Published 3/1/2008

Bone and Joint Decade releases report on neck pain

The international Bone and Joint Decade 2000–2010 Task Force on Neck Pain has released its findings, which will be published in the journal Spine in February. The multidisciplinary, international task force, led by Prof Scott Haldeman from the University of California, Irvine, involved more than 50 researchers based in 9 countries and represented 14 different clinical and scientific disciplines.

A key component of the report is a new four-level classification system for neck pain. Most patients would fall into Grades I and II, with problems that do not involve any major structural cause of the pain. Generally, these patients do not need extensive tests or invasive treatments, the Task Force suggests. Some type of early treatment to prevent long-term disability is recommended for Grade II problems, however, if pain interferes with the patient’s daily activities.

In patients who have no detectable, apparent cause of the pain, treatment options include pain medications, exercise or physical therapy, or some form of manual therapy—with the key focus being on regaining function and returning the patient to normal daily activities. If the pain is associated with a neurologic abnormality (Grade III)—for example, decreased reflexes or weakness—further tests are recommended. For these patients, treatment options may include steroid injections or surgery. If signs of major structural problems (Grade IV) exist, such as fracture, muscle disease, or tumors, immediate specialized evaluation and treatment are vital, according to the Task Force.

The Task Force also provides documented guidelines and identifies areas for further research, including new approaches to prevention following the identification of risk factors. The report also addresses the growing problem of whiplash-associated disorders. New research discussed in the report offers insights into the risk factors for persistent neck pain and related symptoms after an accident, as well as the physical, psychological, and economic factors that affect recovery. The 234-page report is available online at www.spinejournal.org