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Neck pain - non-specific - Management
Basis for recommendation

  • It is not possible to treat neck pain solely on the basis of current evidence, as few treatments have been assessed in high-quality randomized controlled trials [Binder, 2007b]. These recommendations are based on expert advice in a primary care textbook [Williams and Hoving, 2004].
  • Comorbidity is common in people with chronic neck or back pain [Cote et al, 2001]. Most people (87%) with chronic spinal pain report at least one other comorbid condition, including other chronic pain conditions (69%), chronic physical conditions (55%), mental disorders (35%), anxiety disorders, and mood disorders [Von Korff et al, 2005].
  • Although acute non-specific neck pain tends to resolve over a few weeks, evidence indicates that it can progress into a chronic disabling condition.
  • Although there is no trial evidence, expert opinion in review articles [Barry and Jenner, 1995; Binder, 2007b] recommends that:
    • Postural aspects in daily activities, work, and sport should be identified and corrected where possible.
    • A reduction from several pillows at night to one pillow will help many people.
  • The evidence is insufficient to assess the effectiveness of drug treatments, electrotherapy, massage, multidisciplinary biopsychosocial rehabilitation, education, physical treatment, special pillows, and traction.
  • Few randomized controlled trials have specifically tested drug treatments for neck pain. Although evidence is insufficient to assess the effects of drugs to treat neck pain, it is reasonable to extrapolate evidence from trials of these drugs for back pain and other painful musculoskeletal conditions:
    • Paracetamol is a good first-line choice for pain relief and is not associated with gastrointestinal toxicity [SIGN, 2000]. It is suitable for the treatment of mild-to-moderate pain, and it is well tolerated at the recommended daily dose. It is more likely to be effective for neck pain when used regularly rather than 'as required'.
    • Codeine 60 mg plus paracetamol has been shown to provide more pain relief than either codeine 60 mg alone or paracetamol 1000 mg alone [Moore et al, 1997].
    • Codeine can also be combined with an NSAID, or paracetamol can be combined with an NSAID, but there is less evidence to support this.
    • No evidence suggests that any particular NSAID is more effective than another for neck pain. Ibuprofen is generally preferred because of its lower risk of gastrointestinal adverse effects [CSM, 2002].
  • The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders recommended that people with common neck pain (grade 1 neck pain with no signs of major abnormality and no or little interference with daily activities, or grade 2 neck pain with no signs of major abnormality but interference with usual daily activities) should be offered non-invasive treatments if short-term relief is needed [Guzman et al, 2008].
  • Strong evidence favours a multimodal care approach using exercise combined with mobilization or manipulation in people with subacute or chronic neck pain. The relative benefit of different exercise approaches and which subgroups may benefit is unclear. A best-evidence synthesis by the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders concluded that the evidence suggests that manual and supervised exercise interventions are more effective than sham treatments, no treatment, or alternative treatments and that interventions that focussed on regaining function as soon as possible were more effective than interventions that did not have such a focus [Hurwitz et al, 2008].
  • Moderate evidence indicates that acupuncture has clinical treatment benefits, but the effects are short term.
  • Magnetic resonance imaging (MRI) should be done in the presence of widespread neurological symptoms or signs [Williams and Hoving, 2004].

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