Non-specific neck pain: diagnosis and treatment - KCE

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30 Non-Specific Neck Pain: diagnosis and treatment KCE Reports 119 5 SUMMARY History taking Excluding red flags Diagnostic imaging The results displayed in chapter 3 were translated into statements. These statements were scored in accordance with the GRADE-system 21, 72 , by four Belgian experts: two in the field of physiotherapy, one anaesthesiologist and one general practitioner. In consensus with the research team the statements were graded “strong” or “weak” and also “in favour” or “against” the proposed intervention. When the desirable effects of an intervention clearly outweighed (or clearly did not outweigh) the undesirable effects, the guideline panel offered strong recommendations according to the GRADE-system 21, 72 . On the other hand, when the proposed methods were less certain - either because of low quality evidence or because evidence suggested that desirable and undesirable effects were closely balanced - weak recommendations were offered according the GRADE-system 21, 72 . Clinicians should keep in mind that in that case, they should carefully consider the benefits, risks, and burdens in the context of the individual patient. How to individualize decision making in weak recommendations remains a challenge 72 . Table 3: Summary: diagnostic procedures, prognosis and treatment modalities in non-specific neck pain (NSNP) Level of evidence “Strong” or “weak” A, B, C; best available or Proposed intervention(s) and “in favour” or no evidence from the “against” literature 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 anesthetic block when no clinical diagnosis Unfavourable prognostic elements: severity of pain; previous attacks; old age or concomitant low back pain Pathologic radiological findings (e.g. degenerative changes) are associated with worse prognosis 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 - 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
KCE Reports 119 Non-Specific Neck Pain: diagnosis and treatment 31 Chronic NSNP -Multimodal approach: mobilizations/manipulations combined with supervised exercises Chronic NSNP -Manipulation / Mobilization 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 with exercises improving 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 and long term (A) Strong - In favour No effect (C) Weak – Against Effect on pain/function in the long term (B) Effect on function in the short term (C) Effect on pain/function in the 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 – transcutaneous electrical nerve stimulation (TENS) or electrical muscle stimulation (EMS) on trigger points No effect (C) Weak - Against Effect in the 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 the short term (C) Effect on pain in the 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 Chronic NSNP –Acupuncture (e.g. trigger point) No effect (C) Weak - against No effect (B) Weak - against Effect on pain in the short and long term (C) Effect on pain in the short term (B) Weak - in favour Weak - in favour Chronic NSNP -Use of collar or oral splints No effect (B) Weak - against
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Non-specific neck pain: diagnosis and treatment - KCE

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