Aspecifieke nekpijn: diagnose en behandeling - KCE

KCE Reports 119 Non-Specific Neck Pain: diagnosis and treatment 27
• Benefit from TENS (transcutaneous electrical nerve stimulation)
treatment for chronic non-specific neck pain is doubtful (Grade C);
• For EMS (electrical muscle stimulation) and other electrotherapies
(diadynamic currents, iontophoresis…) in chronic non-specific neck pain,
there may be no benefit on pain or function (Grade C);
Thermal and ultrasonic agents as an isolated intervention for chronic nonspecific
neck pain may not be effective (Grade C).
7. Are multimodal approaches effective for non-specific neck pain?
• A multimodal approach of exercises (supervised) combined with
mobilizations and/or manipulations is effective for sub-acute and chronic
non-specific neck pain (Grade A).
8. Is a multidisciplinary approach effective for non-specific neck pain?
• No recommendation could be made based upon the literature search
(Grade C).
9. Does medication work for non-specific neck pain?
There are not enough studies on any medicinal treatment for non-specific neck pain to
allow strong recommendation for treatment regarding medication. Therefore all the
following recommendations should be completed with key messages on pain therapy as
found in general guidelines (American Geriatrics Society
(http://www.americangeriatrics.org/), Sociéte Scientifique de Médecine Générale
(http://www.ssmg.be)).
• Local anaesthetics (lidocaine injections into myofascial trigger points) may
be effective in reducing chronic non-specific neck pain, but it is probably
no more effective than other less invasive procedures (Grade C);
• Botulinum toxin A is no better than saline injections for chronic nonspecific
neck pain (Grade B);
• Subcutaneous carbon dioxide insufflations are no better than sham
ultrasound (placebo treatment) for acute non-specific neck pain (Grade
C);
• Paracetamol, (opoid) analgetics or NSAIDs on pain are beneficial, but no
clear difference is found when analgetics and/or NSAIDs are compared
with each other (Grade C).
10. Do education programs work for patients with non-specific neck pain?
• Educational programs focusing on activation or on stress coping skills are
not beneficial for non-specific neck pain (Grade B);
• Traditional neck schools may not be beneficial for the treatment of nonspecific
neck pain (Grade C);
• Education or counselling programmes for (female) computer workers are
effective to decrease pain intensity and disability (Grade B).
11. Are pillows effective in the treatment of non-specific neck pain?
• Neck pillows in combination with exercises seem effective to reduce pain
for patients with chronic non-specific neck pain (Grade C).
12. Is the use of collars, oral splints effective for patients with non-specific neck
pain?
• There is no benefit of the use of soft collars or oral splints for patients
with non-specific neck pain (Grade B).
13. Does acupuncture have a positive effect on treatment of non-specific neck
pain?
• Acupuncture and more specifically trigger point acupuncture improve pain
but not function in the short term for non-specific chronic neck pain
(Grade B).