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Neck pain is a very common problem in the UK
It can affect anyone, at any age, and is usually caused by a sprain or a strain of the muscles, ligaments, joints or discs in the neck. This can be very painful, and inconvenient, but it is not serious.
Neck pain is classified as acute or chronic, depending on how long the pain has been present. Acute pain is shorter lived and more common. Neck pain is considered chronic once it has been present for more than 3 months.
In most cases neck pain will settle with time. It is important to remain active and continue as normal, but if pain is severe and persistent then prescribe appropriate analgesia, refer to physiotherapy or consider referral to the pain team for persistent (over 12 months) disabling neck pain (this does not include radicular arm pain-see the Nerve Root Pain pathway).
Differentiate between red flags, mechanical neck pain and nerve root pain
Also see section on Red Flags
History taking is most important in differentiating mechanical neck pain from nerve root pain or myelopathy and serious pathology.
If neck pain is mild:
If neck pain is medium or high severity or chronic:
If patient re-presents to GP with persisting symptoms reassess red flags (See management section).
Consider the following differential diagnoses:
NB: Common findings such as osteoarthritis or cervical spondylosis are extremely common in asymptomatic people and may not be the source of pain.
The presence of 2 or more Red flags significantly raises the likelihood of serious spinal pathology.
Send to ED if suspicion of
Refer URGENTLY to Spinal TEAM at RD&E via DRSS
Mark referrals clearly as URGENT and why.
Current NICE /UKSSB guidelines state MRI only for use in specialist clinic if it will change outcome. Patients should be told they may not need imaging if being referred to specialist clinic. There is a high level of incidental findings on scans e.g. disc degeneration therefore appropriate clinical interpretation is needed when feeding back MRI results.
X-ray is rarely required. Will it result in a change in management?
Bloods are appropriate for suspicion of infection or cancer.
Self-care and self-management underpins all activities within this guideline, please encourage patients to engage with this approach throughout.
Positive attitude to outcome – try to keep patient at work and maintain activity levels. Assess and address issues of distress or depression.
Encourage early activity – activity is not harmful and may help to reduce pain in many patients.
Education and rehabilitation – emphasise self-management and reinforce positive attitudes to outcome.
It is expected that patients will have completed a course of physiotherapy and had a prolonged period of conservative management before considering onward referral to any specialist service.
At each re-attendance:
Refer To Physiotherapy:
Refer To Pain Clinic:
Note: It is expected that patients will have completed a course of physiotherapy and had a prolonged period of conservative management before considering onward referral to any specialist service
Refer To RD&E Spinal Team:
Refer via e-Referral Service:
Recommended resources for patients and carers. NEW Devon CCG does not take responsibility for the content of third party information resources.
McCullough BJ, Johnson GR, Brook MI, Jarvik JG. Lumbar MR imaging and reporting epidemiology: do epidemiologic data in reports affect clinical management? Radiology 2012; 262: 941-946.
Hill JC, Whitehurst DGT, Lewis M, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 2011; 378: 1560-1571
This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group.
: February 2019