Since there is not a universally accepted classification for neck pain, it is difficult to study the different neck pain types. While neck pain is the second most common cause of disability and cost $100 billion,[2] the NIH budgets only $10 million to the study of neck pain.[3]
One of the most common neck pains is between the neck and the shoulder. This is technically over the supraspinatus muscle and not in the neck, but it is still called “neck” pain. The cause of this shoulder/neck pain is thought to be due to sleeping with the arm overhead at night in a position causing impingement of the rotator cuff tendon in the shoulder, which is attached to the supraspinatus muscle.[4] This can be simply corrected by sleeping with the arm down next to the body and maintained under a long nightgown.[5] Nightly rotator cuff impingement may lead to an asymptomatic shoulder impingement[6] which explains why over 100 years of research has failed to identify a lesion in the cervical spine that causes this common shoulder/neck pain.
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.
As of 2020[update], neck pain affected about 203 million people globally, with females having higher prevalence.[7]
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.[8]
Meningitis of several types including sudden onset of severe neck or back pain particularly in teens and young adults which may be fatal if not treated quickly
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. [9] 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.[10]
Medication
Analgesics such as acetaminophen or NSAIDs are generally recommended for pain.[11] A 2017 systemic review, however found that paracetamol was not efficacious and that NSAIDs provide a marginal improvement compared to placebo, but not enough to be clinically significant. The study found the number needed to treat (NNT) for NSAIDs in patients with spinal pain was 6, meaning you would need to give 6 separate patients the medication for 1 to feel a clinically significant positive effect. The authors of this review cite the side-effect profile of NSAIDs when compared to placebo as another reason that more research and better drugs are needed. [12]
Muscle relaxants may also be recommended.[11] 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).[13]
Surgery
Surgery is usually not indicated for mechanical causes of neck pain. If neck pain is the result of instability, cancer, or other disease, 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.[14] In particular, specific strengthening exercise may improve function and pain.[15] Motor control using cranio-cervical flexion exercises has been shown to be effective for non-specific chronic neck pain.[16] Both cervical manipulation and cervical mobilization produce similar immediate-, and short-term changes.[17] Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate to long-term follow-up.[17] Thoracic manipulation may also improve pain and function.[17][18]
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.[19] Low quality evidence suggests that cognitive-behavioural therapy may be effective at reducing pain in the short-term.[20] Massaging the area may provide immediate and short-lived benefits, but long term effects are unknown.[21] 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.[22] Radiofrequency denervation may provide temporary relief for specific affected areas in the neck.[23]Transcutaneous electrical nerve stimulation (TENS), the noninvasive use of electrical stimulation on the skin, is of unclear benefit in chronic neck pain.[24]
Epidemiology
Neck pain affects about 330million people globally as of 2010 (4.9% of the population).[25] It is more common in women (5.7%) than men (3.9%).[25] It is less common than low back pain.[26]
Prognosis
About one-half of episodes resolve within one year, and approximately 10% become chronic.[1]
Prevention
Prevalence of neck pain in the population suggests it is a common condition.[1][25] For cervicalgia associated with bad posture the treatment is usually corrective in nature (i.e. ensure shoulders are in one line above the hips) and relating to interventions that provide ergonomic improvement.[27] There is also growing research in how neck pain caused by mobile devices (see iHunch) can be prevented using embedded warning systems.[28][29]
1 2 Mattu A, Goyal D, Barrett JW, Broder J, DeAngelis M, Deblieux P, etal. (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. pp.46–7. ISBN978-1-4051-4166-6.
↑ Garra G, Singer AJ, Leno R, Taira BR, Gupta N, Mathaikutty B, Thode HJ (May 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. PMID20536800.
↑ Gross A, Forget M, St George K, Fraser MM, Graham N, Perry L, etal. (March 2012). "Patient education for neck pain". The Cochrane Database of Systematic Reviews (3): CD005106. doi:10.1002/14651858.cd005106.pub4. PMID22419306.
1 2 Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T (December 2018). "Review article: Best practice management of neck pain in the emergency department (part 6 of the musculoskeletal injuries rapid review series)". Emergency Medicine Australasia. 30 (6): 754–772. doi:10.1111/1742-6723.13131. PMID30168261. S2CID52130773.
↑ Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML (July 2017). "Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis". Annals of the Rheumatic Diseases. 76 (7): 1269–1278. doi:10.1136/annrheumdis-2016-210597. PMID28153830. S2CID22850331.
↑ Huisman PA, Speksnijder CM, de Wijer A (September 2013). "The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: a systematic review". Disability and Rehabilitation. 35 (20): 1677–85. doi:10.3109/09638288.2012.750689. PMID23339721. S2CID12159586.
↑ Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM (December 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): 1897–908. doi:10.1016/S0140-6736(09)61522-1. PMID19913903. S2CID16336402.
↑ Graham N, Gross A, Goldsmith CH, Klaber Moffett J, Haines T, Burnie SJ, Peloso PM (July 2008). "Mechanical traction for neck pain with or without radiculopathy". The Cochrane Database of Systematic Reviews (3): CD006408. doi:10.1002/14651858.cd006408.pub2. PMID18646151.
↑ Niemisto L, Kalso E, Malmivaara A, Seitsalo S, Hurri H (2003-01-20). "Radiofrequency denervation for neck and back pain. A systematic review of randomized controlled trials". The Cochrane Database of Systematic Reviews (1): CD004058. doi:10.1002/14651858.cd004058. PMID12535508.
↑ Giansanti, D.; Colombaretti, L.; Simeoni, R.; Maccioni, G. (2019). "The Text Neck: Can Smartphone Apps with Biofeedback Aid in the Prevention of This Syndrome". In Masia, Lorenzo; Micera, Silvestro; Akay, Metin; Pons, José L. (eds.). Converging Clinical and Engineering Research on Neurorehabilitation III. Biosystems & Biorobotics. Vol.21. Cham: Springer International Publishing. pp.754–758. doi:10.1007/978-3-030-01845-0_150. ISBN978-3-030-01845-0. S2CID81281600.
↑ Toda, Takeshi; Nakai, Masato; Xinxin Liu (2015). "A close face-distance warning system for straightend neck prevention". IECON 2015 - 41st Annual Conference of the IEEE Industrial Electronics Society. pp.003347–003352. doi:10.1109/IECON.2015.7392616. ISBN978-1-4799-1762-4. S2CID25314942.
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