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Neck pain - non-specific - Management
How should I manage someone with non-specific neck pain?

  • Manage any comorbidities, such as other chronic pain conditions, chronic physical conditions, anxiety, and mood disorders.
  • During the first 3–4 weeks (acute phase):
    • Reassure the person that neck pain is a very common problem and that the symptoms are likely to resolve.
    • Encourage the person to remain active and return to a normal lifestyle.
    • Discourage the person from wearing a cervical collar. Neck supports, if used, should be worn for as short a time as possible (2–4 days) and under supervision (e.g. by a physiotherapist), to ensure that mobilization is started as soon as possible.
    • Strongly discourage prolonged absence from work.
    • Poor posture should be corrected if it is thought to precipitate or aggravate the neck pain.
    • Advise the person not to drive if the range of motion of the neck is restricted.
    • A firm pillow may provide comfort at night:
      • The pillow should provide lateral support and support the hollow of the neck.
      • A position of comfort should be found before trying to go to sleep.
      • Using two pillows may force the head into an unnatural position.
    • Offer limited courses of analgesia to relieve symptoms. Choice of analgesia depends on the severity, personal preferences, tolerability, and risk of adverse effects (see Prescribing information on NSAIDs). Options include:
      • Paracetamol or ibuprofen taken as required — this will be sufficient for many people, or
      • Paracetamol taken regularly, or
      • Ibuprofen taken regularly, or
      • Paracetamol and ibuprofen taken regularly, or
      • Codeine taken in addition to regular paracetamol or ibuprofen if the response to either drug is insufficient. Codeine should be prescribed separately to allow flexibility of dosing and titration of analgesic effect. Combination products, such as co-codamol, are not recommended.
  • If symptoms persist from 3 or 4 weeks to 12 weeks (subacute phase), in addition to the above:
    • Refer to a physiotherapist for a multimodal treatment strategy that includes exercise and some form of manual therapy.
    • Look for and address any psychosocial factors:
      • Fear or avoidance beliefs.
      • Associated anxiety and depression.
      • Medico-legal issues.
      • Family dynamics.
    • Promote positive attitudes to activity and work.
    • Consider referral:
      • To a psychologist or occupational health clinician.
      • For acupuncture.
  • If symptoms persist for more than 12 weeks (chronic phase), in addition to the above:
    • Continue physiotherapy if helpful, discontinue if not. Avoid passive interventions, such as massage or electrotherapy.
    • Consider a trial of a low-dose tricyclic antidepressant (for example, start with amitriptyline 10–25 mg and titrate accordingly) if the pain is unresponsive to full-dose standard analgesics. For further information on tricyclic antidepressants (including dose titration), see the CKS topic on Neuropathic pain - drug treatment.
    • Re-examine psychosocial factors periodically.
    • Consider referral to a pain clinic.
    • For people with chronic pain or nerve root symptoms that are poorly controlled, consider referring for assessment for invasive treatment, including surgery.

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