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Neck Pain Care Pathway

Date of last update: February, 2024


Clinical Cornerstone:

  • In most cases of acute neck pain, symptoms go away on their own and most people will recover well. However, for some people the symptoms will continue into chronic pain.

Negative Prognostic Factors: Associated with a poorer outcome or longer duration of pain and disability. The presence of one or more of these factors does not necessarily mean that a patient will have a poor outcome, but they can be used to guide treatment and set realistic expectations.


1. Lifestyle-related factors: Smoking, obesity.

2. Baseline pain intensity: Higher initial pain levels.

3. Belief about pain duration: Patients who believe that their neck pain will last a long time.


4. Psychological factors: Fear avoidance, anxiety, pessimistic expectations.

5. Symptoms: More initial symptoms, presence of arm pain.

6. Duration of symptoms: Chronic symptoms (lasting more than 12 weeks).


7. Work-related factors: Job dissatisfaction, heavy physical work demands, lack of job flexibility.

8. Previous episodes of neck pain


9. Depression: Mental health conditions like depression.

10. Functional impairment: Initial reported disability level, Limitations in daily activities due to pain.

Conduct patient assessment

Red flags present

Red flags present

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Refer to appropriate emergency or healthcare provider

  • Structured patient education

  • Exercise (strength, range of motion)

  • Manual therapies (e.g., spinal manipulation or mobilization, massage)

  • Low-level laser therapy

  • Psychological / social support

  • Medicines

  • Referral

Major symptom/sign change

Goals not achieved


Adjust treatment and management plan or refer

References or links to primary sources







Contact information for further inquiries or feedback


These care pathways are intended to provide information to practitioners who provide care to people with musculoskeletal conditions. The care pathways on this website are 'living' documents, reflecting the state of clinical practice and research evidence to our best knowledge at the time of development. As knowledge and healthcare practices evolve, these pathways may be updated to ensure they remain current and evidence driven. These pathways are not intended to replace advice from a qualified healthcare provider.

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