Consistent evidence was found to support the use of ' red flags ' to screen for serious pathologies , judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance .
Neck pain and whiplash injuries are a common presentation to the ED , and a frequent cause of disability globally .
This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED .
Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy.
OBJECTIVES Acute back and neck strains are very common . In addition to administering analgesics , these strains are often treated with either heat or cold packs . The objective of this study was to compare the analgesic efficacy of heat and cold in relieving pain from back and neck strains . The authors hypothesized that pain relief would not differ between hot and cold packs . METHODS This was a r and omized , controlled trial conducted at a university-based emergency department ( ED ) with an annual census of 90,000 visits . ED patients > 18 years old with acute back or neck strains were eligible for inclusion . All patients received 400 mg of ibuprofen orally and then were r and omized to 30 minutes of heating pad or cold pack applied to the strained area . Outcomes of interest were pain severity before and after pack application on a vali date d 100-mm visual analog scale ( VAS ) from 0 ( no pain ) to 100 ( worst pain ) , percentage of patients requiring rescue analgesia , subjective report of pain relief on a verbal rating scale ( VRS ) , and future desire for similar packs . Outcomes were compared with t-tests and chi-square tests . A sample of 60 patients had 80 % power to detect a 15-mm difference in pain scores . RESULTS Sixty patients were r and omized to heat ( n = 31 ) or cold ( n = 29 ) therapy . Mean ( + /-st and ard deviation [ SD ] ) age was 37.8 ( + /-14.7 ) years , 51.6 % were female , and 66.7 % were white . Groups were similar in baseline patient and pain characteristics . There were no differences between the heat and cold groups in the severity of pain before ( 75 mm [ 95 % CI = 66 to 83 ] vs. 72 mm [ 95 % CI = 65 to 78 ] ; p = 0.56 ) or after ( 66 mm [ 95 % CI = 57 to 75 ] vs. 64 mm [ 95 % CI = 56 to 73 ] ; p = 0.75 ) therapy . Pain was rated better or much better in 16/31 ( 51.6 % ) and 18/29 ( 62.1 % ) patients in the heat and cold groups , respectively ( p = 0.27 ) . There were no between-group differences in the desire for and administration of additional analgesia . Twenty-five of 31 ( 80.6 % ) patients in the heat group and 22 of 29 ( 75.9 % ) patients in the cold group would use the same therapy if injured in the future ( p = 0.65 ) . CONCLUSIONS The addition of a 30-minute topical application of a heating pad or cold pack to ibuprofen therapy for the treatment of acute neck or back strain results in a mild yet similar improvement in the pain severity . However , it is possible that pain relief is mainly the result of ibuprofen therapy . Choice of heat or cold therapy should be based on patient and practitioner preferences and availability
Consistent evidence was found to support the use of ' red flags ' to screen for serious pathologies , judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance .
Neck pain and whiplash injuries are a common presentation to the ED , and a frequent cause of disability globally .
This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED .