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Am Fam Physician. 2021;103(5):262-263

Original Article: Neck Pain: Initial Evaluation and Management

Issue Date: August 1, 2020

See additional reader comments at:https://www.aafp.org/afp/2020/0801/p150.html

We thank Drs. Childress and Stuek for presenting a best practice approach to the initial evaluation and treatment of neck pain. We propose also considering an osteopathic approach.

In the absence of red flag findings, we agree that clinicians should consider treatment focused on the patient's level of pain and function. With this same approach, we encourage clinicians to use osteopathic techniques to treat neck pain and consider the relationship between structure and function. Osteopathic manipulative treatment (OMT) is a group of related techniques used to manage somatic dysfunction (see https://www.aafp.org/afp/2019/0215/p248.html). The goals of applying manual medicine are to restore maximal, pain-free movement of the musculoskeletal system; enhance neuromuscular function; and improve biomechanical balance.1 The evidence indicates that manual therapy is equally or more effective at treating pain and improving function compared with oral analgesics.2 Cervical manipulation and mobilization may be considered to provide short-term improvement in pain relief and function in patients with neck pain.3

In our office, we teach and use OMT in addition to the treatments outlined in the article by Drs. Childress and Stuek. Our patients appreciate the hands-on approach that OMT allows while we are able to minimize the adverse effects of pharmacologic therapies.

Editor's Note: This letter was sent to the authors of “Neck Pain: Initial Evaluation and Management,” who declined to reply.

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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