• Neck and upper back complaints. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM); 2004. 30 p. [75 references]

This is the current release of the guideline.

This guideline updates a previous version: Harris, J, ed. Occupational Medicine Practice Guidelines: American College of Occupational and Environmental Medicine. Beverly Farms, MA: OEM Press; 1997.

Acute and subacute occupational neck and upper back complaints

Diagnosis
Evaluation
Management
Treatment

Family Practice
Internal Medicine
Orthopedic Surgery
Physical Medicine and Rehabilitation
Preventive Medicine
Surgery

Advanced Practice Nurses
Physician Assistants
Physicians
Utilization Management

• To provide information and guidance on generally accepted elements of quality care in occupational and environmental medicine
• To improve the efficiency with which the diagnostic process is conducted, the specificity of each diagnostic test performed, and the effectiveness of each treatment in relieving symptoms and achieving cure
• To present recommendations on assessing and treating adults with potentially work-related neck and upper back complaints

Adults with potentially work-related neck and upper back complaints seen in primary care settings

Note from the National Guideline Clearinghouse (NGC): The following general clinical measures were considered. Refer to the original guideline document for information regarding which specific interventions and practices under these general headings are recommended, optional, or not recommended by the American College of Occupational and Environmental Medicine.

1. History and physical exam
2. Medication
3. Physical treatment methods
4. Injections
5. Rest and immobilization
6. Activity and exercise
7. Detection of neurologic abnormalities
8. Radiography
9. Other imaging procedures
10. Surgical considerations

Missed work days

Searches of Electronic Databases

Note from the National Guideline Clearinghouse (NGC): The American College of Occupational and Environmental Medicine contracted the Work Loss Data Institute to provide medical library research services.

Disability-Duration Data

This edition includes disability-duration data that have been extracted from National Health Interview Survey data. Only data from interviews with individuals without workers' compensation claims has been included.

Not stated

Expert Consensus
Weighting According to a Rating Scheme (Scheme Given)

A = Strong research-based evidence (multiple relevant, high-quality scientific studies).

B = Moderate research-based evidence (one relevant, high-quality scientific study or multiple adequate scientific studies).

C = Limited research-based evidence (at least one adequate scientific study of patients with neck and upper back disorders).

D = Panel interpretation of information not meeting inclusion criteria for research-based evidence.

Review

Contributors reviewed at least one chapter each and reviewed the relevant medical literature that had been published since the creation of the original Guidelines in 1997.

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

Following the chapter and literature review, participants provided written or verbal comments to the American College of Occupational and Environmental Medicine's Practice Guidelines Committee.

Verbal comments were in the form of participation in multi-specialty conference calls, during which the issues raised in each chapter were extensively discussed. Draft chapters were prepared and distributed by the American College of Occupational and Environmental Medicine to all chapter reviewers. Follow-up multi-specialty teleconferences were then held as appropriate, during which time the draft was again reviewed.

Recommendations are followed by evidence classification (A-D) identifying the type of supporting evidence. Definitions for the types of evidence are presented at the end of the "Major Recommendations" field.

Summary of Recommendations for Evaluating and Managing Neck and Upper Back Complaints (refer to the original guideline document for more detailed information)

Definitions:

Levels of Evidence

A = Strong research-based evidence (multiple relevant, high-quality scientific studies).

B = Moderate research-based evidence (one relevant, high-quality scientific study or multiple adequate scientific studies).

C = Limited research-based evidence (at least one adequate scientific study of patients with neck and upper back disorders).

D = Panel interpretation of information not meeting inclusion criteria for research-based evidence.

The following clinical algorithms are provided in the original guideline document:

• American College of Occupational and Environmental Medicine Guidelines for care of acute and subacute occupational neck and upper back complaints
• Initial evaluation of occupational neck and upper back complaints
• Initial and follow-up management of occupational neck and upper back complaints
• Evaluation of slow-to-recover patients with occupational neck or upper back complaints (symptoms >4 weeks)
• Surgical considerations for patients with persistent radiating arm pain
• Further management of occupational neck and upper back complaints

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

• Improved efficiency of the diagnostic process
• Effective treatment resulting in symptom alleviation and cure

Not stated

The American College of Occupational and Environmental Medicine provides this segment of guidelines for practitioners and notes that decisions to adopt particular courses of actions must be made by trained practitioners on the basis of the available resources and the particular circumstances presented by the individual patient. Accordingly, the American College of Occupational and Environmental Medicine disclaims responsibility for any injury or damage resulting from actions taken by practitioners after considering these guidelines.

An implementation strategy was not provided.

Getting Better

Effectiveness
Patient-centeredness

• Neck and upper back complaints. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM); 2004. 30 p. [75 references]

Not applicable: The guideline was not adapted from another source.

1997 (revised 2004)

American College of Occupational and Environmental Medicine - Medical Specialty Society

American College of Occupational and Environmental Medicine

American College of Occupational and Environmental Medicine Practice Guidelines Committee

Chapter Lead: Michael N. Goertz, MD, MPH, FACOEM

Committee Members: Jennifer H. Christian, MD, MPH, FACPM; Philip I. Harber, MD, MPH, FACOEM, FCCP; John P. Holland, MD, MPH, FACOEM; Kathryn L. Mueller, MD, MPH, FACEP, FACOEM; Douglas J. Patron, MD, MSPH; Bernyce M. Peplowski, DO, MS; and Jack Richman, MD, CCFP, DOHS, FACOEM

Timothy J. Key, MD, MPH, FACOEM, as Responsible Officer and ACOEM President Elect, and Edward A. Emmett, MD, MS, FACOEM, Chair of the ACOEM Council on Occupational and Environmental Medical Practice, contributed to the development of the guidelines as well.

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Harris, J, ed. Occupational Medicine Practice Guidelines: American College of Occupational and Environmental Medicine. Beverly Farms, MA: OEM Press; 1997.

None available

None available

This NGC summary was completed by ECRI on March 13, 2006. The information was verified by the guideline developer on November 3, 2006.

The American College of Occupational and Environmental Medicine, the signator of this license, represent and warrant that they are the publisher of the guidelines and/or possess all rights necessary to grant the license rights to AHRQ and its agents.