Non-specific neck pain: diagnosis and treatment - KCE
Non-specific neck pain: diagnosis and treatment - KCE
Non-specific neck pain: diagnosis and treatment - KCE
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<strong>KCE</strong> Reports 119 <strong>Non</strong>-Specific Neck Pain: <strong>diagnosis</strong> <strong>and</strong> <strong>treatment</strong> 27<br />
• Benefit from TENS (transcutaneous electrical nerve stimulation)<br />
<strong>treatment</strong> for chronic non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong> is doubtful (Grade C);<br />
• For EMS (electrical muscle stimulation) <strong>and</strong> other electrotherapies<br />
(diadynamic currents, iontophoresis…) in chronic non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong>,<br />
there may be no benefit on <strong>pain</strong> or function (Grade C);<br />
Thermal <strong>and</strong> ultrasonic agents as an isolated intervention for chronic non<strong>specific</strong><br />
<strong>neck</strong> <strong>pain</strong> may not be effective (Grade C).<br />
7. Are multimodal approaches effective for non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong>?<br />
• A multimodal approach of exercises (supervised) combined with<br />
mobilizations <strong>and</strong>/or manipulations is effective for sub-acute <strong>and</strong> chronic<br />
non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong> (Grade A).<br />
8. Is a multidisciplinary approach effective for non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong>?<br />
• No recommendation could be made based upon the literature search<br />
(Grade C).<br />
9. Does medication work for non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong>?<br />
There are not enough studies on any medicinal <strong>treatment</strong> for non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong> to<br />
allow strong recommendation for <strong>treatment</strong> regarding medication. Therefore all the<br />
following recommendations should be completed with key messages on <strong>pain</strong> therapy as<br />
found in general guidelines (American Geriatrics Society<br />
(http://www.americangeriatrics.org/), Sociéte Scientifique de Médecine Générale<br />
(http://www.ssmg.be)).<br />
• Local anaesthetics (lidocaine injections into myofascial trigger points) may<br />
be effective in reducing chronic non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong>, but it is probably<br />
no more effective than other less invasive procedures (Grade C);<br />
• Botulinum toxin A is no better than saline injections for chronic non<strong>specific</strong><br />
<strong>neck</strong> <strong>pain</strong> (Grade B);<br />
• Subcutaneous carbon dioxide insufflations are no better than sham<br />
ultrasound (placebo <strong>treatment</strong>) for acute non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong> (Grade<br />
C);<br />
• Paracetamol, (opoid) analgetics or NSAIDs on <strong>pain</strong> are beneficial, but no<br />
clear difference is found when analgetics <strong>and</strong>/or NSAIDs are compared<br />
with each other (Grade C).<br />
10. Do education programs work for patients with non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong>?<br />
• Educational programs focusing on activation or on stress coping skills are<br />
not beneficial for non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong> (Grade B);<br />
• Traditional <strong>neck</strong> schools may not be beneficial for the <strong>treatment</strong> of non<strong>specific</strong><br />
<strong>neck</strong> <strong>pain</strong> (Grade C);<br />
• Education or counselling programmes for (female) computer workers are<br />
effective to decrease <strong>pain</strong> intensity <strong>and</strong> disability (Grade B).<br />
11. Are pillows effective in the <strong>treatment</strong> of non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong>?<br />
• Neck pillows in combination with exercises seem effective to reduce <strong>pain</strong><br />
for patients with chronic non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong> (Grade C).<br />
12. Is the use of collars, oral splints effective for patients with non-<strong>specific</strong> <strong>neck</strong><br />
<strong>pain</strong>?<br />
• There is no benefit of the use of soft collars or oral splints for patients<br />
with non-<strong>specific</strong> <strong>neck</strong> <strong>pain</strong> (Grade B).<br />
13. Does acupuncture have a positive effect on <strong>treatment</strong> of non-<strong>specific</strong> <strong>neck</strong><br />
<strong>pain</strong>?<br />
• Acupuncture <strong>and</strong> more <strong>specific</strong>ally trigger point acupuncture improve <strong>pain</strong><br />
but not function in the short term for non-<strong>specific</strong> chronic <strong>neck</strong> <strong>pain</strong><br />
(Grade B).