Aspecifieke nekpijn: diagnose en behandeling - KCE
Aspecifieke nekpijn: diagnose en behandeling - KCE
Aspecifieke nekpijn: diagnose en behandeling - KCE
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<strong>KCE</strong> Reports 119 Non-Specific Neck Pain: diagnosis and treatm<strong>en</strong>t 3<br />
1 INTRODUCTION<br />
1.1 PURPOSE OF THE STUDY<br />
This study aims to review sci<strong>en</strong>tific literature on diagnosis, prognosis and treatm<strong>en</strong>t of<br />
acute, subacute and chronic non-specific neck pain. The objective is to offer an<br />
overview of the curr<strong>en</strong>tly available evid<strong>en</strong>ce to primary care and specialized<br />
practitioners involved with adults who suffer from non-specific neck pain.<br />
1.2 NON-SPECIFIC NECK PAIN: DEFINITION AND<br />
EPIDEMIOLOGY<br />
1.2.1 Definition<br />
Neck pain is a wide concept and many definitions exist. In this report non-specific neck<br />
pain is defined in accordance to established guidelines, high quality systematic reviews,<br />
key text books, search on the topic in Pubmed and discussion with experts 1-5 :<br />
Non-specific neck pain can be defined as simple (non-specific) neck pain without specific<br />
underlying disease causing the pain. Symptoms vary with physical activity and over time.<br />
Each form of acute, subacute or chronic neck pain, where no abnormal anatomic<br />
structure; as cause of pain, can be id<strong>en</strong>tified, is non-specific neck pain. There are<br />
differ<strong>en</strong>t opinions about duration of symptoms but according to Binder, neck pain can<br />
be acute (< 4 weeks duration), sub-acute (1-4 months duration) or chronic (> 4 months<br />
duration) 1 .<br />
The symptoms of non-specific neck pain are very similar to the symptoms of whiplash<br />
associated disorders grades one and two (WAD I-II). Whiplash is an accelerationdeceleration<br />
mechanism of <strong>en</strong>ergy transfer to the neck and can result in injury to bony<br />
or soft tissue. The clinical symptoms, known as whiplash associated disorders, are for<br />
grade I ‘pain, stiffness and t<strong>en</strong>derness in the neck, but no physical signs’ and for grade II<br />
‘neck complaints and other musculoskeletal complaints (e.g., a decreased range of<br />
motion and t<strong>en</strong>der spots)’ 6 . The WAD’s can also include headache and numerous other<br />
symptoms e.g. dizziness, tinnitus, sleep disturbance, mood disturbance, pain in areas<br />
outside the neck. Therefore, as also m<strong>en</strong>tioned in the methodology section, literature<br />
on WAD will be excluded in this review. However, although it is not our purpose to<br />
review WAD primary literature, probably the systematic reviews and primary RCT’s to<br />
be retrieved will not always allow us to separate this subgroup out from non-specific<br />
neck pain. In this case, these data will be accepted.<br />
Non-specific neck pain can be <strong>diagnose</strong>d on clinical grounds alone, provided there are<br />
no features (for example Table 1: ‘Red flags’) to suggest more serious conditions 1 . The<br />
red flags proposed in table 1 are based on a good quality guideline already m<strong>en</strong>tioned<br />
above 3 , and repres<strong>en</strong>t the best available evid<strong>en</strong>ce in the field.