Non-specific neck pain: diagnosis and treatment - KCE

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20 Non-Specific Neck Pain: diagnosis and treatment KCE Reports 119 Evidence from the literature Five systematic reviews studied the effect of physical medicine modalities as treatment for mechanical neck disorders 14, 38, 43, 45, 54 . • Notwithstanding the heterogeneity of the studies identified in the review of Chow, low-level laser therapy (LLLT) with infrared wavelengths has some limited evidence for the treatment of acute and chronic neck pain 54 . The reduction in pain levels with LLLT was modest in patients with chronic neck pain and although limited by short term follow up were supported by positive functional changes 45, 54 . Hurwitz concluded that LLLT is more effective than no treatment to improve acute pain and short term function in persons with sub-acute or chronic neck pain 38 . • For repetitive magnetic stimulation there is limited evidence of a beneficial effect in chronic non-specific neck pain on pain and function at short term (Grade C) 38 . • There is limited evidence that extremely low frequency and high frequency PEMF (pulsed electromagnetic field) reduce pain for patients with acute or chronic mechanical disorders immediately post treatment. The effect is not maintained on short term 14, 45 compared with placebo (Grade C). o Limited evidence of no benefit for chronic non-specific neck pain on pain in the short term is mentioned for magnetic necklace i.e. a static 14, 45 electromagnetic field (Grade C). • Inconsistent evidence is found that TENS treatment is beneficial for chronic neck pain 14, 38 . The limited evidence mentioned by Vernon is based on a low quality RCT 43 (Grade C). • There is limited evidence that for chronic non-specific neck pain, EMS (electrical muscle stimulation) has no detectable effect on pain or function at short or long term follow up 14, 45 Limited evidence of no benefit on pain in the short term is also mentioned for electrotherapies such as galvanic current, diadynamic currents or iontophoresis (Grade C). The studies of Hurwitz 38 and Gross 45 report limited evidence of no benefit for thermal and ultrasonic agents as an isolated intervention for chronic non-specific neck pain (Grade C). Limited evidence of no benefit on pain in the short term is also mentioned for spray and stretch. 3.5.3 Multimodal interventions Multimodal treatment is the combination of at least 2 different therapy modalities used for non-specific neck pain, for example exercises combined with mobilisation and medication. Key messages regarding multimodal interventions • There is evidence to support multimodal therapies for patients with nonspecific neck pain to reduce pain and improve function in the short and the long term. A multimodal approach should consider exercises (supervised) in combination with passive treatment as mobilisation, manipulation or both and if possible forms of education (Grade A). Also active treatment seems advisable for non-specific neck pain patients. However, there is uncertainty of the precise modalities that provide the effective ingredients.
KCE Reports 119 Non-Specific Neck Pain: diagnosis and treatment 21 Evidence from the literature Five systematic reviews 19, 37, 38, 44, 45 analysed the effects of a multimodal treatment for mechanical neck disorders. Multimodal approaches including stretching/strengthening exercise and mobilisation/manipulation for sub acute/chronic mechanical neck disorders reduced pain, improved function and resulted in favourable general perceived effect in the long term 45 . • There is strong evidence of benefit favouring a multimodal care approach of exercise (supervised) combined with mobilisations or manipulations for subacute and chronic mechanical neck disorders 37, 38, 44, 45 (Grade A). • There is moderate evidence that manipulation and/or mobilisation in combination with electrotherapy or medication or other non invasive techniques have shown no difference in benefit for pain relief, improvement in function and global perceived effect 19 . 3.5.4 Multidisciplinary treatments Multidisciplinary approaches, methods or treatments require a team of therapists from different disciplines working on the same patient together or alone without a common discussed purpose 55 . The main difference between multimodal and multidisciplinary is the involved therapists. One therapist can give a multimodal therapy, but one therapist cannot give a multidisciplinary treatment. Key messages regarding multidisciplinary treatments • There is little evidence found to support multidisciplinary approaches. This conclusion is to be considered carefully because little research of good quality has been performed to measure the effect of multidisciplinary approaches for patient with non-specific neck pain (Grade C) . Evidence from the literature Two systematic reviews studied the effect of multidisciplinary approaches for the treatment of patients with neck pain 38, 56 . • A rehabilitation program in a Cochrane review updated in 2008 was considered multidisciplinary if it encompassed a physician’s consultation with either a psychological, social or vocational intervention, or a combination of these last interventions 56 . It could not be shown by the two included studies (of low quality) that multidisciplinary rehabilitation was better than usual care for neck and shoulder pain 56 . • One of these two studies was also included by Hurwitz (2008). Patients with neck pain who took part in a multidisciplinary rehabilitation program had comparable sick-leave outcomes compared to patients who received other care. But patients in this program experienced improved mobility over two years whereas those receiving other care did not 38 .
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