World Congress of Neck Pain – Post Congress Information

Safety Ratings for Head Restraints

Dr. Matthew H. Liang, Professor at the Harvard School of Public Health and Scientific Chair for the congress stated “From a public health perspective the best way to reduce individual suffering and the socio-economic burden of neck pain arising from motor vehicle collisions is for the public to use vehicles with good head restraints and to make sure that head restraints be adjusted appropriately.

Currently consumers can find information about safety ratings for head restraints in existing vehicles from research reports by the Insurance Institute of Highway Safety (IIHS).

www.iihs.org/ratings/head_restraints/head_restraint_info.html

www.icbc.com/buy_car/pdf/TS274T%20web%20head%20rest.pdf

www.thatcham.org/ncwr

List of Vehicles with Good Head Restraints

www.neckpaincongress.org/media/GHR.pdf

Dr. Jack Richman, President of the Canadian Institute for the Relief of Pain and Disability who specializes in family and occupational medicine stated, “Every health care professional office, automobile association magazine, auto-sales outlet, public radio and television station, government and consumer agency should have educational material on the importance of adjusting your head restraint. We need to get the message out about head restraints systems – Get It, Set It and Forget It!“

Task Force Recommendations for Treatment of Neck Pain

Although there is no one “best” treatment for neck pain that is effective for everyone, the Task Force recommended that people with neck pain can take an active role in managing their pain.

• Stay as active as you can
• Try over the counter pain relief
• Reduce mental stress
• Have realistic expectations for relief - pain relief is often modest

For the majority of neck pain the following treatments show evidence of being effective for reducing symptoms:

• Exercise
• Mobilization
• Manipulation
• Massage
• Acupuncture
• Low level laser therapy
• Analgesics

Prolonged treatment was not shown to be beneficial. It was recommended that patients do not continue treatment that doesn’t provide improvement within a reasonable period of time;

• You should see improvement after 2-4 weeks if the treatment is the right one for you
• You may need to try a variety of options
• Short episodes of care may be helpful: lengthy treatment is typically not associated with greater improvements.

The study revealed that the following treatments were unlikely to help in relieving neck pain:

• Collars
• Ultrasound, electrical muscle stimulation
• Most injection therapies
• Radio frequency neurotomies

If you are concerned about neck pain or have troublesome symptoms that interfere with daily activities talk to your health care provider about the range of effective treatment options

The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders

The Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders is an international, multi-centre, multi-disciplinary group of international researchers and clinicians who have spent the past seven years undertaking a comprehensive and structured review of the current research on neck pain.

The goals of the Neck Pain Task Force were to clarify the best ways of diagnosing, treating and rehabilitating those with neck pain, to shed light on prevention measures, and to identify what risk factors contribute to the problem. The Task Force reviewed over 32,000 citations on neck pain and created a best evidence-synthesis based on 550 high quality studies. The final report addresses “the economic consequences, risk and prevention measures, diagnosis, prognosis, treatment and rehabilitation of neck pain and its associated disorders.

Two of the Task Force’s five studies were focused specifically on risks associated with the treatment of neck pain. One of the studies examined the association between strokes and neck adjustment and the other examined serious complications associated with the prescription of non-steroidal anti-inflammatory drugs for the treatment of neck pain.

Research uncovered surprising evidence about what therapies work, what therapies don’t work and where there is little evidence at all to support therapies in current practice.

An executive summary of The Task Force report has been published on line and can be viewed at the following web address:
www.spinejournal.org/pt/re/spine/executivesummary.htm

Access to the full report:
www.spinejournal.org/pt/re/spine/home.htm

“Research to Practice”

A major challenge facing scientists is the gap between what is known by high quality research and what is done in the world. There is typically a 10-15 year gap between research and practice. To this end the congress hosted a panel on ‘Research to Practice’ with Dr. Max Lum, Director of Health Communications for the National Institute for Occupational Safety and Health, Ms. Jean Slutsky, Director of the Center for Outcomes and Evidence at the Agency for Healthcare Research and Quality and Dr. Marc White Research Fellow at Harvard Medical School and a Clinical Assistant Professor with the Department of Family Practice at the University of British Columbia focused on health professional education.

Dr. Max Lum suggested special attention may be needed to get this message out to youth using creative measures. Dr. Lum noted that on the way to the congress his son had picked him up and he noted that his son’s car had no head restraint system. He asked his son – what happened to his head restraint – his son looked at him blankly and said it was a used car it didn’t come with a head restraint. Dr. Lum asked his son, “Have you ever heard about “whiplash”, his son stated ‘Of course I have, who hasn’t, it’s a Metallica [rock band] top hit”. Dr. Lum suggested to the audience that maybe we should ask Metallica if they could help to spread the message to young people, and make use of Wikipedia, YouTube and other social media venues that young people are familiar with and access for important information.

Ms. Jean Slutsky spoke about AHRQ’s experience in reducing the gap between research knowledge and clinical practice. Although ‘There is no magic bullet’, Ms. Slutsky stated, it is important to have early involvement and engagement of partners and end users in the project, to know why the findings matter, and say so.

World Congress of Neck Pain – Post Congress Dissemination

In planning the congress, Dr. Marc White, Executive Director of the Canadian Institute for the Relief of Pain and Disability, brought together 39 professional and consumer-based organization sponsors to the World Congress on Neck Pain including the National Safety Council, American Public Health Association and the Consumer Federation of America to lay the groundwork for post-congress dissemination. Dr. White is seeking public and private partners to launch a coordinated campaign to create targeted interventions to change public and health professional education, clinical practice, workplace and government policy.

Dr. White was involved in two rear-end collisions and speaks from experience, “Many health conditions are preventable if people take appropriate action, neck pain is no different – the challenge is how best to change health behavior. Public and private policy programs have shown to be very effective for certain risk behavior, for instance, seat belt legislation, click it or ticket state programs, worksite occupational safety policies. The most successful change interventions to change social norms, improve safety and reduce unnecessary disability are those linked to accountability and consequences. As a person who has experienced persistent neck pain as a result of motor vehicle accidents it is good to know that each and every one of us can prevent or reduce the impact of neck pain. The findings of the Bone and Joint Neck Pain Task Force can help guide health care professionals and the public in their choice of evidence-based treatment. When you are in pain you tend to try everything and there is a lot of snake oil in the marketplace making big claims of relief. “

Dr. John P. Holland, Past President of the American College of Occupational and Environmental Medicine, a member of the scientific committee for the World Congress states, “We plan to use findings of the Task Force’s high quality evidence-based systematic literature reviews as a major resource in updating recommendations about clinical management of neck pain in the ACOEM Occupational Medicine Practice Guidelines, which are currently used by multiple clinicians, state workers compensation agencies and insurers. Basing clinical care on well developed evidence-based practice guidelines should result in the best clinical outcomes for patients, improving both symptoms and functioning, and is the best mechanism for delivering cost-effective care.”

World Congress of Neck Pain – Awards for Research Excellence

As part of the Congress program the following Awards for Research Excellence were

Awards for Research Excellence Winners

        Sponsored By

The Woodbridge Award for Research Excellence in Auto Safety

• Charles Farmer, Laurie Hellinga, Jo Anne Wells & David Zuby for their paper Relationship of Dynamic Seat/Head Restraint Ratings to Real-World Neck Injury Rates. The study demonstrated that neck injury rates were overall 15% lower for drivers of vehicles with seats rated good compared with seats rated poor. Most importantly, prolonged or persistent neck pain lasting 3 months or more were 35% lower for drivers of vehicles with seats rated good versus seats rated poor.

Awards for Research Excellence in the Clinical Sciences

        Sponsored By

• LA Phillips, LJ Carroll, JD Cassidy & P Côté - Whiplash! Who gets Depressed? Who Stays Depressed? 
• P Côté, S Ibrahim, L Carroll, JD Cassidy, D Beaton,  V. Kristman, S Hogg-Johnson - Mediators of the Association Between Impairment, Activity Limitations and Recovery from Whiplash Injuries 
• S Johnson, ID Cameron, T Rebbeck, D Sindhusake, A-M Feyer & J Walsh - Legislative Change is a Highly Cost Effective Method of Improving Health Status in People with Whiplash.
• CA Hincapié, JD Cassidy, P. Côté, LJ Carroll, J Guzmán – Whiplash Injury is More Than Simply Neck Pain: A Population-Based Study of Pain Localization after Traffic Collisions