When should I consider referring a patient with neck pain for specialist assessment?

Consider referring a patient with neck pain for specialist assessment in the following situations:

• If any red flags suggesting serious spinal abnormality or other concerning pathology are present, refer urgently or arrange immediate assessment depending on clinical judgement ¹,²,³.
• If the patient has cervical radiculopathy with severe or progressive motor weakness or sensory loss, seek immediate specialist advice ²,³.
• If cervical radiculopathy symptoms have persisted for 4–6 weeks or more, or if there are objective neurological signs, refer for MRI confirmation and consideration of invasive procedures or surgery ²,³.
• If neck pain has lasted more than 12 weeks and has not improved with primary care management, consider referral to a pain clinic for multidisciplinary management ¹.
• Consider referral for psychological therapy if there are psychological symptoms or risk factors, or if pain is chronic ¹.
• Consider referral to occupational health if neck pain is related to work ¹.

Do not routinely refer patients with non-specific neck pain without red flags; instead, provide reassurance, advice on activity, analgesia, and physiotherapy ¹.