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European Spine Journal
Published in: European Spine Journal 7/2016

01-07-2016 | Review Article

Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Authors: Pierre Côté, Jessica J. Wong, Deborah Sutton, Heather M. Shearer, Silvano Mior, Kristi Randhawa, Arthur Ameis, Linda J. Carroll, Margareta Nordin, Hainan Yu, Gail M. Lindsay, Danielle Southerst, Sharanya Varatharajan, Craig Jacobs, Maja Stupar, Anne Taylor-Vaisey, Gabrielle van der Velde, Douglas P. Gross, Robert J. Brison, Mike Paulden, Carlo Ammendolia, J. David Cassidy, Patrick Loisel, Shawn Marshall, Richard N. Bohay, John Stapleton, Michel Lacerte, Murray Krahn, Roger Salhany

Published in: European Spine Journal | Issue 7/2016

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Abstract

Purpose

To develop an evidence-based guideline for the management of grades I–III neck pain and associated disorders (NAD).

Methods

This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Target audience includes clinicians; target population is adults with grades I–III NAD <6 months duration.

Recommendation 1

Clinicians should rule out major structural or other pathologies as the cause of NAD. Once major pathology has been ruled out, clinicians should classify NAD as grade I, II, or III.

Recommendation 2

Clinicians should assess prognostic factors for delayed recovery from NAD.

Recommendation 3

Clinicians should educate and reassure patients about the benign and self-limited nature of the typical course of NAD grades I–III and the importance of maintaining activity and movement. Patients with worsening symptoms and those who develop new physical or psychological symptoms should be referred to a physician for further evaluation at any time during their care.

Recommendation 4

For NAD grades I–II ≤3 months duration, clinicians may consider structured patient education in combination with: range of motion exercise, multimodal care (range of motion exercise with manipulation or mobilization), or muscle relaxants. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat.

Recommendation 5

For NAD grades I–II >3 months duration, clinicians may consider structured patient education in combination with: range of motion and strengthening exercises, qigong, yoga, multimodal care (exercise with manipulation or mobilization), clinical massage, low-level laser therapy, or non-steroidal anti-inflammatory drugs. In view of evidence of no effectiveness, clinicians should not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture, or botulinum toxin injections.

Recommendation 6

For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction.

Recommendation 7

For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management.

Recommendation 8

Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.
Appendix
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Metadata
Title
Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
Authors
Pierre Côté
Jessica J. Wong
Deborah Sutton
Heather M. Shearer
Silvano Mior
Kristi Randhawa
Arthur Ameis
Linda J. Carroll
Margareta Nordin
Hainan Yu
Gail M. Lindsay
Danielle Southerst
Sharanya Varatharajan
Craig Jacobs
Maja Stupar
Anne Taylor-Vaisey
Gabrielle van der Velde
Douglas P. Gross
Robert J. Brison
Mike Paulden
Carlo Ammendolia
J. David Cassidy
Patrick Loisel
Shawn Marshall
Richard N. Bohay
John Stapleton
Michel Lacerte
Murray Krahn
Roger Salhany
Publication date
01-07-2016
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 7/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-016-4467-7

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