Spine Task Force Neck Pain Evidence Summary

The Chiro.Org Blog

Toronto, June 18, 2010 – A new neck pain guide offers a concise summary on both helpful and unhelpful approaches to treating Neck Pain, based on the evidence synthesis completed by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain. IWH worked with the Canadian Memorial Chiropractic College, the Ontario Chiropractic Association and some members of the task force’s executive committee to prepare the summary.

In February 2008, Spine published a special edition dedicated to the task force’s reviews on the prevention, prognosis, diagnosis and management of neck pain. After publication, a network of Canadian chiropractic opinion leaders, coordinated by IWH, suggested distilling the evidence into a summary. “It’s exciting to see the chiropractic community take up the work of the task force this way,” says Dr. Sheilah Hogg-Johnson, a task force member and IWH senior scientist. “The Neck Pain Evidence Summary provides a way for health-care professionals to review the evidence easily in their practice, and if they need further information, they can refer to the full research papers.”The task force recommends treatments or further assessments, based on the severity of neck pain. They classified severity into four grades. In the Evidence Summary, a chart outlines the signs and symptoms, and further assessments for each grade. Then both helpful and unhelpful treatments are presented by grade and type of injury.

Because there are several helpful treatments for some grades of neck pain, the patient’s preference should be considered. For instance, any of the following treatments may benefit for the less serious Grade I or II neck pain, in cases with no traumatic accident: acupuncture, neck mobilization and manipulation, supervised exercise, low-level laser therapy and pain relievers. The guide will be useful to various health-care professionals who use these approaches, including chiropractors, doctors, physiotherapists and others.

Table 2: Non-invasive neck pain treatment

For a more complete view of this table
Refer to our LINKS Section

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 (other conditions)

Note: The following scenarios are presented separately as they were not classified in the grade system.

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  

*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, 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
J Manipulative Physiol Ther 2009 (Feb); 32 (2): S141–S175

Review the full 25-page
Neck Pain Evidence Summary

Review the
Press Release from CMCC

Review the complete
Neck Pain Task Force Special Supplement Articles at JMPT

About the Task Force
The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders involved more than 50 people from nine countries and represented 19 clinical and scientific disciplines or specialties. The task force was affiliated with eight collaborating universities and research institutes as well as 11 professional organizations. The task force has published more than 20 research studies and “best evidence” systematic reviews on neck pain.

About the Institute for Work & Health
The Institute for Work & Health is an independent, not-for-profit research organization whose mission is to conduct and share research that protects and improves the health of working people and is valued by policy-makers, workers and workplaces, clinicians, and health & safety professionals. IWH operates with the support of the Ontario Workplace Safety and Insurance Board.

About Canadian Memorial Chiropractic College
The Canadian Memorial Chiropractic College (CMCC) is an accredited leader in chiropractic education and research, offering a four year Doctor of Chiropractic degree, as well as specialty graduate studies. CMCC research spearheads breakthroughs in pain relief and seeks to better understand the body’s power to heal itself. Our community teaching clinics see over 5,500 patients annually.

About the Ontario Chiropractic Association
Established in 1929, the Ontario Chiropractic Association (OCA) is a voluntary professional association representing almost 3,000 (approx. 82 per cent) of Ontario’s practicing chiropractors.