Management of acute neck pain in general practice: a prospective study

Abstract

Background: Research on neck pain in primary care is sparse. The role of GPs in taking care of patients with neck pain has not been described so far. This study focused on interested in the interaction between patients and GPs in their first contact on a new episode of neck pain.

Aim: To describe GPs' management of acute neck pain in patients and to detail the diagnostic and therapeutic procedures undertaken by GPs and self-care by patients.

Design of study: A prospective cohort study with 1-year follow up.

Setting: General practice in The Netherlands.

Method: Patients consulting their GP for non-specific acute neck pain lasting no longer than 6 weeks were invited to participate. Questionnaires were collected from patients at baseline and after 6, 12, 26, and 52 weeks. Patients rated their recovery on a 7-point ordinal scale.

Results: In total 187 patients were included. At baseline GPs prescribed medication for 42% of patients, mostly non-steroidal anti-inflammatory drugs (56%) or muscle relaxation medication (20%); 51% were referred to a physiotherapist. Seventy-four per cent of referred patients reported recovery at the end of the follow-up year, whereas 79% of non-referred patients reported recovery. Frequently-given advice by the GP was to 'wait and see' (23%), 'improve posture' and 'stay active' (22%) or to 'take a rest' (18%). Self-care by patients included different sources of heat application (79%) and exercises (57%). Complementary medicine was used in 12% of cases and 39% of patients visited their GP again during follow up. Consultation of a medical specialist and ordering of X-rays rarely occurred.

Conclusion: Management by GPs included a strategy to 'wait and see' for an expected favourable natural course supported by medication, or referral to a physiotherapist.

Keywords: consultation and referral; duty to follow-up; family practice; neck pain; practice management.