.
RECOMMENDATION
This systematic review is an updated state-of-the-art of the diagnostic procedures and
treatment of non-specific neck pain. From this view point the KCE recommends that
the evidence detailed in this report should be the basis for further elaboration of
guidelines by Belgian scientific organisations of physicians, physiotherapists and other
care providers.
The scientific message of these future guidelines should emphasize the benefit of a
multimodal care approach (including exercises under supervision combined with
mobilizations or manipulations) for the treatment of chronic non-specific neck pain.