Guzman Jaime, Haldeman Scott, Carroll Linda J, Carragee Eugene J, Hurwitz Eric L, Peloso Paul, Nordin Margareta, Cassidy J David, Holm Lena W, Côté Pierre, van der Velde Gabrielle, Hogg-Johnson Sheilah
Department of Medicine, University of British Columbia, Canada.
J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S227-43. doi: 10.1016/j.jmpt.2008.11.023.
Best evidence synthesis.
To provide evidence-based guidance to primary care clinicians about how to best assess and treat patients with neck pain.
There is a need to translate the results of clinical and epidemiologic studies into meaningful and practical information for clinicians.
Based on best evidence syntheses of published studies on the risk, prognosis, assessment, and management of people with neck pain and its associated disorders, plus additional research projects and focused literature reviews reported in this supplement, the 12-member multidisciplinary Scientific Secretariat of the Neck Pain Task Force followed a 4-step approach to develop practical guidance for clinicians.
The Neck Pain Task Force recommends that people seeking care for neck pain should be triaged into 4 groups: Grade I neck pain with no signs of major pathology and no or little interference with daily activities; Grade II neck pain with no signs of major pathology, but interference with daily activities; Grade III neck pain with neurologic signs of nerve compression; Grade IV neck pain with signs of major pathology. In the emergency room after blunt trauma to the neck, triage should be based on the NEXUS criteria or the Canadian C-spine rule. Those with a high risk of fracture should be further investigated with plain radiographs and/or CT-scan. In ambulatory primary care, triage should be based on history and physical examination alone, including screening for red flags and neurologic examination for signs of radiculopathy. Exercises and mobilization have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain after a motor vehicle collision. Exercises, mobilization, manipulation, analgesics, acupuncture, and low-level laser have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain without trauma. Those with confirmed Grade III and severe persistent radicular symptoms might benefit from corticosteroid injections or surgery. Those with confirmed Grade IV neck pain require management specific to the diagnosed pathology.
The best available evidence suggests initial assessment for neck pain should focus on triage into 4 grades, and those with common neck pain (Grade I and Grade II) might be offered the listed noninvasive treatments if short-term relief is desired.
最佳证据综合分析。
为基层医疗临床医生提供基于证据的指导，以明确如何最佳地评估和治疗颈部疼痛患者。
有必要将临床和流行病学研究结果转化为对临床医生有意义且实用的信息。
基于已发表的关于颈部疼痛及其相关疾病的风险、预后、评估和管理研究的最佳证据综合分析，以及本增刊中报道的其他研究项目和重点文献综述，颈部疼痛特别工作组的12名多学科科学秘书处成员采用四步法为临床医生制定实用指南。
颈部疼痛特别工作组建议，因颈部疼痛寻求治疗的患者应分为4组：I级颈部疼痛，无重大病理迹象，对日常活动无或几乎无干扰；II级颈部疼痛，无重大病理迹象，但对日常活动有干扰；III级颈部疼痛，有神经受压的神经学体征；IV级颈部疼痛，有重大病理迹象。颈部钝性创伤后在急诊室，分诊应基于NEXUS标准或加拿大颈椎规则。骨折风险高的患者应进一步进行X线平片和/或CT扫描检查。在门诊基层医疗中，分诊应仅基于病史和体格检查，包括筛查警示信号和进行神经根病体征的神经学检查。运动和松动术已被证明可在一定程度上短期缓解机动车碰撞后I级或II级颈部疼痛。运动、松动术、手法治疗、镇痛药、针灸和低强度激光已被证明可在一定程度上短期缓解无创伤的I级或II级颈部疼痛。确诊为III级且有严重持续性神经根症状的患者可能从皮质类固醇注射或手术中获益。确诊为IV级颈部疼痛的患者需要针对所诊断病理进行治疗。
现有最佳证据表明，颈部疼痛的初始评估应侧重于分为4个等级进行分诊，如果希望短期缓解，常见颈部疼痛（I级和II级）患者可采用所列的非侵入性治疗方法。
