The purpose of this review is to examine the evidence-based literature for effective, non-invasive (non-surgical) acute neck pain treatments. Neck pain accounts for 10.2 million (U.S stats) doctor and hospital visits annually. 30-50% of adults’ experience neck each year with more than 80% of individuals’ experiencing neck pain during their lifetime.

This paper is going to discuss the recent recommendations made by the Ontario Protocol for Traffic Injury Management (OPTIMa – March 2016) collaboration. The OPTIMa collaboration was commissioned by the Ontario Ministry of Finance and the Financial Services Commission of Ontario (FSCO). The purpose of OPTIMa is to develop evidence-based clinical practise guidelines (CPG) for the management neck pain and associated disorders. This management based guideline is intended for medical doctors, nurse practitioners, chiropractors, physiotherapists and massage therapists.

Classification of neck pain:

OPTIMa splits the duration of neck pain into 2 groups. Neck pain less than 3 months of duration is classified a recent-onset (acute). Neck pain of 4-6 months in duration is classified a persistent (chronic).

OPTIMa uses previous CPG’s to classify neck pain into four neck pain and associates disorders (NAD)

• NAD I: neck pain with no or minor interference with activities of daily living
• NAD II: neck pain with major interference with activities of daily living
• NAD III: neck pain with neurological signs (numbness and tingling; i.e. carpal tunnel)
• NAD IV: neck pain with sign & symptoms of major structural pathology (i.e: fracture, cancer)

OPTIMa only focused on NAD I to NAD III, as NAD IV management is out of the scope of practise of everyone except medical doctors.

This review is only going to focus on acute (recent-onset) NAD I & NAD II. This is because there is limited evidence to recommend any treatment for patients with acute NAD III besides education.

Treatments that ARE recommended for acute neck pain:

Acute Neck Pain Treatments: Range of motion exercises

Research has shown that acute neck pain patients get worse with immobility. Therefore, OPTIMa recommends that ROM be taught to neck pain patients by a healthcare professional: chiropractor, physiotherapist, nurse or kinesiologist. ROM exercises should be performed, resistance free, 5-10 times (repetitions) and up to 6-8 times per day (sets).

ROM exercises should be performed in a slow and controlled manner. They should involve the neck and shoulders. These exercises should include neck retraction, forward bending, extension, side to side bending and rotation. Scapular retraction ROM exercises should also be included

Acute Neck Pain Treatments: Spinal Manipulation

OPTIMa recommends six sessions of spinal manipulation and ROM exercises over an eight-week period. Research has shown that the combination of spinal manipulation and ROM exercises is more cost effective than exercises with ultrasound and electrotherapy. Spinal manipulation and exercise is also more effective than advice and medication (analgesics).

Acute Neck Pain Treatments: Medications 

OPTIMa recommendations are consistent with the World Health Organizations’ non-opioid “Pain Ladder”. The first ‘step’ on the pain ladder includes NSAIDs, muscle relaxants and acetaminophen (Tylenol).

It should be noted that OPTIMa states there is insufficient evidence for prescribing NSAIDs or Tylenol for acute neck or spinal pain. Furthermore, recent studies have found Tylenol to be ineffective at managing acute neck or spinal pain.

One high quality study found muscle relaxants may be more effective than a placebo. Ironically, for acute neck the benefit of a muscle relaxant is its ability to decrease pain (analgesia). Not it’s ability to relax a tight muscle. Nevertheless, OPTIMa advises against prolonged use due to the significant adverse effects associated with muscle relaxants.

Acute Neck Pain Treatments: Education and Reassurance

This is pretty standard management for any condition or injury. Patients that have a better understanding about the nature, management and clinical course of neck pain tend to do better than patients who are uninformed.

Patients should be made aware that the majority of neck pain cases are self-limiting. The majority of time the patient will still get better even if they do nothing. The goal of therapy is to reduce the duration and intensity of symptoms.

Nevertheless, OPTIMa advises against education as a stand alone treatment program. This is because research has shown that education alone is less effective than a combination of spinal manipulation and range of motion (ROM) exercises.

Treatments that ARE NOT recommended for acute neck pain:

These recommendations were made based on limited available evidence or treatments that have been shown to be ineffective in the management of acute neck pain. These treatments include, structured patient education alone, strain-counter strain therapy (ART), relaxation massage, cervical collar, electroacupuncture, electrotherapy or heat applied at a clinic.

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