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Title
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Non-specific neck pain and evidence-based practice
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Author
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Abstract
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| Background Non-specific neck pain (NS-NP) is a common reason for adults to consult health care providers. Therefore one should always seek the most effective intervention(s) within the wide spectrum of treatments available. Equally important is to optimize evidence-based treatment decisions. Methods The first aim of this paper was to review (identify, critically appraise, and synthesize) the literature published on interventions for NS-NP. The second aim was to further provide advice for health care providers to make evidence-based treatment decisions and to optimize their delivery of carefor diagnosing, treating and managing adults with NS-NP. Literature was systematically searched in PubMed, Cochrane, Embase and Pedro. Results Data could not be statistically pooled. History taking, excluding red flags and radicular pain/radiculopathy and assessing self-rated disability was deemed crucially important prior to selecting management and treatment modalities for NS-NP. Strong evidence of benefit was only found for multimodal care (manipulation/mobilization and supervised exercises) for chronic NS-NP. Consensus on proposed management was achieved by an expert panel. In contempory practice there is a tendency to base the intervention on the underlying mechanism of the disorder and to direct specific treatment. For this reason also we screened for targeted management based on the underlying mechanism. Conclusions A clinician should always exclude red flag pathology and also conduct precise history taking, and if needed also communicate with other health care providers. The diagnostic label NSNP suggests that this entity is in fact a heterogenic condition. For the treatment of the diagnostic label NS-NP strong evidence of efficacy was only found for multimodal care (manipulation/mobilization and supervised exercises). Unfortunately there is a lack of evidence on accurate and reproducible characterization of subgroups of patients with a NS-NP label to facilitate treatment to be tailored. For future research we suggest to focus on fine tuning the diagnosis and management beyond NS-NP, with specific attention for the underlying mechanisms driving the neck pain disorder subtype and the collaboration needed to accomplish this. |
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Language
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English
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Source (journal)
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European scientific journal
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Publication
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2013
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ISSN
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1857-7881
1857-7431
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Volume/pages
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9
:3
(2013)
, p. 1-19
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Full text (open access)
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