Non-specific neck pain: diagnosis and treatment - KCE

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viii non-specific neck pain KCE reports 119C Chronic NSNP -Multimodal approach: mobilizations/manipulations combined with professionally supervised exercises Chronic NSNP -Manual therapy combined with other modalities Chronic NSNP -Supervised exercise: stretching and strengthening programs focussing e.g. on the cervical region Chronic NSNP -Supervised exercise: stretching and strengthening of the shoulder region and general condition Chronic NSNP -Supervised exercise: eye-fixation and proprioceptive exercises Acute and chronic NSNP -Manipulation / Mobilization alone Treatment of non-specific neck pain (NSNP) Effect on pain/function in short/long term(A) Strong - In favour No effect (C) Weak – Against Effect on pain/function in long term (B) Effect on function in short term (C) Effect on pain/function in short term (B) Weak - In favour Weak - In favour Weak - In favour No effect (B) Weak – Against Chronic NSNP -Traction No effect (C) Weak – Against Acute and chronic NSNP -Massage No conclusion (C) Weak – Against Chronic NSNP -Isolated Home exercises, isolated group exercises, non-multidisciplinary traditional neck schools Acute and chronic NSNP -Low level laser therapy (LLLT); Pulsed electromagnetic fields (PEMF) Chronic NSNP –TENS (transcutaneous electrical nerve stimulation); EMS (electrical muscle stimulation) on trigger points No effect (C) Weak - Against Effect in short term on pain/function (LLLT); on pain (PEMF)(C) Weak - In favour No effect (C) Weak - Against Chronic NSNP -Multidisciplinary approach No conclusion (C) Weak - In favour Acute and chronic NSNP -Paracetamol, NSAIDs, opioids analgesics Chronic NSNP -Local anaesthetic injection with lidocain into myofascial trigger points Effect on pain in short term (C) Effect on pain in short term (C) Weak - in favour Weak - in favour Chronic NSNP -Botulinum toxin A No effect (B) Weak - against Acute NSNP -Subcutaneous carbon dioxide insufflations Acute and chronic NSNP -Isolated educational programs Chronic NSNP -Pillows in combination with exercises No effect (C) Weak - against No effect (B) Weak - against Effect on pain in short/long term (C) Weak - in favour Chronic NSNP - Acupuncture (e.g. trigger point) Effect on pain in short term (B) Weak - in favour Chronic NSNP - Use of collar – oral splints No effect (B) Weak - against
KCE Reports 119 Non-Specific Neck Pain: diagnosis and treatment 1 Scientific summary Table of contents 1 INTRODUCTION .............................................................................................................3 1.1 PURPOSE OF THE STUDY .................................................................................................................................. 3 1.2 NON-SPECIFIC NECK PAIN: DEFINITION AND EPIDEMIOLOGY ...................................................................... 3 1.2.1 Definition ........................................................................................................................................ 3 1.2.2 Importance of neck pain .............................................................................................................. 5 2 METHODOLOGY .............................................................................................................6 2.1 SELECTION CRITERIA ........................................................................................................................................ 6 2.1.1 Participant ....................................................................................................................................... 6 2.1.2 Intervention .................................................................................................................................... 7 2.1.3 Comparison .................................................................................................................................... 7 2.1.4 Outcome ......................................................................................................................................... 7 2.2 LOCATING STUDIES .......................................................................................................................................... 8 2.2.1 Searches in databases ................................................................................................................... 9 2.2.2 Screening of titles and abstracts ................................................................................................ 9 2.2.3 Screening full text and quality appraisal .................................................................................... 9 2.2.4 New search for diagnosis and prognosis .............................................................................. 10 2.3 DATA EXTRACTION ...................................................................................................................................... 11 3 RESULTS ........................................................................................................................ 12 3.1 NUMBER OF PUBLICATIONS INCLUDED ....................................................................................................... 12 3.2 DIAGNOSIS ..................................................................................................................................................... 12 3.3 ASSESSMENT OF PAIN AND DISABILITY ......................................................................................................... 14 3.4 PROGNOSIS .................................................................................................................................................... 15 3.5 TREATMENT ................................................................................................................................................... 15 3.5.1 Manual therapy ........................................................................................................................... 15 3.5.2 Electrotherapy and other physical medicine modalities..................................................... 19 3.5.3 Multimodal interventions .......................................................................................................... 20 3.5.4 Multidisciplinary treatments ..................................................................................................... 21 3.5.5 Medication ................................................................................................................................... 22 3.5.6 Other methods ........................................................................................................................... 23 3.6 CLINICAL QUESTIONS ON NON-SPECIFIC NECK PAIN: SUMMARY OF THE LITERATURE FINDINGS .......... 25 3.6.1 Management of non-specific neck pain .................................................................................. 26 4 DISCUSSION ................................................................................................................. 28 5 SUMMARY ...................................................................................................................... 30 6 APPENDICES ................................................................................................................. 32 APPENDIX 1: SEARCH STRATEGY ..................................................................................... 32 SEARCH STRATEGY MEDLINE CLINICAL QUERIES AND SYSTEMATIC REVIEWS ...................................................... 32 SEARCH STRATEGY MEDLINE OTHERS ..................................................................................................................... 33 SEARCH STRATEGY COCHRANE ............................................................................................................................... 34 SEARCH STRATEGY PEDRO ........................................................................................................................................ 34 SEARCH STRATEGY GUIDELINES ................................................................................................................................ 34 SEARCH STRATEGY EMBASE ....................................................................................................................................... 35 SEARCH STRATEGY PUBMED SECOND SEARCH ........................................................................................................ 36 SEARCH STRATEGY EMBASE ....................................................................................................................................... 36 APPENDIX 2: CRITERIA USED TO ASSESS THE METHODOLOGICAL QUALITY OF THE STUDIES: RESULTS OF THE QUALITY APPRAISAL .............................................. 37 QUALITY APPRAISAL: PAPERS ON DIAGNOSIS .......................................................................................................... 37
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Non-specific neck pain: diagnosis and treatment - KCE

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