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Neck pain

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of neck pain are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2021,2020), the American College of Physicians (ACP/AAFP 2020), the American College of Radiology (ACR 2019), the American Physical Therapy Association (APTA 2017), the Canadian Chiropractic Association (CCA 2016), and the Infectious ...
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Diagnostic investigations

Initial assessment
As per AAFP 2020 guidelines:
Evaluate and treat urgently any signs and symptoms of myelopathy, including lower extremity weakness, balance problems, and bowel and bladder irregularities.
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Assess patients with neck pain for comorbidities, as underlying inflammatory or rheumatologic conditions can increase the risk of cervical spine injury.
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  • Diagnostic imaging

  • Electrodiagnostic testing

Medical management

NSAIDs: as per AAFP/ACP 2020 guidelines, offer topical NSAIDs with or without menthol gel as first-line therapy to reduce or relieve symptoms, including pain, and to improve physical function in patients with acute pain from non-low back, musculoskeletal injuries.
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  • Opioids

  • Muscle relaxants

Nonpharmacologic interventions

Physical therapy, recent neck pain: as per CCA 2016 guidelines, consider offering either range-of-motion home exercises, medication, or multimodal manual therapy to reduce pain and disability in patients with recent (< 3 months) grade I-II neck pain.
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  • Physical therapy (persistent neck pain)

  • Physical therapy (neck pain with headache)

  • Physical therapy (neck pain with radiating pain)

  • Physical therapy (neck pain with mobility deficits)

  • Physical therapy (neck pain with coordination impairment)

  • Acupressure

Therapeutic procedures

Transcutaneous electrical nerve stimulation: as per AAFP/ACP 2020 guidelines, consider offering transcutaneous electrical nerve stimulation to reduce pain in patients with acute pain from non-low back, musculoskeletal injuries.
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