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Managing Non-Specific Neck Pain by Healthcare Professionals in Qatar

Identifying the areas where evidence-based guidance is needed

Managing Non-Specific Neck Pain by Healthcare Professionals in Qatar: Identifying the areas where evidence-based guidance is needed
INTRODUCTION
 
Neck pain is a common condition and is a leading cause of disability worldwide. The estimated mean, annual and lifetime prevalence rates are 7.6%, 37.2% and 48.5%, respectively. Despite this, it attracts only a fraction of the research funding, and few clinical trials are dedicated solely to neck pain.  
 
Simple (or non-specific) neck pain is the most common of neck pain and it denotes pain or discomfort in the neck and/or shoulder girdle with or without pain referred to the arms which cannot be attributed to a specific cause.  The cause is usually multifactorial and includes poor posture, neck strain, sporting or occupational activities, anxiety, and depression. It usually goes away on its own within a few days or weeks. It may last longer or keep coming back in some people. Neck pain is “chronic” if it lasts more than 3 months.
 
 
The aim of this exploratory study is to identify areas of uncertainty that healthcare professionals in Qatar believe they need evidence-based recommendations to follow when managing non-specific neck pain.
 
By responding to this questionnaire, you agree to participate in this study.
A. General Demographics and Workload:(Required.)
Please rate the following statements from 1 to 10 based on the scale provided. You may add any useful comments or clarification that you think will help us in developing recommendations
B-1: When presenting with neck pain, it is:(Required.)
1
(Strongest Disagreement)
2
3
4
5
6
7
8
9
10
(strongest Agreement)
I Don't Know
Generally acute and self-limiting.
Usually a secondary complaint (not the main reason for visiting the physician).
Commonly associated with shoulder pain and/or headache.
Either purely nociceptive (mechanical) or neuropathic (with radicular pain). (not a mixture of both)
B-2: You believe a patient should presenting with neck pain should URGENTLY be referred or admitted if the patient (Required.)
1
(Strongest Disagreement)
2
3
4
5
6
7
8
9
10
(strongest Agreement)
I Don't Know
Is over 50 years of age with cancer.
Is over 50 years with vascular disease
Has fever
Has neck stiffness
Has nausea or vomiting
Has unexplained weight loss
Has torticollis
Has limited neck mobility
Has erythema or exudate at the neck
Has severe neck tenderness
Has high erythrocyte sedimentation rate (ESR)
Has high C reactive protein
Has raised white blood cell count
Has trauma to the neck.
Has incontinence
Has altered cognitive status.
Has ataxia
Has visual loss
Has new or severe headache
Has photophobia or phonophobia
Has signs of cervical myelopathy (upper motor neuron signs).
B-3 : In managing a patient with non-specific neck pain, how likely you would perform the following:(Required.)
1
(Not At All Likely)
2
3
4
5
6
7
8
9
10
(Extremely Likely)
I Don't Know
Provide reassurance if there are no red flags.
Advise the patient to remain active.
Advise the patient to have bed rest
Advise the patient to avoid movement/activity that provokes radiating pain or other symptoms in the arm
Advise the patient to continue/return to work
Provide the patient with work-related/occupational/postural advice
Assess the psychosocial aspects that delay/inhibit recovery
Order an x-ray of the neck
Order MRI of cervical spine
Order CT scan of cervical spine
Refer to electromyography
Prescribe paracetamol
Prescribe NSAIDs
Prescribe analgesics only if accompanied by neuropathic pain
Prescribe opioids including tramadol
Prescribe oral steroids
Prescribe topical medications including NSAIDs
Prescribe Spinal epidural steroid injection with severe persistent symptoms
Offer sick leave
Schedule a follow-up visit
B-4: The following modalities are helpful in managing patients with neck pain:(Required.)
1
(Strongest Disagreement)
2
3
4
5
6
7
8
9
10
(strongest Agreement)
I Don't Know
Thermotherapy including hot/ cold compress, bath, sauna
Manual therapy including mobilisation, manipulation and soft-tissue techniques
Exercise programs/therapy
Postural re-education
Traction
Electrotherapy including light, laser, Low Level Laser Therapy (LLLT), pulsed electromagnetic, TENS, Ultrasound (US), shockwave, Magnetic, electromagnetic
Cervical orthoses (soft and stiff neck collars)
Cervical cushion (as the one used in long flights)
Acupuncture/dry needling
Kinesiology taping and strapping
Psychological therapies incl. behavioural and cognitive-behavioural therapies
Multidisciplinary treatment/programs
B-5: How useful to you are the following imaging methods in managing a patient with neck pain?(Required.)
1
(Not At All Useful)
2
3
4
5
6
7
8
9
10
(Very Useful)
I Don't Know
X-ray of the neck
MRI of cervical spine
CT scan of cervical spine
Other imaging techniques (select 1 if there is none, or explain in the box below)
B-6: How often do you refer a patient with neck pain to the following specialists?(Required.)
1
(Not At All Likely)
2
3
4
5
6
7
8
9
10
(Extremely Likely)
I Don't Know
Physical therapist
Occupational health officer
Psychologist/psychiatrist
Orthopedic Surgeon
Neurologist.
Pain management clinic.
B-7: When managing patients with neck pain, how important to you are the following outcome? (Required.)
1
(Not At All Important)
2
3
4
5
6
7
8
9
10
(Extremely Important)
I Don't Know
Relief of symptom
Preserving neck and arm mobility
Prevention of recurrence
Prevention of complications
Not causing harm to the patient
Patient satisfaction
Other outcomes