New guidelines help you tackle chronic neck pain

By Sabrina Hariri

Chronic neck pain affects up to half the world's population every year, but it's notoriously undertreated. So the World Health Organization created a Task Force to investigate it. Their report, published in the February 15 issue of Spine, has come up with a four-grade classification of neck pain, with corresponding treatments, to help primary care physicians .

Grade I is defined as a patient with no sign of structural pathology and whose pain isn't stopping them from going about their business. Grade II is for patients whose pain has got to the point where they can't function normally, but there's still no structural damage. Grade III is for those with neurologic symptoms like decreased deep tendon reflexes or sensory deficits, and Grade IV is for those with major structural pathology like a fracture or disease.

"A thorough physical exam and a history can rule out serious causes," says Linda Carroll, PhD, researcher at the Alberta Centre for Injury Control and Research and an author of the report. These patients should be referred to a specialist. But even Grade I or II neck pain "can have a serious impact on the quality of life," says Dr Carroll. So, here are some things you can tell your patients to tackle the problem head on.

MAKING THE GRADE
Grade them For Grade I pain (not interfering with daily activities), an ice pack will reduce any swelling and a neck rub will increase the blood flow, bringing relief. A non-prescription cream like Bengay may help too. If the patient has more severe Grade II pain, a treatment strategy is needed to prevent longterm disability, advises the Task Force. "There's no one treatment that's perfect for everyone," says Dr Carroll. Prepare your patient for the fact that the pain relief will often be modest and short-lived.

Pain relievers Inform your patient that NSAIDs or acetaminophen reduce the inflammation and offer temporary relief from the pain. Corticosteroid injections don't appear to have an effect, according to the Task Force.

Refer to a chiro. No, really The Task Force recommends physio and regular massages for Grade II neck pain. But, surprisingly, they also want you to let patients know that a visit to the chiropractor or the acupuncturist is a safe and potentially effective option. It found no link between chiropractor visits and an increased risk of stroke. "Going to your family doctor can increase the risk of stroke for some, but nobody thinks that family doctors are causing stroke," notes Dr Carroll.

Keep it moving Contrary to popular belief, a neck collar won't make the pain go away faster. Advise your patient to get on with their daily activities as soon as possible, it'll speed up the recovery.

LONGTERM PREVENTION
"Most of the time, neck pain tends to be recurrent," says Dr Carroll. But there are some things your patient can do to reduce the recurrence.

Change habits Neck pain is worse at the end of the day? Tell your patient to watch how they sit at their desk. A change in position would help. If morning pain is the problem, advise your patient to invest in a pillow that'll keep their neck straight and to avoid sleeping on their stomach with their neck twisted.

Jettison stress "A lot of factors play a role in developing neck pain, including mental health and stress," says Dr Carroll. Tell your patient to try some relaxation techniques and stress-relieving exercises.

Download the Task Force's executive summary at http://spinejournal.com/pt/re/spine/executivesummary.htm. For more on chronic pain, turn to page 17.