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Neck pain

https://doi.org/10.1016/S1521-6942(02)00097-9Get rights and content

Abstract

Neck pain is second only to low back pain as the most common musculoskeletal disorder in population surveys and primary care, and, like low back pain, it poses a significant health and economic burden, being a frequent source of disability. While most individuals with acute neck pain do not seek health care, those that do account for a disproportionate amount of health care costs. Furthermore, in the setting of the whiplash syndrome, neck pain accounts for significant costs to society in terms of insurance and litigation, and days lost from work. Much neck pain is not attributable to a specific disease or disorder and is labelled as ‘soft-tissue’ rheumatism or muscular/mechanical/postural neck pain. Most chronic neck pain is attributed to whiplash injury, another enigmatic diagnosis. Despite decades of research and posturing to explain chronic neck pain on the basis of a specific disease or injury, and despite increasingly sophisticated radiological assessment, little advance has been made in either achieving a specific structural diagnosis or, more importantly, in reducing the health and economic burden of chronic neck pain. There is some evidence, however, that measures which address the psychosocial factors that promote pain chronicity, and shift the patient's view away from injury and disease to more benign perspectives on their condition, may be helpful. This chapter considers briefly the magnitude of the neck pain problem, our limitations in understanding it from a traditional medical perspective, and suggestions for therapeutic and societal approaches that appear more likely to be helpful.

Section snippets

Definition and aetiology

Neck pain is generally defined as stiffness and/or pain felt dorsally in the cervical region somewhere between the occipital condyles and the C7 vertebral prominence. Neck pain, however, is often accompanied by pain in the occiput (a headache), the upper thoracic region, and the jaws. Clinically, it is recognized that even in subjects with no evidence of nerve root irritation or compression, neck pain may be associated with pain referred along myotomal patterns to the anterior chest, arm, and

Epidemiology and risk factors

Chronic neck pain is perhaps second only to chronic low back pain as the most common musculoskeletal disorder associated with injury and disability claims, both in the work place and after motor vehicle collisions. At any given time, approximately 10% of the population reports having neck pain on at least 7 days per month, and neck pain (of unspecified duration) occurs in at least 80% of the population at some time2., 3., 4., with a 20–30% annual incidence of acute neck pain in population-based

Physical symptoms and signs of neck pain

The traditional medical model involves searching for underlying tissue pathology and is based on an analysis of the history, physical examination and investigations. There are no studies which examine the specificity or sensitivity of various symptoms or signs for differing diagnoses in neck pain patients. An attempt has been made using ‘red flags’ in patients with low back pain. Even here they have poor specificity and no similar factors have been studied for neck pain. Nor are there studies

Diagnosis and radiological assessment of neck pain

The differential diagnosis of neck pain has been described in detail in an earlier issue.1 It is worth emphasizing here the rather disappointing fact that the myriad of imaging techniques available to physicians provide little or no diagnostic assistance in most neck pain patients. Radiological investigation seems pertinent when a patient presents with neck pain and any of weight loss, dysphagia, neck lumps, nocturnal pain only, or physical examination findings suggestive of radiculopathy (loss

Treatment of acute neck pain

Despite the fact that only 25% of acute neck pain may lead the patient to seek health care4, and only a percentage of these patients will develop chronic pain, this percentage accounts for disproportionately higher costs. Thus, the Quebec Task Force on Whiplash-Associated Disorders found, for example, that 12% of whiplash patients in Quebec remained in chronic pain 1 year after their collision. Yet, these 12% accounted for 47% of costs of all whiplash injuries in terms of treatment and lost

Treatment of chronic neck pain

The studies evaluating treatments for chronic neck pain suffer also from being few in number, having very mixed populations, and limited clinical information about the patients, as well as having widely varying inclusion and exclusion criteria. The review by Kjellman et al35 of studies up to 1995 reveals that, for chronic neck pain of varying duration (from 3 months to more than 2 years), only five of 27 randomized clinical trials of treatment of chronic neck pain had a follow-up to 6 months or

Paradigm shift

One way to change our approach is to look at the factors known to affect the outcome from acute neck pain, and study and utilize an approach that directly addresses those very factors. Previous neck pain episodes, for example, have an effect as a poor prognostic factor for the outcome (development of chronicity) in future neck pain episodes. This is either for some physical reason or is due to the effect that previous experience has on future illness behaviour, or both. It may be tempting, even

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