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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56 <strong>Non</strong>-Specific Neck Pain: <strong>diagnosis</strong> <strong>and</strong> <strong>treatment</strong> <strong>KCE</strong> Reports 119<br />
Rubinstein, S.M. <strong>and</strong> M. van Tulder, A best‐ medium (4 on<br />
evidence review of diagnostic procedures for cochrane)<br />
<strong>neck</strong> <strong>and</strong> low‐back <strong>pain</strong>. Best Practice <strong>and</strong><br />
Research: Clinical Rheumatology, 2008. 22(3):<br />
p. 471‐482.<br />
Sehgal, N., et al., Systematic review of<br />
diagnostic utility of facet (Zygapophysial)<br />
joint injections in chronic spinal <strong>pain</strong>: An<br />
update. Pain Physician, 2007. 10(1): p. 213‐<br />
228.<br />
Vos, C.J., A.P. Verhagen, <strong>and</strong> B.W. Koes, The<br />
Ability of the Acute Low Back Pain Screening<br />
Questionnaire to Predict Sick Leave in<br />
Patients With Acute Neck Pain. Journal of<br />
Manipulative <strong>and</strong> Physiological Therapeutics,<br />
2009. 32(3): p. 178‐183.<br />
2008 The aim is to present an overview<br />
of the best available evidence on<br />
diagnostic procedures for <strong>neck</strong><br />
<strong>and</strong> low‐back <strong>pain</strong>.<br />
high (6 on cochrane) 2007 To evaluate <strong>and</strong> update available<br />
evidence (2004 to 2006) relating<br />
to clinical utility of facet joint<br />
injections (intraarticular <strong>and</strong><br />
medial brach blocks) in<br />
diagnosing chronic spinal <strong>pain</strong> of<br />
facet joint origin<br />
high (10 Quadas) 2009 The aim of this study was to<br />
investigate the use of the Acute<br />
Low Back Pain Screening<br />
Questionnaire (ALBPSQ) in<br />
patients with acute <strong>neck</strong> <strong>pain</strong> in<br />
general practice.<br />
publications for cervical<br />
region:<br />
1. Barnsley, 1993 <strong>and</strong> 1995<br />
2. Lord, 1996<br />
3. Manchikanti, 2002a+b, 2004<br />
4. Manchukonda, 2007<br />
5. Speldewinde, 2001<br />
up until 2007 not diagnostic procedures valid procedures There is sufficient sound evidence from<br />
reported<br />
systematic reviews to make the following<br />
recommendations:<br />
* the history is principally for triage,<br />
during which 'red flags' should be<br />
identified<br />
* the presence of multiple red flags<br />
should raise clinical suspicion <strong>and</strong><br />
indicates the need for further<br />
investigation<br />
* the physical examination is used to<br />
confirm suspision from history:<br />
‐ in the case of cervical radiculopathy,<br />
tests such as Spurling's can be used to<br />
make the <strong>diagnosis</strong>, while others , such<br />
as the upper limb tension test, can be<br />
used to rule it out<br />
* in patients older or 50 years of age,<br />
plain spinal radiography together with<br />
st<strong>and</strong>ard laboratory tests are highly<br />
accurate in identifying underlying<br />
systematic disease; however, plain spinal<br />
radiography is not a valuable tool for non‐<br />
<strong>specific</strong> <strong>neck</strong> <strong>pain</strong><br />
* there is strong evidence for the<br />
diagnostic accuracy of facet joint blocks in<br />
evaluating spinal <strong>pain</strong>, <strong>and</strong> moderate<br />
dec/06 n= 1002 controlled diagnostic blocks prevelance <strong>and</strong> false‐ All studies had a prevalence between 36 <strong>and</strong> 67% (from one<br />
positive rate study no data were available)<br />
The false‐positive rate was between 27% <strong>and</strong> 63% (from 3<br />
studies no data were available)<br />
n=180 The Acute Low Back Pain Screening<br />
Questionnaire (ALBPSQ)<br />
reliability of the<br />
questionnaire <strong>and</strong><br />
sick leave<br />
ICC of the total scores on the ALBPSQ of the stable group was<br />
0,85 (95% CI, 0,73‐0,92)<br />
A cutoff score of 72 at baseline identified patients with or<br />
without long‐term sick leave with a sensitivity of 77% <strong>and</strong> a<br />
<strong>specific</strong>ity of 62%.<br />
The evidence obtained from the<br />
literature review suggests that controlled<br />
comparative local anesthetic blocks of<br />
facet joints (medial branch or dorsal<br />
ramus) are reproducable, reonably<br />
accurate <strong>and</strong> safe.<br />
In this prospective cohort study, in<br />
general practice, the ALBPSQ was shown<br />
to be a reliable instrument <strong>and</strong> to be able<br />
to screen patients with <strong>neck</strong> <strong>pain</strong> that<br />
may be at risk for prolonged sick leave.