Neck pain patients can be triaged into four groups

In brief

  • Clinicians who are assessing patients with neck pain should place them in one of the four grades.
  • Based on the grade and cause of neck pain, clinicians can use evidence for further diagnosis or treatment as needed.

Why was this review done?

There is a need for evidence-based guidance for clinicians on how to assess and treat patients with neck pain. One goal of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders was to give meaningful and practical information to clinicians. This review aimed to provide guidance on how to assess patients with neck pain, and further diagnose or treat them.

How was the review done?

Neck Pain Task Force researchers evaluated a total of 552 scientifically sound studies and summarized the results into “best evidence” syntheses on different aspects of neck pain. The current study, which had input from all members of the task force, aimed to develop recommendations for clinicians based on the whole body of evidence.

What did the researchers find?

The Neck Pain Task Force recommended initially triaging patients with neck pain into four broad categories or grades:

  • Grade I: no signs of serious injury or illness, and few or no problems with daily activities
  • Grade II: no signs of serious injury or illness, but some difficulty with daily activities
  • Grade III: signs of nerve injury
  • Grade IV: signs of major illness or injury

Patients with Grade I and II neck pain after a motor vehicle collision may find short-term relief from exercise and manual mobilization of the neck. For neck pain not caused by trauma in Grades I and II, the following treatments may provide relief: exercise, mobilization, manipulation, pain-killers, acupuncture or low-level laser treatments. Patients with Grade III or IV neck pain should have their injuries further diagnosed. Those in Grade III might benefit from steroid injections or surgery. Patients within Grade IV require specialized treatment based on their condition. In their article, the researchers also provided information on medical assessments, non-invasive and invasive treatments, complications, and treatment flowcharts for emergency and primary health-care settings.

What are some strengths and weaknesses of the review?

During the development of these recommendations, the Neck Pain Task Force used the best evidence synthesis approach to ensure the results they used were of high scientific quality as possible. However, there were some gaps in the research, so the recommendations were based on the evidence available.

Publication Information

Author(s): 

Guzman J, Haldeman S, Carroll L, Carragee E, Hurwitz E, Peloso P, Nordin M, Cassidy D, Holm L, Côté P, van der Velde G, Hogg-Johnson S

Journal: 

Spine, 2008: vol. 33, no 4, pp. S199-S213