Non-specific neck pain: diagnosis and treatment - KCE

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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.
KCE reports 119C non-specific neck pain vii History taking Excluding red flags Diagnostic imaging Proposed intervention(s) The “Neck Disability Index” as instrument for selfrated disability Confirm radiculopathy: Spurling’s test – traction/neck distraction – Shoulder abduction – Valsalva’s manoeuvre Rule out radiculopathy: Negative Upper Limb Tension test Diagnose facet joint spinal pain: Local anaesthetic block when no clinical diagnosis Unfavourable prognostic elements: severe pain; previous attacks; old age or concomitant low back pain Pathologic radiological findings are associated with worse prognosis Level of evidence A, B, C; best available or no evidence from the literature Diagnosis and prognosis No evidence from the literature Best available evidence from the literature No evidence from the literature Level of evidence not applicable- Valid instrument “Strong” or “weak” and “in favour” or “against” Strong - In favour Strong - In favour Weak - Against Strong - In favour C Weak - in favour C Weak-In favour C Weak - In favour C Weak - In favour C Weak - Against
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