RT Journal Article
SR Electronic
T1 Evaluation and Treatment of Posterior Neck Pain in Family Practice
JF The Journal of the American Board of Family Practice
JO J Am Board Fam Med
FD American Board of Family Medicine
SP S13
OP S22
DO 10.3122/jabfm.17.suppl_1.S13
VO 17
IS suppl 1
A1 Alan B. Douglass
A1 Edward T. Bope
YR 2004
UL http://www.jabfm.org/content/17/suppl_1/S13.abstract
AB Neck pain is almost universal and is a common patient complaint. Although the differential diagnosis is extensive, most symptoms are from biomechanical sources, such as axial neck pain, whiplash-associated disorder (WAD), and radiculopathy. Most symptoms abate quickly with little intervention. There is relatively little high-quality treatment evidence available, and no consensus on management of axial neck pain or radiculopathy. A number of general pain management guidelines are applicable to neck pain, and specific guidelines are available on the management of WAD. The goal of diagnosis is to identify the anatomic pain generator(s). Patient history and examination are important in distinguishing potential causes and identifying red flags. Diagnostic imaging should be ordered only when necessary because of the high incidence of asymptomatic radiographic abnormalities. First-line drug treatments include acetaminophen, cyclo-oxygenase 2–specific inhibitors, or nonsteroidal anti-inflammatory drugs. Short-term use of muscle relaxants may be considered. Opioids should be used if other treatments are ineffective and continued if improved function outweighs impairment. Adjuvant antidepressants and anticonvulsants should be considered in chronic or neuropathic pain and coincident depression. Epidural steroids should be considered only in radiculopathy. Physical modalities supported by evidence should be used. If symptoms have not resolved in 4 to 6 weeks, re-evaluation and additional workup should be considered.