Best Evidence Rehabilitation for Chronic Pain Part 4: Neck Pain

Abstract

Neck pain, whether from a traumatic event such as a motor vehicle crash or of a non-traumatic nature, is a leading cause of worldwide disability. This narrative review evaluated the evidence from systematic reviews, recent randomised controlled trials, clinical practice guidelines, and other relevant studies for the effects of rehabilitation approaches for chronic neck pain. Rehabilitation was defined as the aim to restore a person to health or normal life through training and therapy and as such, passive interventions applied in isolation were not considered. The results of this review found that the strongest treatment effects to date are those associated with exercise. Strengthening exercises of the neck and upper quadrant have a moderate effect on neck pain in the short-term. The evidence was of moderate quality at best, indicating that future research will likely change these conclusions. Lower quality evidence and smaller effects were found for other exercise approaches. Other treatments, including education/advice and psychological treatment, showed only very small to small effects, based on low to moderate quality evidence. The review also provided suggestions for promising future directions for clinical practice and research.

<p>Relationships Between Context, Process, and Outcome Indicators to Assess Quality of Physiotherapy Care in Patients with Whiplash-Associated Disorders: Applying Donabedian’s Model of Care</p>

“…89 This is consistent with the importance of transforming the existing model of chronic pain into the clinical management of patients with chronic pain 90 in accordance with the best evidence on the management of patients with chronic musculoskeletal pain, particularly patients with neck pain and low back pain. 91,92 Only a moderate-to-fair association was observed between the psychological questionnaires as selected process variables and "pain intensity" and "functioning" as outcome variables. This is probably due to a failure of outcome attribution.…”

“…23,24 In addition to the poor prospects for recovery, poor treatment response is another important issue. [25][26][27] To date, assessment and management of patients with WAD remains a significant challenge for physiotherapists. Donabedian's model [28][29][30] could be a useful tool to evaluate the quality of physiotherapy in patients with WAD for two main reasons: (1) internationally it is the dominant model for evaluating quality of care, 31-35 and (2) this model is used by the Royal Dutch Society for Physical Therapy (KNGF) for the implementation and evaluation of clinical practice guidelines (CPGs), 36 and for the development of QIs for physiotherapy.…”

Visceral Origin: An Underestimated Source of Neck Pain. A Systematic Scoping Review

“…Likewise, manual visceral treatment has also been shown to improve NP and electromyographic recordings of the upper trapezius muscles of subjects suffering from chronic non-specific NP and dyspepsia [94], and has improved neck mobility and NP thresholds in subjects suffering from gastroesophageal reflux disease [95]. On the contrary, the likely participation of patients with NP of visceral origin might contribute to explaining the scarce success of usual treatments for NP, achieving at most moderate effects in the short-term [96].…”

Rehabilitation Succeeds Where Technology and Pharmacology Failed: Effective Treatment of Persistent Pain across the Lifespan

“…This suggests that multimodal lifestyle-centered approaches may be effective for chronic pain. Actually, this matter is touched on in each of the five invited contributions on the best evidence rehabilitation for chronic pain [10,[12][13][14][15], thus underscoring its topicality for persistent pain rehabilitation and providing important avenues for future research.…”

“…This paper is of particular importance to the field of oncology, especially now that common practices to manage cancer pain are being challenged due to a lack of supporting evidence [16,17]. In parts 3 and 4, Malfliet et al [13] and Sterling et al [14] present an overview of the best evidence non-invasive rehabilitation for people having chronic low back pain and neck pain, respectively. Finally, in part 5, a state-of-the-art review of rehabilitation for osteoarthritis pain is provided by Rice et al [15].…”