Assessment of Neck Pain and Its Associated Disorders: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

Nordin, Margareta; Carragee, Eugene J.; Hogg-Johnson, Sheilah; Weiner, Shira Schecter; Hurwitz, Eric L.; Peloso, Paul M.; Guzman, Jaime; van der Velde, Gabrielle; Carroll, Linda J.; Holm, Lena W.; Côté, Pierre; Cassidy, J. David; Haldeman, Scott

doi:10.1016/j.jmpt.2008.11.016

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Volume 32, Issue 2, Supplement , Pages S117-S140, February 2009

Assessment of Neck Pain and Its Associated Disorders:

Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

Margareta Nordin, PT, Dr Med Sc
- Departments of Orthopaedics and Environmental Medicine and Program of Ergonomics and Biomechanics, School of Medicine and Graduate School of Arts and Science, New York University, NY
- Occupational and Industrial Orthopaedic Center (OIOC), New York University Medical Center, NY
- Address correspondence and reprint requests to Margareta Nordin, Dr Sci, OIOC-NYU HJD, 63 Downing Street, New York, NY 10014
Eugene J. Carragee, MD, FACS
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
- Orthopaedic Spine Center and Spinal Surgery Service, Stanford University Hospital and Clinics, Stanford, CA
Sheilah Hogg-Johnson, PhD
- Institute for Work and Health, Toronto, Canada
- Department of Public Health Sciences, University of Toronto, Canada
Shira Schecter Weiner, PT, PhD (Candidate)
- Occupational and Industrial Orthopaedic Center (OIOC), New York University-Hospital for Joint Diseases, New York University Medical Center, New York
- Program of Ergonomics and Biomechanics. Graduate School of Arts and Science and School of Medicine, New York University, New York
Eric L. Hurwitz, DC, PhD
- Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Mânoa, Honolulu, HI
Paul M. Peloso, MD, MSc, FRCP(C)
- Endocrinology, Analgesia and Inflammation, Merck & Co. Rahway, NJ
Jaime Guzman, MD, MSc, FRCP(C)
- Department of Medicine, University of British Columbia, BC, Canada
- Occupational Health and Safety Agency for Healthcare in BC, Canada
Gabrielle van der Velde, DC
- Institute for Work & Health, Toronto, Canada
- Department of Health Policy, Management and Evaluation, University of Toronto, Canada
- Centre of Research Expertise in Improved Disability Outcomes (CREIDO), University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Canada
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada
Linda J. Carroll, PhD
- Department of Public Health Sciences, and the Alberta Centre for Injury Control and Research, School of Public Health, University of Alberta, Canada
Lena W. Holm, Dr Med Sc
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Pierre Côté, DC, PhD
- Departments of Public Health Sciences and Health Policy, Management and Evaluation, University of Toronto, Canada
- Institute for Work & Health, Toronto, Canada
- University Health Network Rehabilitation Solutions, Toronto Western Hospital, Canada
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada
- Institute for Work & Health, Toronto, Canada
- Centre of Research Expertise in Improved Disability Outcomes (CREIDO), University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Canada
J. David Cassidy, PhD, Dr Med Sc
- Departments of Public Health Sciences and Health Policy, Management and Evaluation, University of Toronto, Canada
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada
- Centre of Research Expertise in Improved Disability Outcomes (CREIDO), University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Canada
Scott Haldeman, DC, MD, PhD
- Department of Neurology, University of California, Irvine, CA
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA

Abstract

Study Design

Best evidence synthesis.

Objective

To critically appraise and synthesize the literature on assessment of neck pain.

Summary of Background Data

The published literature on assessment of neck pain is large and of variable quality. There have been no prior systematic reviews of this literature.

Methods

The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders conducted a critical review of the literature (published 1980–2006) on assessment tools and screening protocols for traumatic and nontraumatic neck pain.

Results

We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain.

Conclusion

The scientific evidence supports screening protocols in emergency care for low-risk patients; and CT-scans for high-risk patients with blunt trauma to the neck. In nonemergency neck pain without radiculopathy, the validity of most commonly used objective tests is lacking. There is support for subjective self-report assessment in monitoring patients' course, response to treatment, and in clinical research.

Key words: best evidence synthesis, cervical spine, neck pain, whiplash-associated disorder, assessment, diagnosis

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Corporate/Industry, Foundation, and Professional Organizational funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Reprinted from Nordin M et al. Assessment of neck pain and its associated disorders. Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008;33:S101-S122. Reprinted with permission from Lippincott Williams & Wilkins.

PII: S0161-4754(08)00343-6

doi:10.1016/j.jmpt.2008.11.016

Refers to erratum:

Erratum
Journal of Manipulative and Physiological Therapeutics February 2009 (Vol. 32, Issue 2, Supplement, Pages S252-S253)
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