Welcome back to the Head to Sacrum series on Spine IQ’s Back Blog. This week continues our discussion of acute neck pain by reviewing patient presentations commonly seen by doctors of chiropractic. We also focus on strategies for evidence-based clinical decision-making. Let’s jump right in!
The Institute for Work & Health’s Bone and Joint Task Force on Neck Pain (1) recommends a triage approach to the assessment of acute neck pain. This includes taking a thorough patient history to determine the mechanism of injury and identify red-flags or other serious conditions. Patient history should be directed by the patient’s presentation, including the location of the complaint and any associated symptoms like muscle weakness. If red flags are identified, further examination, testing and/or special imaging may be considered to rule out serious conditions such as meningitis, fracture, infection or cancer. (2-5)
Objective measures, like the Neck Disability Index, can also be used to determine the patient’s level of pain and functional disability. The Neck Pain Task Force suggests that neck pain be classified from Grade 1 to Grade 4, based on the severity of the patient’s symptoms and physical examination findings. (1) Conservative care approaches are recommended for grades 1 and 2, while grades 3 and 4 may indicate more severe pathology. Clincial Pearl: Many factors can contribute to neck pain and it is important to keep in mind that most are not the result of serious injury or disease. This contributes to the difficulty of identifying the causative issue, but the pain is no less debilitating to the patient. Communication is important in these cases to provide information and assurance.
Up to 50% of patients report experiencing neck pain! Curious about what’s next for treatment of acute neck pain? Sign up below to receive alerts for Spine IQ’s Head to Sacrum series! Next week: Conservative clinical management of acute neck pain.
Referenes:
1. Guzman J, Haldeman S, Carroll LJ, Carragee EJ, Hurwitz EL, Peloso P et al. Clinical practice implications of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders: from concepts and findings to recommendations. Spine. 2008; 33[4S]: S199-S213.
2. Differential Diagnosis and Management for the Chiropractor: Fifth Edition. Souza, Thomas A; 2016.
3. Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000 Jul 13;343(2):94-9. doi:
10.1056/NEJM200007133430203. Erratum in: N Engl J Med 2001 Feb 8;344(6):464. PMID:10891516.
4. Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M,McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I,Morrison L, Reardon M, Worthington J. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841-8. doi: 10.1001/jama.286.15.1841. PMID: 11597285.
5. Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, et al. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma. New England Journal of Medicine. 2003. 349(26): 2510-2518.