Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Abstract

For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction. RECOMMENDATION 7: For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management. RECOMMENDATION 8: Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.

A commentary on the implications of medication prescription rights for the chiropractic profession

“…If granted limited prescriptive authority, chiropractors would be in a position to help advise patients against improper usage of these types of medications. This notion is consistent with current best-practice guidelines [31–38] and appears to resonate with a large number of chiropractors [4, 6, 8, 24, 40, 41]. In two recent survey reports from Ontario, Canada [6, 8], for example, between 68 and 72 % of chiropractic respondents expressed interest in gaining limited prescription privileges because of this potential role for the profession.…”

“…Currently, most international guidelines recommend, alongside prescription medication, a course of manual therapy and/or exercise as well as education and reassurance as part of a multi-modal approach to managing various spine-related and other MSK conditions [31, 33–38]. Regarding the effectiveness of these and other individual conservative therapies, several studies indicate that no one intervention is clearly superior to another for managing acute MSK disorders [44–46].…”

“…For instance, first line medications suggested for uncomplicated back and neck pain include analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), and/or muscle relaxants [31–38]. As primary contact health care providers for spinal pain and other MSK complaints, chiropractors may be asked by their patients to make recommendations regarding these medications.…”

Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review

“…High-quality CPGs were: four for osteoarthritis, from the European League Against Rheumatism,41 American Academy of Orthopedic Surgeons,42 Osteoarthritis Research Society International43 and NICE38; 2 for low back pain, from NICE23 and the Council on Chiropractic Guidelines and Practice Parameters44; 1 for neck pain, from the Ontario Protocol for Traffic Injury Management Collaboration45; and 1 for shoulder pain, from the University of New South Wales 46. The two CPGs from NICE had scores greater than 70% in all domains, which was substantially higher than other CPGs.…”

“…Five of the eight high-quality CPGs stated that the development group included members with expertise in CPG development, such as methodologists or representatives from CPG departments. In two high-quality CPGs that did not specifically include members with CPG expertise, clinical epidemiologists41 45 and/or health economists and library scientists were involved in guideline development 45. The University of New South Wales shoulder CPG engaged a CPG development consultancy during the development process 46.…”