Recent research: NICE guidance on recognition of child maltreatment & report of the Task Force on neck pain

Sept. 3, 2009

Here are a disparate pair of subjects for a research update. One is the recent NICE guideline on " ... alerting features in children and young people (under 18 years) of: physical, sexual and emotional abuse, neglect, fabricated or induced illness." I have posted on NICE and its guidelines before. This 146 page full guidance on "When to suspect child maltreatment" carefully covers this, sometimes controversial, subject. The much shorter 18 page quick reference guide gives one a good sense of the main points being made. The guideline distinguishes when one should "consider" and when one should "suspect" child maltreatment. By "consider" the guideline means "maltreatment is one possible explanation for the alerting feature or is included in the differential diagnosis.", whereas "suspect" means a "serious level of concern about the possibility of child maltreatment but not proof of it."

The 18 page reference guide helpfully lists physical, behavioural, and interpersonal "alerting features" and provides a flow chart of suggested information gathering and action. NICE states "If you encounter an alerting feature described in this guidance it is good practice to follow the process outlined ... ". If necessary they recommend contacting children's social care and, in England, following local Safeguarding Children procedures. The internet is a rich source of other useful contacts - for example, here in Scotland, we have the National Child Protection Line as a helpful option.

The second subject I touch on in this research update is the report by the The Task Force on Neck Pain and Its Associated Disorders. Chronic pain is only tangentially an area I look at in this blog, however the Task Force report is important and overlaps into the territories of stress and wellbeing. I only recently came across this Journal of Manipulative and Physiological Therapeutics special supplement on neck pain. This material had largely already been published a little earlier in a special supplement of Spine.

As Lars Lidgren writes "It was also becoming evident that neck pain and its associated disorders—including headache and pain radiating into the upper back and arms—were much more common than anyone had previously believed. Indeed, neck-related pain has become a major cause of disability around the world: •In North America, about 5% of the general population is disabled because of neck pain. •In any given 6-month period, another 10% of North Americans report experiencing low-level disability along with high-intensity neck pain. •In Europe, surveys show that chronic or persistent neck pain affects between 10% and 20% of the population. •Studies in other countries confirm that these statistics are not limited to people living in industrialized nations."

Hogg-Johnson et al in their major synthesis of research on "The burden and determinants of neck pain in the general population" highlight the broad network of contributing factors commenting "Risk factors for neck pain included genetics, poor psychological health, and exposure to tobacco. Disc degeneration was not identified as a risk factor." and in their conclusion they recommend that "Future research should concentrate on longitudinal designs exploring preventive strategies and modifiable risk factors for neck pain." with the the modifiable aspects they specifically mention being psychological state and smoking.

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