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7-year neck pain study sheds light on best care

Toronto -- February 15, 2008 -- A seven-year, international study published today finds that some alternative therapies such as acupuncture, neck manipulation and massage are better choices for managing most common neck pain than many current practices.

Also included in the short-list of best options for relief are exercises, education, neck mobilization, low level laser therapy and pain relievers.

Therapies such as neck collars and ultrasound are not recommended.

The study found that corticosteroid injections and surgery should only be considered if there is associated pain, weakness or numbness in the arm, fracture or serious disease.

The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders 236 page review of the current research on neck pain is published in the journal Spine.

The multi-national and inter-disciplinary study team included Canadian, American, South American, Australasian and European researchers.

The Task Force was created to help neck pain sufferers and health professionals use the best research evidence to prevent, diagnose and manage neck pain.

"Neck pain is not a trivial condition for many people," says Task Force president Dr. Scott Haldeman, clinical professor, department of neurology at the University of California, Irvine; and adjunct professor, department of epidemiology University of California Los Angeles.

"It can be associated with headaches, arm and upper back pain and depression.

"Whether it arises from sports injuries, car collisions, workplace issues or stress, it can be incapacitating. Understanding the best way to diagnose and manage this problem is of high importance for those who are suffering and for those who manage and pay for its care."

The study found that neck pain is a widespread experience that is a persistent and recurrent condition for the majority of sufferers.

It is disabling for approximately two out of every 20 people who experience neck pain and affects their ability to carry on with daily activities says the Task Force.

A key recommendation of the Task Force is that neck pain, including whiplash-related pain, be classified and treated in a common system of 4 grades:

Grade 1: neck pain with little or no interference with daily activities
Grade 2: neck pain that limits daily activities
Grade 3: neck pain accompanied by radiculopathy ("pinched nerve" -- pain weakness and/or numbness in the arm)
Grade 4: neck pain with serious pathology, such as tumor, fracture, infection, or systemic disease.

"The majority of neck pain falls into Grades 1 or 2," says Task Force member, Dr. Linda Carroll, Associate Professor, School of Public Health at the University of Alberta, and Associated Scientist, Alberta Centre for Injury Control and Research (ACICR).

"Many sufferers manage to carry on with their daily activities. Others find their pain interferes with their ability to carry out daily chores, participate in favorite activities or be effective at work.

"For these people, the evidence shows there are a relatively small number of therapies that provide some relief for a while, but there is no one best option for everyone."

In addition to its comprehensive review of the existing body of research on neck pain, the Task Force also initiated a new study into the association between chiropractic care of the neck and stroke. This innovative piece of research found that patients who visit a chiropractor are no more likely to experience a stroke than are patients who visit their family physician. The study concludes that this type of stroke commonly begins with neck pain and/or headache which causes the patient to seek care from their chiropractor or family physician before the stroke fully develops.

"This type of stroke is extremely rare and has been known to occur spontaneously or after ordinary neck movements such as looking up at the sky or shoulder-checking when backing up a car," noted the study's lead author, Dr. David Cassidy, professor of epidemiology at the University of Toronto and senior scientist at the University Health Network at Toronto Western Hospital.

For the minority of neck pain sufferers who experience Grade 3 neck pain -- that is neck pain accompanied by pain, weakness and/or numbness in the arm, also referred to as a "pinched nerve", corticosteroid injections may provide temporary relief says the study.

Surgery is a last resort according to the findings and should only be considered if accompanying arm pain is persistent or if the person is experiencing Grade 4 pain due to serious injury or systemic disease.

Top findings for neck pain suffers:

Stay as active as you can, exercise and reduce mental stress.

Don't expect to find a single "cause" for your neck pain.

Be cautious of treatments that make "big" claims for relief of neck pain.

Trying a variety of therapies or combinations of therapies may be needed to find relief -- see the therapies for which the Task Force found evidence of benefits.

Once you have experienced neck pain, it may come back or remain persistent.

Lengthy treatment is not associated with greater improvements; you should see improvement after 2-4 weeks, if the treatment is the right one for you.

There is relatively little research on what does or does not prevent neck pain; ergonomics, cervical pillows, postural improvements etc. may or may not help.

"This is an important body of research that will help to improve the quality of patient care by incorporating the best evidence into practice and patient education," says Dr. Carroll.

"Neck pain can be a stubborn problem -- we hope this comprehensive analysis of the evidence will help both sufferers and health care providers better manage this widespread complaint."