Table 2: Non-invasive neck pain treatment
Grade of neck pain and scenario Likely helpful Possibly helpful Likely not helpful Not enough evidence * Grade I and II (acute) traumatic neck pain Educational video, mobilization, exercises, mobilization plus exercises Pulsed electromagnetic therapy Pamphlet/neck booklet alone, passive modalities (heat, cold, diathermy, hydrotherapy), referral to fitness or rehab program, frequent early health-care service, methylprednisolone, passive modalities (ultrasound, TENS), exercise instruction, botulinum toxin A Manipulation, traction, non-steroidal anti-inflammatory drugs (NSAIDS), other drugs Grade I and II (non-acute) traumatic neck pain Supervised exercises, coordinated multidisciplinary care Passive modalities (TENS, ultrasound), corticosteroid injections Manipulation, traction, NSAIDs, other drugs Grade I and II non-traumatic neck pain Manipulation, mobilization, supervised exercises, manual therapy (manipulation, mobilization, massage) plus exercises, acupuncture, low-level laser therapy, analgesics Percutaneous neuromuscular therapy, brief intervention using cognitive behavioural principles Advice alone, collars, passive modalities (heat therapy, ultrasound, TENS, electrical muscle stimulation), exercise instruction, botulinum toxin A Magnetic stimulation, massage alone, traction, NSAIDS, other drugs Grade III (suspected cervical radiculopathy) All interventions Non-invasive neck pain treatment Grade of neck pain and scenario Likely helpful Possibly helpful Likely not helpful Not enough evidence * Cervicogenic headache Manipulation, mobilization, supervised exercises, manipulation or mobilization plus supervised exercises, water pillow Passive modalities, traction, NSAIDS, other drugs Neck pain in workers Supervised exercises plus strength or endurance training and/or relaxation training with behavioral support Ergonomic interventions, forced work breaks, rehabilitation programs, stress management programs, relaxation training, physical training, exercise instruction Neck pain in workers Note: The scenarios above are presented separately as they were not classified in the grade system. *More research is needed to understand the impact of these treatments and greater clinical judgment should be used if considering these options. Modified version of: Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J et al. Treatment of neck pain: noninvasive interventions: results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders.
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