Neck pain referral checklist

Urgency tier

• Immediate ED assessment for progressive neurologic deficits, new gait/bowel/bladder symptoms or suspected cervical injury; protect the spine and use EMS when indicated.
• Prompt reassessment for severe persistent symptoms, systemic illness or cancer/infection concern before routine specialist referral.
• Routine referral for chronic non-urgent but function-limiting pain.

Minimum pre-referral workup

• Emergency transfer must not wait for completion of this checklist.
• Trauma history, neurologic exam findings, and pain trajectory.
• Conservative management attempts and response timeline.
• Red-flag screening for infection, malignancy, and myelopathy.

Referral packet checklist

• Structured symptom chronology and exam findings.
• Imaging/tests performed and key results.
• Current medications and functional limitations.

Pre-referral optimization tasks

• Continue safe activity-modification and analgesia plan.
• Reinforce red-flag return precautions.
• Arrange interim follow-up while referral is pending.

References

• Choosing Wisely Canada Emergency medicine: cervical imaging (2024) (opens in a new tab)
• NICE NG41 Spinal injury assessment (2016; UK guidance) (opens in a new tab)
• HealthLink BC Neck pain (opens in a new tab)
• HealthLink BC Neck problems and injuries (opens in a new tab)

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