Successful use of a multidisciplinary approach in the treatment of neck pain
A pleasant, moderately obese, 50-year-old female teacher presented to CareChain with an eight-month complaint of severe neck pain that began suddenly without warning. She denied any mechanism of injury as well as any arm dominant symptoms. She reported experiencing similar, less intense episodes of neck pain in her thirties and forties, but those episodes would resolve after two to four weeks with medication and physiotherapy. She indicated that her neck pain had become a significant concern to her as it had started affecting her ability to perform her work duties as well as her quality of life.
Unlike her previous episodes, this current episode has not responded to medication or physiotherapy. She continued to work at her teaching job albeit with significant discomfort. Her duties are comprised of lesson planning, classroom instruction and grading assignments. She had tried modifying her work duties but with little success. Due to her unrelenting neck dominant symptoms, she had completely given up both her recreational and social activities.
With regards to her general health, she reported no significant physical ailments aside from her neck pain. However, she did indicate that she had recently been diagnosed with major depressive disorder as well as obesity. To date, she has not been referred for diagnostic imaging or for a surgical consultation. Her family physician had instead referred her to a CareChain physiotherapist for a comprehensive neck assessment in an effort to get expert answers for his patient, rapid access to services and an evidence-based personalized plan of management.
At her CareChain physiotherapist appointment, the patient underwent a comprehensive neck assessment. During her assessment, the CareChain physiotherapist noted that she had no gait disturbances. Her Spurling’s tests were negative bilaterally and there was no evidence of upper extremity myotomal weakness or dysesthesia. Additionally, her reflexes were normal bilaterally and her upper motor neuron tests were negative bilaterally. A review of her pain scores revealed 8/10 pain at rest and 10/10 pain with activity. Overall, the patient’s orthopedic testing was unremarkable and there did not appear to be a mechanical reason for the symptoms she was experiencing.
Accordingly, she was diagnosed with non-mechanical neck pain.
The patient was provided with a personalized plan of management which included a cardiovascular exercise program emphasizing walking and swimming as well as specific neck and periscapular stability exercises. However, due to her non-mechanical symptoms, she was advised that she would require a multimodal/multidisciplinary approach to her care if treatment was going to be successful.
The CareChain physiotherapist took the time to educate the patient on the specific aspects of her condition including prognosis, activity limitations, and types of available treatments. At the end of the consultation, the CareChain physiotherapist sent a consult note to the referring family physician which included an outline of the patient’s personalized plan of management as well as recommendations for ongoing treatment. The note was followed up with a phone call to the referring physician’s office to discuss a potential multimodal/multidisciplinary approach to managing the patient’s condition – changes to her medication, motivational interviewing, cognitive behavioural therapy as well as ongoing physiotherapy and psychotherapy. Both the referring physician and the patient were agreeable to the plan.
The patient was advised to touch base with her family physician as soon as possible to review her current medications and to investigate the possibility of using a non-opioid prescription pain relieving medication. Further, she was asked to review her plan of management with her referring physician. Additionally, she was advised to find a reputable physiotherapist who would be confident in executing on her multimodal/multidisciplinary CareChain plan of management. She was advised to follow up with her CareChain physiotherapist on an as-needed basis.
Over the course of the next six months, the patient attended several physiotherapy sessions to help address the physical components of her recovery. She elected to attend treatment at her CareChain physiotherapist’s office. She was initially seen twice per week and was instructed to perform her CareChain home exercise program on her days away from the clinic. On top of this, she regularly attended psychotherapy sessions to help manage her depression as well as the non-mechanical symptoms of her condition. Each week, her condition was reevaluated by her treating physiotherapist and her exercises progressed as per her CareChain plan of management.
Her physiotherapy sessions were reduced as her symptoms improved. Her tolerance for her work duties began to steadily increase and she slowly started reintroducing her social and recreational activities.
- 60% improvement in non-mechanical neck pain
- Increased tolerance in work duties
- Reintroduction of social and recreational activities
- Mood improvement
- Weight loss
- Education on her condition and the importance of staying active
At her 6-month follow-up appointment with her CareChain physiotherapist the patient reported a 60% improvement in her non-mechanical neck pain and that overall, she was in a much better place. She was feeling more positive about her recovery and felt that she had been provided with the proper tools to manage her condition. Additionally, she noted that she had lost a substantial amount of weight (15 kg) over the course of the last six months.
Physical examination at the time of her follow-up remained unremarkable. The patient was further educated about her condition and the importance of staying active and managing her condition with a multimodal/multidisciplinary approach.
In most cases, patients with neck dominant pain do not go on to develop non-mechanical symptoms as many resolve with conservative management. In this patient’s case, her neck symptoms did not improve and in fact, deteriorated significantly due to a phenomenon known as central sensitization. Key to providing this patient with the right care was a comprehensive neck assessment and rapid access to a network of physiotherapists who can recognize patients with non-mechanical symptoms and direct them to the most appropriate care. Instead of waiting months or years for an appointment with a spine surgeon, the patient received the care she needed in just a few weeks.
Effective neck pain assessment and treatment with physiotherapy
Not all patients need surgery to relieve neck pain. That’s why CareChain enables physiotherapists to effectively assess and treat neck pain using artificial intelligence. Do you suffer from neck pain? Make an appointment with one of our CareChain physiotherapists for an in-depth evaluation of your neck pain. And if you’re still experiencing pain after your treatment, your physiotherapist will be happy to refer you to a spine specialist in Montreal.