The Empowerment of People With Neck Pain: Introduction

ArticlePlus Click on the links below to access all the ArticlePlus for this article. Please note that ArticlePlus files may launch a viewer application outside of your web browser. https://links.lww.com/SPINE/A343 Most people can expect to experience some degree of neck pain in their lifetime. In many cases, this will amount to nothing more than mild discomfort which does not require treatment and which has no major impact on work or other activities. However, some people will go on to develop prolonged or repetitive episodes of neck pain—sometimes associated with headaches and/or arm pain and, on occasion, more serious neurologic symptoms such as arm weakness, numbness, and/or sensory deficits—which may become persistent and debilitating. Although the individual risk of developing persistent and disabling neck pain is low, the number of affected persons in the general population is of concern. Debilitating neck pain not associated with serious pathology or systemic disease can be very frustrating, both for sufferers and for those who are asked to treat them. Opinions vary widely on what causes neck pain and how best to manage it. Treatment is often not very effective in reducing pain and disability, and the costs to those who pay for care—patients, insurers, governments, and employers—can be high. Opinions on what causes or exacerbates neck pain often depend more on the training and experience of the treating clinician than on any scientific studies or consensus. This can lead to conflict and confusion. For example: People with neck pain, who seek treatment often consult multiple clinicians in some attempt to get relief. They are often willing to consider prolonged or invasive treatment if it is recommended by the clinician they happen to be seeing at the time. Clinicians who treat patients with neck pain often order multiple tests, hoping to uncover a pathologic source for the pain. Findings from these tests may be contradictory. In an effort to help their patients, clinicians may give more credence to those tests which are consistent with a treatment approach they favor, whether or not these tests can be justified by the available evidence. Faced with paying for expensive diagnostic tests and treatments, which seem to be ineffective in reducing symptoms and disability, governments and private payer organizations often become frustrated. This may lead to delays in authorizing reasonable and justifiable patient care or to outright refusal to pay for treatment. Confusion about neck pain typically leads to blaming behavior, as people seek to assign responsibility or fault. Often the blame is assigned to a motor vehicle crash or other event, and sometimes to job-related or leisure activities. If the person with neck pain does not respond to treatment, and particularly when there is no obvious cause for neck pain, assumptions may be made that he or she is not being truthful about the presence and nature of their pain, or is exaggerating symptoms for financial gain. The problem of neck pain and associated disorders is not unique to developed nations. As noted in the preceding preface by Dr. Lars Lidgren, chairman of the International Steering Committee of the Bone and Joint Decade 2000–2010, musculoskeletal injuries related to motor vehicle crashes, industrial mishaps, and armed conflict are becoming a major cause of disability throughout the world. The cost of treatment for musculoskeletal disorders (MSDs), including neck pain, is increasing rapidly and consuming an ever-growing percentage of healthcare resources in both industrialized and developing countries. In a bold move to gain some control, both of the human suffering and the economic impact related to MSDs, the World Health Organization proclaimed that the years 2000–2010 would be the Decade of the Bone and Joint. This global initiative, involving World Health Organization, the United Nations, and the governments of 60 countries, aims to achieve several goals: To raise awareness of the growing burden of MSDs on society. To empower patients to participate in their own care. To promote cost-effective prevention and treatment. To advance our understanding of MSDs through research, which will yield improvements in prevention and treatment. A Neck Pain Task Force Is Born As the 1990s ended, there was growing awareness that neck pain and certain related conditions (referred to here as “associated disorders”) were becoming a serious burden. Patients, clinicians, payers, and researchers agreed on 2 points: that neck pain was not well understood and that, in many cases, it was difficult to manage. This awareness, combined with the global push for improving knowledge about MSDs provided by the Bone and Joint Decade, led to the formation of The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force). Early on, the Neck Pain Task Force Secretariat confronted a vital question: who would be the primary audience for its findings and recommendations? Members of the Scientific Secretariat were all too aware that information produced by such an initiative might be taken out of context or misinterpreted. For example: Clinicians often look at the results of guideline recommendations to see whether their own favored treatment approach has been approved or is rated low in usefulness; they are also interested in finding new interventions which might be useful in the their practices. Those who pay for health care and social support have a natural tendency to pay for the most cost-effective care. They are also interested in finding evidence that supports increasingly effective care and at the same time reduces costs, payments, and time lost to disability. Attorneys and their expert witnesses commonly use task force reports and other “learned documents” to bolster their legal cases surrounding issues of causation and responsibility. But what about the person with neck pain whose symptoms are affecting both life and livelihood? What about someone who has recovered once, but who worries about future episodes of debilitating neck pain? With the person with neck pain firmly in mind, members of the Neck Pain Task Force chose to focus on the second stated goal of the Bone and Joint Decade: “To empower individuals to participate in their own care.” They believed this type of patient-focused approach would yield the greatest positive impact on neck pain among the broadest array of stakeholders: Among Persons With Neck Pain People who understand what behaviors and environment factors are likely to increase their risk for neck pain may be better able to modify their habits and environs. Understanding the factors involved in recovering from neck pain and in preventing future episodes may help people adopt new behaviors or change their environment—for example, in the workplace or during leisure activities. Reliable information about the natural course of neck pain would help patients and their families understand what the future may hold. This should reduce anxiety and increase their ability to cope with neck pain if it occurs or reoccurs. People who understand the relative benefits and risks of treatment options for neck pain may make better decisions about whether or not to seek health care. Those who choose to seek care may feel more confident in selecting providers. They may be better equipped to ask the right questions when considering their treatment options. An informed public may be better able to influence government and other policy makers, both in terms of providing access to effective diagnostic tests and treatment, and also in efforts to prevent neck injuries and associated disability. This may help avoid unnecessary and expensive testing and treatment. Among Clinicians Knowing the relative value of tests commonly used to diagnose the source of neck pain and its severity—or to determine the likelihood of successful treatment—will give clinicians much needed evidence-based guidance. This should enable them to educate their patients about neck pain, which in turn should reduce patient demands for unnecessary, expensive, and often painful diagnostic tests. Reliable information about the natural course of neck pain should help clinicians understand what the future may hold, and this may help them provide better counsel to patients. Clinicians who treat neck pain, or who are asked for advice by people with neck pain, may find it easier to discuss risk factors and prognosis with greater confidence, and to appropriately reassure and counsel patients. This includes presenting the relative risks and benefits of various treatment approaches and providing advice that goes beyond their individual specialty or area of training. Among Other Stakeholders Insurance carriers and other payers who understand the science behind various approaches to treating neck pain may make more informed decisions on the reasonableness of diagnostic and treatment requests. This may help ensure that appropriate treatment is delivered quickly and efficiently. Greater consensus about neck pain causes, treatments, and prognosis may be useful to attorneys—and their clients—who are involved in litigation after injuries that result in neck pain. The existence of reliable information should help them to resolve issues of fault and future costs of treatment and to avoid dependence on the opinions of experts who often disagree with one another. Researchers and public health practitioners need to focus on population level strategies to prevent and control neck pain and its associated disorders. Ultimately, this will empower the general public and those with neck pain to assume greater responsibility for the prevention and management of these conditions. This supplement contains the best, most current evidence, and consensus regarding neck pain and its associated disorders. It is the culmination of 7 years of hard work and relentless focus, involving more than 40 international researchers, clinicians, consultants, research associates, and graduate students. A brief history of the Task Force is given in Table 1.Table 1: A Brief Timeline and History of the Neck Pain Task ForceTheir overarching goal has been to collect and share information which will yield the most valuable outcome possible: an informed and empowered public who will change attitudes and beliefs about neck pain diagnosis, treatment, management, and prevention. How the Neck Pain Task Force Is Organized The Neck Pain Task Force consists of a 5-member Administrative Committee, a 12-member Scientific Secretariat plus a research librarian, a 17-member Advisory Committee, and a support staff consisting of secretarial and scientific graduate student support. The Neck Pain Task Force relied on a number of highly qualified researchers and consultants who assisted in compiling the original research information and in conducting the final review of the scientific data. The Administrative Committee The 5-member Administrative Committee was responsible for: Obtaining funding for the Neck Pain Task Force. Assuming financial responsibility for the Neck Pain Task Force. Organizing meetings and coordinating specific Neck Pain Task Force activities. All funds were given as unrestricted research grants to the universities and research institutions of the two Scientific Secretaries of the Task Force. Collaborating Institutions Seven academic institutions with faculty members participating in Neck Pain Task Force activities agreed to become affiliated as collaborating centers. As such, these institutions (Table 2) gave permission for their names and logos to appear on the Neck Pain Task Force letterhead.Table 2: Collaborating InstitutionsThe Scientific Secretariat of the Neck Pain Task Force This key group was responsible for the following tasks: Establishing the scope for the literature review and the criteria for the best evidence synthesis of the literature. Screening all the scientific abstracts. Carrying out detailed reviews of the articles that were considered. Developing the evidence tables which formed the basis for the Neck Pain Task Force conclusions and recommendations. Conducting original research; when necessary, in collaboration with other scientists. Collating and integrating all data collected over the 6 years of active research. Developing a new and relevant model for neck pain. Developing a set of “key messages” on neck pain based on Neck Pain Task Force findings. Writing a series of articles and recommendations to be developed into proceedings published in this supplement of Spine. To accomplish their complex and wide-ranging tasks, members of the Scientific Secretariat attended three, 4-day meetings each year for most of the 6 years. Throughout the 6-year period, members of the Scientific Secretariat took part in telephone meetings (lasting 2 to 3 hours each) to discuss the review of scientific studies. This does not include the time it took for members to review 31,878 abstracts and the 1203 relevant articles drawn from the scientific literature and to conduct original research studies. These Proceedings are the result of the expertise and dedication of the Scientific Secretariat that was unflagging over half a dozen years. The Advisory Committee of the Neck Pain Task Force The contributions of the 17-member Advisory Committee were crucial to the success of the Neck Pain Task Force. Members were invited to participate, based on their areas of expertise. It was also important to ensure that there was an international and interdisciplinary representation (Tables 3, 4).Table 3: National Representation of the Neck Pain Task Force MembersTable 4: Professional Backgrounds of Neck Pain Task Force Members Advisory Committee members were asked to attend 4 meetings where details of the literature review and the original research were presented for their consideration. Their input resulted in extensive revisions to the original research protocols and also to the literature review process. When a dispute or concern arose over a particular issue under consideration, the Scientific Secretariat could ask members of the Advisory Committee to review pertinent material and give their advice. In addition to these responsibilities, certain members of the Advisory Committee were active as coinvestigators in many of the original research projects. Neck Pain Task Force Observers Each Professional Association Sponsor (Table 5) and each Financial Sponsor (Table 6) of the Neck Pain Task Force was invited to send an observer to attend the 4 meetings of the full Neck Pain Task Force (full Neck Pain Task Force meetings included members of the Scientific Secretariat, the Administrative Committee, and the Advisory Committee).Table 5: Professional Association Sponsors (Nonfinancial) of the Neck Pain Task ForceTable 6: Financial Sponsors of the Neck Pain Task ForceAs important stakeholders, the observers were permitted to provide scientific articles which they felt were important for the Neck Pain Task Force to review. The goal was to help ensure that no important scientific data were missed. The observers were not permitted to participate in any of the Neck Pain Task Force deliberations or to provide input to the Task Force Proceedings. The Objectives and Scope of the Neck Pain Task Force The Neck Pain Task Force has 5 primary objectives: To complete a systematic search and critical review of the scientific literature on neck pain and its associated disorders, including the epidemiology, diagnosis, prognosis, economic costs, and treatment of neck pain and its associated disorders. To identify the risks associated with the treatment of neck pain and its associated disorders. To complete original research using decision analysis to examine patient preferences for various treatment options. To collate the above evidence, using best evidence synthesis methodology, into recommendations for the control and management of neck pain and its associated disorders. The scope of the Neck Pain Task Force was limited to neck pain and its associated disorders (Table 7). Studies on neck pain that resulted from destructive and progressive affecting the neck such as and and other systematic and were for several These conditions much the population than more of neck pain and their management is often given the time and expertise of the Neck Pain Task it would be to these more neck However, diagnostic and studies related to out and in neck pain were included in the scope of the Neck Pain Task the Scope of the Neck Pain Task Neck Pain Task conclusions were based on the results of the best evidence synthesis and on the original research out over the 6-year Although experience is of vital in much of the evidence, opinions and experience primary scientific evidence not the basis for the Neck Pain Task Force relied on a group for all including of the data. there was the Scientific Secretariat regarding most of the as well as the Task final recommendations. of and of The members of the Scientific Secretariat that there is a for in any research. When it to research the of may be were and right from the the primary goal was to conduct original research about neck pain and to review the literature for scientific the Neck Pain Task Force it was that all members of the Scientific Secretariat have a and scientific It was also vital that in the care of patients with neck pain were on the Neck Pain Task Force. This that expertise would be available during When members of the Advisory Committee were was given to those with research experience and It was also important to include members from that were not the Scientific A patient was to on the Advisory This was to ensure that the of would be and would be by the Neck Pain Task Force during its many and In order to determine and among Task Force an observer was was asked to help the Scientific Secretariat and the Advisory Committee consider what impact their individual and opinions might have on their opinions and and of Neck Pain Task Force Findings and The work of the Neck Pain Task the original research and the literature in The results and a set of conclusions were presented at a full of the Neck Pain Task Force in in The input from this for some of findings and This input was taken by members of the Scientific Secretariat and was used to a that was for in of the Neck Pain Task Force findings and conclusions will as The results of the Neck Pain Task Force will be presented in a series of articles that is being published as a supplement in the international Spine. This is to have the greatest impact and in the area of disorders includes neck Members of the Scientific Secretariat have been invited to their findings at multiple and scientific These meetings will for input and on the part of interested and also for of the findings where is in of the Task Force findings on neck pain, including knowledge and The members of the Task are to and of the and in and of knowledge and As a group and as members of the Task Force will these as much as However, given that Task Force members participate in such and that there will be various of this the Task Force when considering such and will those efforts in which the Task Force members are on the and of Neck Pain Task Force It is difficult to the impact of the work by the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated of the may the findings and recommendations or specific recommendations into their own for Other or may feel that the findings of the Neck Pain Task Force are not with their own regarding neck pain. might look at what in after the of task force those from the Task Force on Associated Disorders and from the for Health and on These and also some over recommendations and It is that government and will into the recommendations of the Neck Pain Task Force when considering public policy However, these recommendations should not be should they be in by those such issues as or public health The Neck Pain Task Force not consider studies in the of or prevention they were studies of outcome from The literature review also studies of many that may be associated with neck pain such as and systemic and approach to treat person with neck pain. The individual of such patients, how they respond to treatment, and the impact of specific factors may not be or in and research. In its published years the Task Force on Disorders recommended that a task force on neck pain be by the year to review new evidence and patient care This the for the current Neck Pain Task Force. a new be the Neck Pain Task Force has in neck pain research which be As new studies are out and it will be important to the evidence regarding neck pain risk factors and management the 5 to years. of a task force such as this is to focus and the researchers who will participate in future studies on neck pain and its associated disorders. its the Scientific Secretariat as a for graduate and with specific in neck pain. of these researchers during the course of the Task Force. They also experience in and the scientific literature and/or in the original research projects. The Neck Pain Task and that clinicians and will be and by the findings in this But the key for this new information on neck pain are the many of people suffering from neck pain, not to the of the population with neck pain in their This is consistent with a key goal of the Bone and Joint Decade to empower patients to participate in their own care. If this is to a the time and effort to the research and of this supplement over the 6 years will have been well

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.