Neck Pain in Adults _________________________________________________________________________
Poorly controlled acute pain can have negative consequences that include delayed recovery, disrupted sleep, and impaired physical and social functioning that diminishes the quality of life. Regardless of origin, poorly managed acute pain can transition to chronic pain [115]. Pain should be treated at once if it impairs functioning, and treatment options should be discussed clearly with the patient to prevent unrealistic expectations and possible disappointment [71]. The adverse impact of chronic pain on mortality captures the gravity of this state and importance to control. In one observational follow-up study, patients with noncancer chronic pain who attended an outpatient pain clinic from 2004–2012 were followed until May 2019. During a mean 10.4-year follow-up of 1,498 patients, 296 died. Of these, standardized mortality ratios among patients in the youngest age group (18 to 49 years of age) was significantly higher than that of the general population: 2.6 for men and 2.9 for women. Women 60 to 69 years of age had a mortality ratio of 2.3. Low baseline health-related quality of life and poor ratings in psychosocial dimensions were associated with an increased risk of death [116]. PATIENT EDUCATION As noted, acute neck pain guidelines recommend that clinicians educate and reassure patients of the typically benign nature and self-limited course of nonspecific neck pain and the importance of maintaining activity and movement. Education and counseling may also include spine anatomy and proper postures, pain perception neuroscience, pain coping strategies, and resumption of normal activities. Education interventions may add small benefits to physiotherapy but should not be used alone due to ineffectiveness [8; 117].
For patients who are not proficient in English, it is important that information regarding the etiology of their pain and pain management resources be provided in their native language, if possible. When there is an obvious disconnect in the communication process between the practitioner and patient due to the patient’s lack of proficiency in the English language, an interpreter is required. Interpreters can be a valuable resource to help bridge the communication and cultural gap between patients and practitioners. Interpreters are more than passive agents who translate and transmit information back and forth from party to party. When they are enlisted and treated as part of the interdisciplinary clinical team, they serve as cultural brokers who ultimately enhance the clinical encounter. In any case in which information regarding treatment options and medication/treatment measures are being provided, the use of an interpreter should be considered. Print materials are also available in many languages, and these should be offered whenever necessary. PHARMACOTHERAPIES Standard practice guidelines recommend the following analgesic options for acute/subacute neck pain [7; 102; 103]: • Acetaminophen • NSAIDs
• Muscle relaxants • Opioid analgesics
Chronic neck pain management is more difficult and complex, but pharmacotherapy guidelines for chronic neck pain are non-existent, and general guidelines for the management of chronic pain may be unhelpful. Practice guidelines recommend drug and non-drug therapies based on randomized controlled trials, considered the best study design to detect efficacy. Analgesic randomized controlled trials are usually placebo-controlled. Systematic reviews examine treatment efficacy by pooling the results of randomized controlled trials to measure differences in average response to treatment versus comparator/placebo [118]. Systematic reviews of guideline-recommended analgesics for neck pain have found acetaminophen ineffective and NSAIDs minimally effective, compared with placebo. Systematic reviews have also found minimal benefit in other analgesics considered effective. These results may reflect true ineffectiveness or possible limitations with randomized controlled trial evaluation of analgesics, including [119; 120]: • Rigid protocols that disallow dose adjustments when ineffective or intolerable • Strict enrollment criteria, with outcomes of research subjects dissimilar to typical patients • Increasing placebo-response rates that require larger studies to show relevant differences from placebo
For patients with acute neck pain with movement coordination impairments (including WAD), the American Physical Therapy Association recommends clinicians provide the education of the patient to return to normal, non-provocative pre-
accident activities as soon as possible; to minimize use of a cervical collar; and to perform postural and mobility exercises to decrease pain and increase range of motion. Patients should be reassured that recovery is expected to
occur within the first two to three months. (https://www.jospt.org/doi/full/10.2519/
jospt.2017.0302. Last accessed September 26, 2025.) Strength of recommendation/Level of Evidence : B (Moderate recommendation based on one or more level II systematic reviews or a preponderance of level III systematic reviews or studies support the recommendation, providing evidence for a mild to moderate magnitude of effect)
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