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How Do We Know What Is the Best Evidence on Treatment of Neck Pain?

Posted on: 03/13/2008
Studies show that the number of people affected by neck pain every year is on the rise. Health care providers want to offer the best treatment for each condition. But how do doctors keep up with current ideas and information for this condition?

In this article, members of the Task Force on Neck Pain and its Associated Disorders tell us the process by which they came up with the best evidence for treatment of neck pain. They used asystematic review as their basic approach.

A systematic review means the Task Force looked for studies on neck pain and then summarized their results. Over a period of six years, the Task Force found over 31,000 citations (mentions) of articles about neck pain. Only 1,200 were considered relevant for the first step of this review. After looking them over more carefully, 552 were included in the best-evidence category.

A similar systematic review was done in 1995 but it was just related to whiplash injuries. This new review included neck pain in anyone from any traumatic, occupational, or other work-related causes. Anytime a first systematic review is published, it's considered a baseline. This means it's a place to start. Future studies can be compared to the baseline to look for changes.

The purpose of such studies is to publish guidelines for everyone to follow when treating patients with neck pain. The hope is that these recommendations will lead to more effective prevention and management of neck pain. Meeting these goals would also reduce the financial, social, and emotional cost of neck pain to society.

The Task Force on Neck Pain was made up of a large group (over 50 people) from around the world. Scientists, clinicians, and other experts to guide the process were included. There was an Advisory Committee to keep the process going and on track.

A list of questions was decided upon and used when reviewing each article. For example, who gets neck pain? What is the risk for work-related strains or injuries? What determines who gets better and who doesn't? What evidence is there that a specific treatment was successful? What's the best way to evaluate or diagnose neck pain?

Studies were included if there were more than 20 human subjects with neck pain. Cases of neck pain from a serious medical problem such as infection, fracture, or tumor were not included. Each one had to be published in English, French, and Swedish sometime after 1980. Opinion articles, letters to the editor, and studies that didn't have proper reporting or data were not included.

A critical review of the included studies also focused on the study design, how the study was conducted, how the data was collected and analyzed, and follow-up rates. The study was not included if it was not consistent with best research practices.

The final results were published in a series of nine topic-specific reviews in this edition of the Spine journal. Clinical and research implications of the evidence are presented whenever possible.

Linda J. Carroll, PhD, et al. Methods for the Best Evidence Synthesis on Neck Pain and Its Associated Disorders. In Spine. Supplement to February 15, 2008. Vol. 33. No. 4S. Pp. S33-S38.

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