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Task
Force presents evidence-based
recommendations on neck pain
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 Spine
Recognized 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.
About Lippincott Williams & Wilkins
Wolters Kluwer Health (Conshohocken, PA), a
division of Wolters Kluwer, is a leading
provider of information and business
intelligence for students, professionals,
and institutions in medicine, nursing,
allied health, pharmacy and the
pharmaceutical industry.
Major brands include traditional publishers
of medical and drug reference tools and
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Wilkins and Facts & Comparisons; electronic
information providers, such as Ovid
Technologies, Medi-Span and ProVation; and
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International and Source®.
For more information, visit WKHealth.com.
Wolters Kluwer is a leading global
information services and publishing company.
The company provides products and services
for professionals in the health, tax,
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legal, and regulatory sectors.
Wolters Kluwer has 2006 annual revenues of
€3.4 billion, employs approximately 18,450
people worldwide, and maintains operations
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information, visit
www.WoltersKluwer.com.