Screening protocol s have high predictive values to detect cervical spine fracture in alert , low-risk patients seeking emergency care after blunt neck trauma .
Computerized tomography ( CT ) scans had better validity ( in adults and elderly ) than radiographs in assessing high-risk and /or multi-injured blunt trauma neck patients .
In the absence of serious pathology , clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression .
One exception is the manual provocation test for cervical radiculopathy , which has high positive predictive value .
There was no evidence that specific MRI findings are associated with neck pain , cervicogenic headache , or whiplash exposure .
No evidence supports using cervical provocative discography , anesthetic facet , or medial branch blocks in evaluating neck pain .
Reliable and valid self-report question naires are useful in assessing pain , function , disability , and psychosocial status in individuals with neck pain .
CONCLUSION The scientific evidence supports screening protocol s in emergency care for low-risk patients ; and CT-scans for high-risk patients with blunt trauma to the neck .
In nonemergency neck pain without radiculopathy , the validity of most commonly used objective tests is lacking .
OBJECTIVE To critically appraise and synthesize the literature on assessment of  neck pain .
SUMMARY OF BACKGROUND DATA The published literature on assessment of neck pain is large and of variable quality .
There have been no prior systematic review s of this literature .
The Utility of Comparative Local Anesthetic Blocks Versus Placebo‐Controlled Blocks for the Diagnosis of Cervical Zygapophysial Joint Pain
Background : The development of target-specific local anesthetic blocks has enabled pain physicians to explore the anatomical source of chronic spinal pain . However , such blocks rely on subjective responses and may be subject to the placebo effect . Comparative local anesthetic blocks have been advocated as a means of identifying true-positive cases and excluding placebo responders . This paradigm employs two local anesthetics with different duration s of action ; only patients who obtain reproducible relief and correctly identify the longer-acting agent are considered positive . Objective : Our objective was to evaluate the reliability of comparative blocks of the medial branches of the cervical dorsal rami in the diagnosis of cervical zygapophysial joint pain .  Design : We compared comparative blocks and the criterion-st and ard of r and omized , double-blind , placebo-controlled blocks . Setting : The study was conducted at a tertiary referral center . Patients : We studied the first 50 consecutive patients referred for assessment of chronic neck pain ( > 3 months ' duration ) after a motor vehicle accident , who completed a series of placebo-controlled blocks after an initial positive response . Patients were 41 ± 11 years ( mean ± SD ) old with a male/female ratio of 1:2 . Methods : Patients underwent three blocks using three different agents— lignocaine , bupivacaine , and normal saline — administered on separate occasions , in r and om order and under double-blind conditions . The diagnostic decision based on comparative blocks alone was compared with that based on placebo-controlled blocks . Results : Comparative blocks were found to have a specificity of 88 % , but only marginal sensitivity ( 54 % ) . Although comparative blocks result in few false-positive diagnoses , their liability is that they result in a high proportion of false-negative diagnoses . Exp and ing the comparative blocks diagnostic criteria to include all patients with reproducible relief , irrespective of duration , increases sensitivity to 100 % but lowers specificity to 65 % . Conclusions : Whether physicians use comparative or placebo-controlled blocks depends upon the implication s of their results . If innocuous therapy will be prescribed , comparative blocks might suffice . However , when diagnostic certainty is critical , such as in a medicolegal context or when surgical intervention is contemplated , placebo-controlled blocks are recommended
Screening protocol s have high predictive values to detect cervical spine fracture in alert , low-risk patients seeking emergency care after blunt neck trauma .
Computerized tomography ( CT ) scans had better validity ( in adults and elderly ) than radiographs in assessing high-risk and /or multi-injured blunt trauma neck patients .
In the absence of serious pathology , clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression .
One exception is the manual provocation test for cervical radiculopathy , which has high positive predictive value .
There was no evidence that specific MRI findings are associated with neck pain , cervicogenic headache , or whiplash exposure .
No evidence supports using cervical provocative discography , anesthetic facet , or medial branch blocks in evaluating neck pain .
Reliable and valid self-report question naires are useful in assessing pain , function , disability , and psychosocial status in individuals with neck pain .
CONCLUSION The scientific evidence supports screening protocol s in emergency care for low-risk patients ; and CT-scans for high-risk patients with blunt trauma to the neck .
In nonemergency neck pain without radiculopathy , the validity of most commonly used objective tests is lacking .
OBJECTIVE To critically appraise and synthesize the literature on assessment of  neck pain .
SUMMARY OF BACKGROUND DATA The published literature on assessment of neck pain is large and of variable quality .
There have been no prior systematic review s of this literature .