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N.B. This guideline is aimed to support all clinicians in the community (e.g., AHP, physiotherapists, GPs) who are involved in managing patients with neck pain with or without radiculopathy. As such, some aspects may appear unusually detailed to the experienced clinician.
Red flag signs and symptoms include:
1) Non-specific neck pain:
a) Advice and education:
b) Pharmacological interventions:
c) Exercise/Physiotherapy:
d) Further options in specific situations:
2) Cervical Radiculopathy
a) Advice and education
b) Exercise/Physiotherapy
c) Follow up
3) Cervical Myelopathy
a) Refer
b) Safety net
1) Refer to the Spinal Interface Service
The Spinal Interface service will complete a comprehensive assessment, refer for diagnostic tests or refer onto pain management and spinal surgeons via the Spinal MDT where appropriate.
Urgent – patients without red flags requiring same-day assessment who:
Routine - patients without red flags or urgent features who:
Referrals made outside of these referral criteria will be triaged based on the information provided and managed appropriately. To facilitate this process and maintain patient safety, please ensure that the reason for referral and clinical concerns are clearly stated in the referral letter.
2) Refer To Pain Management Service:
Refer to the Spinal Interface Service via e-RS
Specialty: Orthopaedics
Clinic Type: Spine – Back Pain (not scoliosis/deform)
Service: DRSS-Western Back Pain – Devon ICB / DRSS-Western Back Pain-Cornwall-Devon ICB
Refer to the Pain Management Service via e-RS
Specialty: Pain Management
Clinic Type: Pain Management
Service: DRSS-Western-Pain Management-Devon ICB-15N
BMJ (2022) Assessment of neck pain. BMJ Best Practice.
NICE - Neck pain - non-specific
NICE - Neck pain - cervical radiculopathy
Wong JJ, Côté P, Quesnele JJ, Stern PJ, Mior SA. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J. 2014 Aug 1;14(8):1781-9.
Versus Arthritis - Neck Pain
NHS Conditions - Neck Pain and stiff neck
Your physio - Cervical Radiculopathy
Mr S Pritchard. Neurosurgical Spinal Extended Scope Physiotherapist (Neurosurgery Department University Hospitals NHS Trust)
Mr Paul Fewings. Consultant Neurosurgeon. (Neurosurgery Department University Hospitals NHS Trust)
Dr N Keysell DRSS GP Planned Care Lead
Publication date: October 2024