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A New Model for the Onset, Course, and Care of Neck Pain

Posted on: 03/13/2008
Scientists, doctors, and therapists are struggling to find reliable and predictable ways to treat neck pain. Researchers want a model that can be tested and reported on. They want to find out what works and what doesn't.

Toward that end, the World Health Organization's (WHO) Task Force on Neck Pain has come up with a new model for neck pain. The committee members of this task force met 18 times with many phone calls in-between over a period of six years. The result was a model for the classification of patients with neck pain.

The authors of this article review and summarize this new model. The first part of the model gives us a clear picture of the anatomic area considered as the neck. Diagrams with areas shaded in gray guide our understanding of who should be in these groups.

Members of the Task Force agreed that neck pain isn't a single event with a permanent solution. Neck pain is best understood if viewed as a condition that can come and go over time. Many personal and environmental (outside) factors influence when and how this happens.

These can include genetic traits, age, social, and economic factors. There can also be health, workplace, and cultural issues at play. Research is needed to pinpoint which factors are likely to affect treatment for each patient or for groups of patients. The goal is to find modifiable (changeable) factors that can be altered to prevent neck pain or to reduce pain and disability when recovering from neck pain.

The next step is to classify patients in a way that helps guide management. In this model, a four-grade subgrouping is proposed for all types of neck pain. This model is based on neck pain severity. It includes traumatic and nontraumatic causes of neck pain. The key difference among the groups is whether or not the pain interferes with daily function.

For research purposes, patients are also viewed according to settings. These settings are broken down into work setting (sports, general, specific occupation), health care setting (emergency room, walk-in clinic, primary care doctor), and type of claim (insurance, worker's compensation, personal injury).

Classification can also be done according to duration (how long the symptoms have been present) and the pattern of neck pain over time. Some of the categories include single episode (no previous neck pain), recurrent episode (recovery in-between), and persistent (no recovery).

This new model will help health care providers and patients measure short- and long-term outcomes of various treatment methods used for neck pain. There are benefits of this model for patients, clinicians, and policy makers. They may help guide us in providing more effective care for patients with neck pain.

Jaime Guzman, MD, MSc, FRCP(C), et al. A New Conceptual Model of Neck Pain. In Spine. Supplement to February 15, 2008. Vol. 33. No. 4S. Pp. S14-S23.

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