Non-Specific Neck Pain: Guideline for Assessment, Diagnosis and Treatment in Primary Medical Care

Abstract

Neck pain is a symptom as common in working age as low back pain; and requires high treatment cost. Effective treatment of non-specific neck pain is not clearly available. The objective of this review was to provide guidance on the assessment, diagnosis and treatment of non-specific neck pain in primary care. The review procedure was conducted by searching database from PubMed, Scopus and Science using “mechanical neck pain”, “non-specific neck pain”, “randomized controlled trial”, “systematic review” and “primary medical care” as the keywords. Eligible studies included risk factors, assessment and diagnosis, treatments and prognosis covering the period from January 2005 to June 2015. It was found that the pattern of the neck pain assessment was mainly focused on the history and physical examination. Clinical radiographic or laboratory test were rarely required unless the patient had “red flags” features such as neck pain in patients younger than 20 years of age which might be associated with congenital abnormalities or infections; and patients over 50 years old who might need to rule out metastatic cancer, infections, vertebral fracture, carotid or vertebral artery dissection and autoimmune disease. The severity of neck pain could be categorized into 4 grades for monitoring symptoms and considering further investigation and treatment. Most cases of the neck pain were grade 1 or 2; and varieties of remedies were likely to be helpful. Combination of treatments showed more effectiveness than single treatment. The factors that provided high or moderate confidence in their ability to predict a negative outcome were a history of other musculoskeletal disorders prior to the current episode of neck pain and older age. In addition, regular exercise before the development of non-specific neck pain might have a protective effect against longterm problems, although the confidence was low.