by Alan Jordan
In a recent article on the Broadgate Journal I introduced a new neck pain classification system that was developed by an international research group led by Drs Scott Haldemann and David Cassidy. These two renowned researchers led an international Task Force in investigating all aspects of Neck Pain over a 10 year period. The research was sponsored by the World Health Organisation and published as an entire edition of the European Spine Journal.
In this article I will review their findings relating to the most commonly used treatments in the primary healthcare sector.
They systematically searched Medline (the authoritative on-line medical database) and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of noninvasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in their best evidence synthesis.
RESULTS:
Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 were accepted as scientifically admissible, and 139 of these related to noninvasive interventions (including health care utilization, costs, and safety).
Whiplash Associated Disorders
For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care by General Practitioners or physical modalities such as ultrasound, diathermy and so forth.
Neck Pain
It is essential that a thorough case history and physical examination be carried out. Blood tests and diagnostic imaging will rarely provide information that impacts treatment, but if necessary should most definitely be requested.
Information
Patients should be well informed about the benefits and risks of any treatment provided as well as treatment expectations particularly as regards the time axis of expected improvement. Information relating to work, daily activities including leisure activities, and pain relieving medication are essential.
Treatments
The evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus.
CONCLUSION:
“Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies.” At the Broadgate Spine and Joint Clinic we offer all of the treatments recommended by this esteemed Task Force.
