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REVIEW ARTICLE
Year : 2014  |  Volume : 9  |  Issue : 6  |  Page : 42-53

Diagnosis and management of neck and back pain


Centre for Research in Rehabilitation, School of Health Studies and Social Care, Brunel University, Uxbridge, UB8 3PH, UK

Correspondence Address:
Andrew O Frank
Centre for Research in Rehabilitation, School of Health Studies and Social Care, Brunel University, Uxbridge, UB8 3PH, UK

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Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.injr.2014.09.015

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Neck and back pains are features of life worldwide. Few with spinal pain (SP) have serious medical (non-spinal) conditions; significant spinal pathology; or compression of root or cord such as to require surgery. Although the causes of most episodes of SP remain unclear in practice, physical stress and its consequences on discs, facet joints and supporting soft tissue structures at work or leisure activities are thought to trigger many initial attacks. But prognosis usually depends on psychosocial issues. A minority of episodes are prolonged, intractable and disabling, contributing to the high cost for society. Around 10% of those presenting to a rheumatological service have non-spinal conditions. There is good evi- dence to support prevention of SP through primary, secondary and tertiary routes. Modern management of chronic SP emphasises the role of self-care, which should begin in general practice at presentation of the first episode and be reinforced by all health professionals. In the absence of root compression, bed rest should be minimal. A positive approach is encouraged, acknowledging that returning to a normal life may require working through pain. More emphasis is laid on actively encouraging a return to physical fitness and other activities, including employment. Medication plays a secondary role by facilitating these objectives.


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