Neck pain

Neck pain, also known as cervicalgia, is a common problem, with two-thirds of the population having neck pain at some point in their lives.[1]

Neck pain
Other namesCervicalgia
A person with neck pain
SpecialtyNeurosurgery

Neck pain, although felt in the neck, can be caused by numerous other spinal problems. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the nerves emanating from the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back.

The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The top three joints in the neck allow for most movement of the neck and head. The lower joints in the neck and those of the upper back create a supportive structure for the head to sit on. If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.

Neck pain affects about 5% of the global population as of 2010.[2]

Differential diagnosis

Neck pain may come from any of the structures in the neck including: vascular, nerve, airway, digestive, and musculature / skeletal, or be referred from other areas of the body.[3]

Major and severe causes of neck pain (roughly in order of severity) include:

More common and lesser neck pain causes include:

  • Stress – physical and emotional stresses
  • Prolonged postures – many people fall asleep on sofas and chairs and wake up with sore necks.
  • Minor injuries and falls – car accidents, sporting events, and day to day injuries that are really minor.
  • Referred pain – mostly from upper back problems
  • Over-use – muscular strain is one of the most common causes
  • Whiplash
  • Pinched nerve

Although the causes are numerous, most are easily rectified by either professional help or using self help advice and techniques.

More causes can include: poor sleeping posture, torticollis, head injury, rheumatoid arthritis, Carotidynia, congenital cervical rib, mononucleosis, rubella, certain cancers, ankylosing spondylitis, cervical spine fracture, esophageal trauma, subarachnoid hemorrhage, lymphadenitis, thyroid trauma, and tracheal trauma.

Treatment

Treatment of neck pain depends on the cause. For the vast majority of people, neck pain can be treated conservatively. Recommendations in which it helps alleviate symptoms include applying heat or cold.[5] Other common treatments could include medication, body mechanics training, ergonomic reform, and physical therapy. Treatments may also include patient education, but existing evidence shows a lack of effectiveness.[6]

Medication

Analgesics such as acetaminophen or NSAIDs are recommended for pain.[7][8] Muscle relaxants are often prescribed and are known to be effective. However, one study showed that one muscle relaxant called cyclobenzaprine was not effective for treatment of acute cervical strain (as opposed to neck pain from other etiologies or chronic neck pain).[9] Over the counter topical creams and patches may be effective for some patients.

Surgery

Surgery is usually not indicated for mechanical causes of neck pain. If neck pain is the result of instability, cancer, or other disease process surgery may be necessary. Surgery is usually not indicated for "pinched nerves" or herniated discs unless there is spinal cord compression or pain and disability have been protracted for many months and refractory to conservative treatment such as physical therapy.

Alternative medicine

Exercise plus joint manipulation has been found to be beneficial in both acute and chronic mechanical neck disorders.[10] In particular, specific strengthening exercise may improve function and pain.[11] Both cervical manipulation and cervical mobilization produce similar immediate-, and short-term changes.[12] Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate to long-term follow-up.[12] Thoracic manipulation may also improve pain and function.[12][13] Low level laser therapy has been shown to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients that experience chronic neck pain.[14] Low quality evidence suggests that cognitive-behavioural therapy may be effective at reducing pain in the short-term.[15] Massaging the area may provide immediate and short-lived benefits, but long term effects are unknown.[16] There is a lack of high-quality evidence to support the use of mechanical traction, and side effects include headaches, nausea and injury to tissue.[17] Radiofrequency denervation may provide temporary relief for specific affected areas in the neck.[18]

Epidemiology

Neck pain affects about 330 million people globally as of 2010 (4.9% of the population).[19] It is more common in women (5.7%) than men (3.9%).[19] It is less common than low back pain.[20]

Prognosis

About one half of episodes resolve within one year.[1] About 10% of cases become chronic.[1]

References
  1. Binder AI (2007). "Cervical spondylosis and neck pain". BMJ. 334 (7592): 527–31. doi:10.1136/bmj.39127.608299.80. PMC 1819511. PMID 17347239.
  2. March, L; Smith, EU; Hoy, DG; Cross, MJ; Sanchez-Riera, L; Blyth, F; Buchbinder, R; Vos, T; Woolf, AD (June 2014). "Burden of disability due to musculoskeletal (MSK) disorders". Best Practice & Research. Clinical Rheumatology. 28 (3): 353–66. doi:10.1016/j.berh.2014.08.002. PMID 25481420.
  3. Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. p. 46. ISBN 978-1-4051-4166-6.
  4. Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. p. 47. ISBN 978-1-4051-4166-6.
  5. Garra, Gregory; Singer, Adam J.; et al. (2010). "Heat or Cold Packs for Neck and Back Strain: A Randomized Controlled Trial of Efficacy". Academic Emergency Medicine. 17 (5): 484–9. doi:10.1111/j.1553-2712.2010.00735.x. PMID 20536800.
  6. Gross, Anita; Forget, Mario; St George, Kerry; Fraser, Michelle MH; Graham, Nadine; Perry, Lenora; Burnie, Stephen J; Goldsmith, Charles H; Haines, Ted (2012-03-14). "Patient education for neck pain". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd005106.pub4. ISSN 1465-1858.
  7. Machado, Gustavo C; Maher, Chris G; Ferreira, Paulo H; Day, Richard O; Pinheiro, Marina B; Ferreira, Manuela L (2 February 2017). "Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis". Annals of the Rheumatic Diseases. 76 (7): annrheumdis–2016–210597. doi:10.1136/annrheumdis-2016-210597. PMID 28153830.
  8. "UpToDate Inc".
  9. Khwaja SM, Minnerop M, Singer AJ (January 2010). "Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial". CJEM. 12 (1): 39–44. doi:10.1017/S1481803500012008. PMID 20078917.
  10. "BestBets: Manipulation and/or exercise for neck pain?".
  11. Gross, Anita; Kay, Theresa M; Paquin, Jean-Philippe; Blanchette, Samuel; Lalonde, Patrick; Christie, Trevor; Dupont, Genevieve; Graham, Nadine; Burnie, Stephen J (2015-01-28). "Exercises for mechanical neck disorders". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd004250.pub5. ISSN 1465-1858.
  12. Gross, Anita; Langevin, Pierre; Burnie, Stephen J.; Bédard-Brochu, Marie-Sophie; Empey, Brian; Dugas, Estelle; Faber-Dobrescu, Michael; Andres, Cristy; Graham, Nadine (2015-09-23). "Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment". The Cochrane Database of Systematic Reviews (9): CD004249. doi:10.1002/14651858.CD004249.pub4. PMID 26397370.
  13. Huisman PA, Speksnijder CM, de Wijer A (January 2013). "The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: a systematic review". Disabil Rehabil. 35 (20): 1677–1685. doi:10.3109/09638288.2012.750689. PMID 23339721.
  14. Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM (2009). "Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials". Lancet. 374 (9705): 1897–1908. doi:10.1016/S0140-6736(09)61522-1. PMID 19913903.
  15. Monticone, Marco; Cedraschi, Christine; Ambrosini, Emilia; Rocca, Barbara; Fiorentini, Roberta; Restelli, Maddalena; Gianola, Silvia; Ferrante, Simona; Zanoli, Gustavo (2015-05-26). "Cognitive-behavioural treatment for subacute and chronic neck pain". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd010664.pub2. ISSN 1465-1858.
  16. Patel, Kinjal C; Gross, Anita; Graham, Nadine; Goldsmith, Charles H; Ezzo, Jeanette; Morien, Annie; Peloso, Paul Michael J (2012-09-12). "Massage for mechanical neck disorders". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd004871.pub4. ISSN 1465-1858.
  17. Graham, Nadine; Gross, Anita; Goldsmith, Charles H; Klaber Moffett, Jennifer; Haines, Ted; Burnie, Stephen J; Peloso, Paul Michael J (2008-07-16). "Mechanical traction for neck pain with or without radiculopathy". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd006408.pub2. ISSN 1465-1858.
  18. Niemisto, Leena; Kalso, Eija A; Malmivaara, Antti; Seitsalo, Seppo; Hurri, Heikki (2003-01-20). "Radiofrequency denervation for neck and back pain". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd004058. ISSN 1465-1858.
  19. Vos, T (Dec 15, 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
  20. Deen, Hanifa; Bartleson, J. D. (2009). Spine disorders medical and surgical management. Cambridge, UK: Cambridge University Press. p. 3. ISBN 978-0-521-88941-4.
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