Neck pain

Last updated
Neck pain
Other namesCervicalgia
Neck pain illustration.jpg
Illustration of a person with neck pain
Specialty Neurosurgery

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]

Contents

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, 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]

Common and lesser neck pain causes include:

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

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. [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 330 million 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]

References

  1. 1 2 3 Binder AI (March 2007). "Cervical spondylosis and neck pain". BMJ. 334 (7592): 527–31. doi:10.1136/bmj.39127.608299.80. PMC   1819511 . PMID   17347239.
  2. ↑ Dieleman, Joseph L.; Cao, Jackie; Chapin, Abby; Chen, Carina; Li, Zhiyin; Liu, Angela; Horst, Cody; Kaldjian, Alexander; Matyasz, Taylor; Scott, Kirstin Woody; Bui, Anthony L.; Campbell, Madeline; Duber, Herbert C.; Dunn, Abe C.; Flaxman, Abraham D. (2020-03-03). "US Health Care Spending by Payer and Health Condition, 1996-2016". JAMA. 323 (9): 863–884. doi:10.1001/jama.2020.0734. ISSN   1538-3598. PMC   7054840 . PMID   32125402.
  3. ↑ Nguyen, Mytien; Gonzalez, Luis; Newman, Ashley; Cannon, Ashley; Zarebski, Shenika A.; Chaudhry, Sarwat I.; Pomahac, Bohdan; Boatright, Dowin; Dardik, Alan (2023-07-01). "Rates of National Institutes of Health Funding for Surgeon-Scientists, 1995-2020". JAMA Surgery. 158 (7): 756–764. doi:10.1001/jamasurg.2023.1571. ISSN   2168-6262. PMC   10193263 . PMID   37195709.
  4. ↑ Gorski, Jerrold M.; Schwartz, Lawrence H. (April 2003). "Shoulder impingement presenting as neck pain". The Journal of Bone and Joint Surgery. American Volume. 85 (4): 635–638. doi:10.2106/00004623-200304000-00008. ISSN   0021-9355. PMID   12672838.
  5. ↑ Gorski, Jerrold (2018-11-01). "Letter to the Editor: Sleep Quality in Patients With Rotator Cuff Disease". The Journal of the American Academy of Orthopaedic Surgeons. 26 (21): e465 –e466. doi:10.5435/JAAOS-D-18-00164. ISSN   1940-5480. PMID   30180096.
  6. ↑ Torchia, Michael T.; Sefko, Julianne A.; Steger-May, Karen; Teefey, Sharlene A.; Middleton, William D.; Keener, Jay D. (July 2023). "Evaluation of survivorship of asymptomatic degenerative rotator cuff tears in patients 65 years and younger: a prospective analysis with long-term follow-up". Journal of Shoulder and Elbow Surgery. 32 (7): 1432–1444. doi:10.1016/j.jse.2023.03.008. ISSN   1532-6500. PMID   37024038.
  7. ↑ Wu AM, et al. (March 2024). "Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021". The Lancet. Rheumatology. 6 (3): e142 –e155. doi:10.1016/S2665-9913(23)00321-1. PMC   10897950 . PMID   38383088.
  8. 1 2 Mattu A, Goyal D, Barrett JW, Broder J, DeAngelis M, Deblieux P, et al. (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. pp. 46–7. ISBN   978-1-4051-4166-6.
  9. ↑ 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. PMID   20536800.
  10. ↑ Gross A, Forget M, St George K, Fraser MM, Graham N, Perry L, et al. (March 2012). "Patient education for neck pain". The Cochrane Database of Systematic Reviews (3): CD005106. doi:10.1002/14651858.cd005106.pub4. PMID   22419306.
  11. 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. PMID   30168261. S2CID   52130773.
  12. ↑ 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. PMID   28153830. S2CID   22850331.
  13. ↑ Khwaja SM, Minnerop M, Singer AJ (January 2010). "Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial". Canadian Journal of Emergency Medicine. 12 (1): 39–44. doi: 10.1017/S1481803500012008 . PMID   20078917.
  14. ↑ Carley S (June 2005). "Manipulation and/or exercise for neck pain?". BestBets.
  15. ↑ Gross A, Kay TM, Paquin JP, Blanchette S, Lalonde P, Christie T, et al. (January 2015). "Exercises for mechanical neck disorders". The Cochrane Database of Systematic Reviews. 1 (1): CD004250. doi:10.1002/14651858.cd004250.pub5. PMC   9508492 . PMID   25629215.
  16. ↑ Martin-Gomez, Carmen; Sestelo-Diaz, Rebeca; Carrillo-Sanjuan, Victor; Navarro-Santana, Marcos Jose; Bardon-Romero, Judit; Plaza-Manzano, Gustavo (2019). "Motor control using cranio-cervical flexion exercises versus other treatments for non-specific chronic neck pain: A systematic review and meta-analysis". Musculoskeletal Science and Practice. 42: 52–59. doi:10.1016/j.msksp.2019.04.010. PMID   31030111. S2CID   139105299.
  17. 1 2 3 Gross A, Langevin P, Burnie SJ, Bédard-Brochu MS, Empey B, Dugas E, et al. (September 2015). "Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment". The Cochrane Database of Systematic Reviews. 2015 (9): CD004249. doi:10.1002/14651858.CD004249.pub4. PMC   10883412 . PMID   26397370.
  18. ↑ 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. PMID   23339721. S2CID   12159586.
  19. ↑ 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. PMID   19913903. S2CID   16336402.
  20. ↑ Monticone M, Cedraschi C, Ambrosini E, Rocca B, Fiorentini R, Restelli M, et al. (May 2015). "Cognitive-behavioural treatment for subacute and chronic neck pain". The Cochrane Database of Systematic Reviews. 2016 (5): CD010664. doi:10.1002/14651858.cd010664.pub2. hdl: 2434/352344 . PMC   8922276 . PMID   26006174.
  21. ↑ Gross, Anita R.; Lee, Haejung; Ezzo, Jeanette; Chacko, Nejin; Gelley, Geoffrey; Forget, Mario; Morien, Annie; Graham, Nadine; Santaguida, Pasqualina L.; Rice, Maureen; Dixon, Craig (2024-02-28). "Massage for neck pain". The Cochrane Database of Systematic Reviews. 2024 (2): CD004871. doi:10.1002/14651858.CD004871.pub5. ISSN   1469-493X. PMC   10900303 . PMID   38415786.
  22. ↑ 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. PMID   18646151.
  23. ↑ 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. PMID   12535508.
  24. ↑ Martimbianco AL, Porfírio GJ, Pacheco RL, Torloni MR, Riera R (December 2019). "Transcutaneous electrical nerve stimulation (TENS) for chronic neck pain". The Cochrane Database of Systematic Reviews. 2019 (12): CD011927. doi:10.1002/14651858.cd011927.pub2. PMC   6953309 . PMID   31830313.
  25. 1 2 3 Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, et al. (December 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.
  26. ↑ Deen H, Bartleson JD (2009). Spine disorders medical and surgical management. Cambridge, UK: Cambridge University Press. p. 3. ISBN   978-0-521-88941-4.
  27. ↑ Driessen, Maurice T.; Proper, Karin I.; Anema, Johannes R.; Bongers, Paulien M.; van der Beek, Allard J. (2010-08-24). "Process evaluation of a participatory ergonomics programme to prevent low back pain and neck pain among workers". Implementation Science. 5 (1): 65. doi: 10.1186/1748-5908-5-65 . ISSN   1748-5908. PMC   2936444 . PMID   20735823.
  28. ↑ 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. ISBN   978-3-030-01845-0. S2CID   81281600.
  29. ↑ 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. ISBN   978-1-4799-1762-4. S2CID   25314942.
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