Newswise — A long-awaited report by a special international Task Force underscores the need for a systematic, evidence-based approach to the common, costly, and underestimated problem of neck pain. The report will appear in print as a supplement to the Feb. 15 issue of Spine, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
The report of the Bone and Joint Decade 2000"2010 Task Force on Neck Pain and Its Associated Disorders has been posted on the journal website, http://www.spinejournal.com. All readers can access the Task Force's Executive Summary free of charge. The complete report is available free to Spine subscribers and to libraries and other institutional subscribers via Ovid Technologies. Non-subscribers can access the full contents using the Pay-Per-View option.
The multidisciplinary Neck Pain Task Force was assembled in 2002 as part of the larger United Nations/World Health Organization "Bone and Joint Decade" project. By assembling and analyzing the best available research data on neck pain and related disorders, the Task Force sought to raise awareness of the problem, promote cost-effective prevention and treatment, and empower people with neck pain to participate in their own care.
The effort is warranted by the high frequency and impact of neck pain. Studies typically suggest that 30 to 50 percent of people experience neck pain per year, including a two to eleven percent rate of neck pain leading to activity limitations. Occupational studies estimate that neck pain accounts for three to eleven percent of claims for lost work time.
Once present, neck pain does not completely resolve in at least half of cases. Studies suggest that the chances of recovery are more affected by psychological factors and work stress than by physical factors.
A key component of the recommendations is a proposed new system for classification of neck pain. Patients with Grade I or II neck pain have no evidence of any major structural cause of their pain and generally don't need extensive tests or invasive treatments, the Task Force suggests. However, especially if pain is interfering with the patient's daily activities (Grade II), some type of early treatment is recommended to prevent long-term disability.
For many patients, no specific cause of neck pain is apparent. Treatment options include pain medications; exercise or physical therapy; or some form of manual therapy, such as chiropractic treatment. Treatments that focus on regaining function and returning to work appear more effective. However, a decision analysis study finds "no important differences" between competing treatment options for nonspecific neck pain—thus the choice depends on the patient's and physician's preferences, keeping in mind the possible side effects.
When neck pain is accompanied by some type of neurological abnormality (Grade III)—for example, decreased reflexes or weakness— further tests are recommended. For these patients, treatment options may include steroid injections or surgery. Immediate evaluation and treatment are needed when there are signs or symptoms of major structural causes (Grade IV)—for example, fracture, muscle disease, or tumors.
Other topics in the Task Force report include the increasingly frequent problem of whiplash-associated disorders. Research has lent new insights into the risk factors for persistent neck pain and related symptoms after traffic accidents, as well as the physical, psychological, and economic factors affecting recovery.
Two studies evaluate the reputed link between chiropractic treatment for neck pain and a type of stroke called vertebrobasilar stroke. The results suggest that previous reports of such an association are probably related to patients seeking care for neck pain or headache occurring as initial symptoms of this type of stroke.
The report represents an important step toward increased recognition of the problem of neck pain and the need for a systematic approach based on research evidence. The Task Force identifies some key areas for further research, including new approaches to preventing neck pain based on modifiable risk factors. "Changes in public policy which address these risk factors may significantly reduce the burden and cost of neck pain in society," the Task Force writes.
About SpineRecognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine and is the leading subspecialty journal for the treatment of spinal disorders. It is published by Lippincott Williams & Wilkins (www.LWW.com), a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services. Lippincott Williams & Wilkins is part of Wolters Kluwer Health, a leading multinational publisher and information services company. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine ranks highest among general orthopaedic journals and subspecialty titles. Visit the journal website at www.spinejournal.com.
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