What are the recommended first-line treatments for a patient with cervical spondylosis presenting with neck pain and radiculopathy?

Recommended first-line treatments for cervical spondylosis with neck pain and radiculopathy:

• Initial assessment: Exclude red flags indicating serious spinal abnormalities and refer urgently if present. Immediate specialist advice is needed if there is severe or progressive motor weakness or sensory loss.
• Conservative management (if radiculopathy duration is less than 4–6 weeks and no objective neurological signs): Provide reassurance and information about the generally good prognosis and likelihood of improvement without surgery.
• Encourage activity: Advise continuation of normal activities including work and home exercise as soon as possible, but caution against driving if neck range of motion is restricted.
• Discourage cervical collars: Avoid use as they restrict mobility and may prolong symptoms.
• Comfort measures: Recommend a firm pillow that supports the neck’s natural curve and lateral support; avoid using two pillows which may cause unnatural head positioning.
• Pharmacological treatment: Offer oral analgesics such as ibuprofen, paracetamol, or codeine based on pain severity, patient preference, tolerability, and risk of adverse effects.
• Neuropathic pain medications: Consider amitriptyline, duloxetine, pregabalin, or gabapentin if neuropathic pain features are present.
• Physiotherapy referral: Consider referral for physiotherapy including strengthening, stretching exercises, and manual therapy.
• Follow-up: Arrange review to monitor for progression of neurological signs which may necessitate further investigation and referral.

If symptoms persist beyond 4–6 weeks or objective neurological signs develop, refer for MRI to confirm diagnosis and consider invasive procedures or surgery if indicated.

These recommendations are based on UK clinical guidelines and NICE-aligned sources.

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