Neck Pain: Revision 2017 (original) (raw)
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Physical therapy, 2018
The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of published systematic reviews.During the intake, the patient is screened for serious pathologies and corresponding patterns. Patients with cervical radiculopathy can be included or excluded through corresponding signs and symptoms and possibly diagnostic tests (Spurling test, traction/distraction test, and Upper Limb Tension Test). History taking is done to gather information about patients' limitations, course of pain, and prognostic factors (eg, coping style) and answers to health-related questions.In case of a normal recovery (treatment profile A), management should be hands-off, and patients should receive advice from the physical therapist and possibly some simple exercises to supplem...
Journal of Occupational and Environmental Medicine, 2010
Objective: To summarize the key findings of a best-evidence synthesis on neck pain. Methods: A systematic search, critical review, and best-evidence synthesis of the literature on the burden and determinants of neck pain, its assessment and intervention, and its course and prognostic factors. Results: There were 552 studies judged to have adequate internal validity to form the basis of the best-evidence synthesis. Neck pain is common across populations and age groups. Most do not experience a complete resolution of symptoms, and its course of recovery is similar across populations. In the absence of trauma and "red flags," routine imaging is not needed. Treatments emphasizing activity and return to normal function are more beneficial than those without such a focus. Conclusion: Neck pain is common, and its determinants and prognosis are multifactorial.
Conservative Treatment for Neck Pain: Medications, Physical Therapy, and Exercise
Physical Medicine and Rehabilitation Clinics of North America, 2011
This article offers conservative treatment strategies for patients suffering from musculoskeletal causes of neck pain. Basic pharmacology is reviewed, including that of opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), adjuvants, and topical analgesics. Moreover, indications for therapeutic exercise, manual therapy, and modalities are reviewed, along with any supporting literature. Treatment considerations with each category of medication and physical therapy are discussed. This article is meant to serve as a resource for physicians to tailor conservative treatment options to their individual patients. MEDICATIONS Recommendations of the World Health Organization (WHO) can help guide clinical decision making regarding appropriate medications for the patient with neck pain. These are organized into a conceptual stepladder (Box 1). The first step of the ladder involves the use of nonopioid medications and adjuvant medications. Nonopioid medications typically include acetaminophen and NSAIDs, Nothing to disclaim and no source of grant money.
Acta Fisiátrica, 2012
We started the preparation of this directive with the capacitation of the authors by means of the metodology employed by the Oxford Centre for Evidence Based Medicine, for the preparation of clinical directives by the Directives Program of the Brazilian Medical Association (Associação Médica Brasileira-AMB). Next, we had five directive preparation meetings with the AMB Program's coordinators. Articles from the MEDLINE (PubMed) databases, the Cochrane Database of Systematic Reviews, by means of the Health Virtual Library, with no time limitation. The search strategy adopted was based on (P.I.C.O.) structured questions (from the initials "Patient"; "Intervention"; "Control" and "Outcome". The resulting search syntax for non-specific neck pain was: Question 1: neck pain AND (analgesics OR paracetamol OR acetaminophen OR dipyrone OR non narcotics OR analgesics OR opioid); Question 2: neck pain AND (muscle relaxants OR ciclobenzaprine OR carisoprodol); Question 3: neck pain AND (non-steroidal anti-inflammatory agents); Question 4: neck pain AND (physical modalities OR hyperthermia induced OR diathermy OR ultrasonic therapy OR electric stimulation OR ultrasound OR transcutaneous electric nerve stimulation OR TENS); Question 5: neck pain AND (exercise therapy OR physical activity); Question 6: (neck pain OR myofascial pain syndromes) AND (massage OR manual therapy); Question 7: (neck pain OR myofascial pain syndromes) AND (posture OR ergonomic OR ergometry); Question 8: neck pain AND (sleep OR posture); Question 9: (neck pain OR myofascial neck pain) AND (acupuncture therapy OR trigger points; Question 10: neck pain AND education; Question 11: neck pain AND (psychology OR interdisciplinary communication OR interprofessional relations OR cognitive behaviour therapy OR work style intervention); Question 12: neck pain AND (mechanical OR manipulation); Question 13: neck pain AND (nerve blocks OR local anesthetics); Question 14: (neck pain OR myofascial pain syndrome) AND botulinum Toxin; On all searches, we used Field: All Fields, Limits: no age limits, with metodological filter for study types: narrow. In this manner, we found 1495 articles. Next, based on the abstracts, we selected the ninety-one papers related to neck pain and its treatment. We classified the scientific evidence strength of these studies according to the Oxford Centre for Evidence Based Medicine guidelines. The randomized and controlled clinical essays were submitted to critical evaluation according to the Jadad scale, 1996. Finally, we selected the forty-seven references which, due to greater scientific evidence strength, consistence, and clinical relevance, gave support to the recommendations of this directive. LEVEL OF RECOMMENDATION AND EVIDENCE: A: Strong consistency experimental or observational studies. B: Fair consistency experimental or observational studies. C: Case reports (uncontrolled studies). D: Opinion lacking critical evaluation, based on consensus, physiological studies or animal models. OBJECTIVES: Offering information about the rehabilitation of chronic non-specific neck pain.