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Neck Pain Care Pathway

Date of last update: February, 2024

Treatment and Management

 

Neck Pain with or without radiculopathy (i.e., non-specific neck pain and neck pain with radiculopathy, NAD I – III classifications)

Clinical Cornerstone:

  • A comprehensive approach to managing neck pain may integrate education, self-care, conservative management, and specific interventions when necessary. This approach should be grounded in evidence-based practice, respective of cultural nuances, patient needs and values. It emphasizes professional collaboration and is continuously fine-tuned based on patient feedback and progress, ensuring a unified, empathetic, and efficient pathway.

  • While passive modalities such as Transcutaneous Electrical Nerve Stimulation (TENS), needling therapies (acupuncture, dry needling), and traction might offer pain relief or relaxation, it is essential to integrate these with active management strategies. This combination addresses the multifaceted nature of neck pain, fostering sustainable pain management and enhancing function and participation.

Overview of treatment and management strategies for neck pain: May include education, self-care, exercise, manual therapy, medicines, psychological therapy, social support, and mind-body interventions.

 

Additionally for neck pain with radiculopathy (NAD III): May include medical/surgical consultation for significant, persistent, or progressive neurological deficits.

Strategy Details

  • Patient Education: Focus on patient understanding of the condition, implementing pain management strategies, and actively participating in the rehabilitation process. Reassure patients that most acute neck pain episodes improve within a few weeks and typically do not stem from serious pathology. Clarify the biopsychosocial dimensions of pain, address underlying psychosocial factors, and underscore the importance of  active participation in care and setting realistic expectations.

  • Self-care: Crucial for managing neck pain and facilitating a return to meaningful activities. Incorporate strategies like goal setting/Brief Action Planning/SMART goals.

    • Utilize techniques like Brief Action Planning to support self-management and promote regular movement and engagement in normal activities, including work.

    • Lifestyle changes: Prioritize a healthy diet, regular physical activity, good sleep habits, maintaining a healthy body weight, and abstaining from smoking.

    • Ergonomics and behaviour change to reduce strain during physical or sedentary work.

    • Engage in social and work activities.

  • Exercise: e.g., strengthening/range of motion, aerobic, mind-body, or a combination of approaches; group-based or individual, supervised or home-based.

  • Manual therapy: e.g., mobilization, manipulation, soft tissue techniques, clinical or relaxation massage.

 

  • Medicines: e.g., over-the-counter pain relievers, muscle relaxants, non-steroidal anti-inflammatories (NSAIDs). Medicines should be used judiciously and combined with other treatments.  Scope of practice regarding conversations about medications varies by profession and jurisdiction.

  • Psychological therapy: Referral to an appropriate healthcare provider if needed.

  • Low-level laser therapy

  • Medicines: e.g., over-the-counter pain relievers, muscle relaxants, non-steroidal anti-inflammatories (NSAIDs). Medicines should be used judiciously and combined with other treatments. Scope of practice regarding conversations about medications varies by profession and jurisdiction.

  • Social support

  • Psychological therapy: Referral to an appropriate healthcare provider if needed.

  • Mind-Body interventions: Techniques like mindfulness, meditation, and cognitive-behavioral therapy (CBT).

Persistent Neck Pain: As the duration of neck pain extends, functional limitations are more likely to emerge. Adopting a biopsychosocial approach to assessment and care planning becomes paramount. Rehabilitation aims to sustain independence in daily activities and ensure active participation in vital areas like work and community life, crucial for well-being. It involves a spectrum of non-pharmacologic and pharmacologic interventions, with non-pharmacological options often taking precedence. Rehabilitation thus spans a wide array of services, supports, and community resources, all aimed at enhancing overall well-being and societal involvement.

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

Re-evaluate

Adjust treatment and management plan or refer

References or links to primary sources

 

 

 

 

 

 

Contact information for further inquiries or feedback

carolina.cancelliere@ontariotechu.ca

Disclaimer:

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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