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

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:

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. [4] 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. [5]

Medication

Analgesics such as acetaminophen or NSAIDs are generally recommended for pain. [6] 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. [7]

Muscle relaxants may also be recommended. [6] 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). [8]

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. [9] In particular, specific strengthening exercise may improve function and pain. [10] Motor control using cranio-cervical flexion exercises has been shown to be effective for non-specific chronic neck 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] Transcutaneous electrical nerve stimulation (TENS), the noninvasive use of electrical stimulation on the skin, is of unclear benefit in chronic neck pain. [19]

Epidemiology

Neck pain affects about 330 million people globally as of 2010 (4.9% of the population). [20] It is more common in women (5.7%) than men (3.9%). [20] It is less common than low back pain. [21]

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] [20] 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. [22] There is also growing research in how neck pain caused by mobile devices (see iHunch) can be prevented using embedded warning systems. [23] [24]

Related Research Articles

<span class="mw-page-title-main">Chiropractic</span> Form of pseudoscientific alternative medicine

Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It has esoteric origins and is based on several pseudoscientific ideas.

<span class="mw-page-title-main">Sinusitis</span> Inflammation of the inner lining of the sinuses

Sinusitis, also known as rhinosinusitis, is an inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain.

<span class="mw-page-title-main">Back pain</span> Area of body discomfort

Back pain is pain felt in the back. It may be classified as neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia based on the segment affected. The lumbar area is the most common area affected. An episode of back pain may be acute, subacute or chronic depending on the duration. The pain may be characterized as a dull ache, shooting or piercing pain or a burning sensation. Discomfort can radiate to the arms and hands as well as the legs or feet, and may include numbness or weakness in the legs and arms.

<span class="mw-page-title-main">Otitis media</span> Inflammation of the middle ear

Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, increased crying, and poor sleep. Decreased eating and a fever may also be present. The other main type is otitis media with effusion (OME), typically not associated with symptoms, although occasionally a feeling of fullness is described; it is defined as the presence of non-infectious fluid in the middle ear which may persist for weeks or months often after an episode of acute otitis media. Chronic suppurative otitis media (CSOM) is middle ear inflammation that results in a perforated tympanic membrane with discharge from the ear for more than six weeks. It may be a complication of acute otitis media. Pain is rarely present. All three types of otitis media may be associated with hearing loss. If children with hearing loss due to OME do not learn sign language, it may affect their ability to learn.

<span class="mw-page-title-main">Tension headache</span> Medical condition

Tension headache, stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain usually radiates from the lower back of the head, the neck, the eyes, or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches.

<span class="mw-page-title-main">Sciatica</span> Lower back pain that extends down leg

Sciatica is pain going down the leg from the lower back. This pain may go down the back, outside, or front of the leg. Onset is often sudden following activities like heavy lifting, though gradual onset may also occur. The pain is often described as shooting. Typically, symptoms are only on one side of the body. Certain causes, however, may result in pain on both sides. Lower back pain is sometimes present. Weakness or numbness may occur in various parts of the affected leg and foot.

<span class="mw-page-title-main">Pain management</span> Interdisciplinary approach for easing pain

Pain management is an aspect of medicine and health care involving relief of pain in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.

<span class="mw-page-title-main">Osteoarthritis</span> Form of arthritis caused by degeneration of joints

Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone. It is believed to be the fourth leading cause of disability in the world, affecting 1 in 7 adults in the United States alone. The most common symptoms are joint pain and stiffness. Usually the symptoms progress slowly over years. Other symptoms may include joint swelling, decreased range of motion, and, when the back is affected, weakness or numbness of the arms and legs. The most commonly involved joints are the two near the ends of the fingers and the joint at the base of the thumbs, the knee and hip joints, and the joints of the neck and lower back. The symptoms can interfere with work and normal daily activities. Unlike some other types of arthritis, only the joints, not internal organs, are affected.

<span class="mw-page-title-main">Peripheral neuropathy</span> Nervous system disease affecting nerves beyond the brain and spinal cord

Peripheral neuropathy, often shortened to neuropathy, refers to damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerve fibers are affected. Neuropathies affecting motor, sensory, or autonomic nerve fibers result in different symptoms. More than one type of fiber may be affected simultaneously. Peripheral neuropathy may be acute or chronic, and may be reversible or permanent.

<span class="mw-page-title-main">Low back pain</span> Medical condition

Low back pain or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute, sub-chronic, or chronic. The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain. The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people recovered by six weeks.

<span class="mw-page-title-main">Tennis elbow</span> Condition in which the outer part of the elbow becomes sore and tender

Tennis elbow, also known as lateral epicondylitis or enthesopathy of the extensor carpi radialis origin, is an enthesopathy of the origin of the extensor carpi radialis brevis on the lateral epicondyle. The outer part of the elbow becomes painful and tender. The pain may also extend into the back of the forearm. Onset of symptoms is generally gradual, although they can seem sudden and be misinterpreted as an injury. Golfer's elbow is a similar condition that affects the inside of the elbow.

Prolotherapy, also called proliferation therapy, is an injection-based treatment used in chronic musculoskeletal conditions. It has been characterised as an alternative medicine practice.

<span class="mw-page-title-main">Spinal manipulation</span> Intervention performed on spinal joints

Spinal manipulation is an intervention performed on synovial joints of the spine, including the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse and costovertebral joints. It is typically applied with therapeutic intent, most commonly for the treatment of low back pain.

<span class="mw-page-title-main">Spinal disc herniation</span> Injury to the connective tissue between spinal vertebrae

A spinal disc herniation is an injury to the intervertebral disc between two spinal vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRI, and treatment may range from painkillers to surgery. Protection from disc herniation is best provided by core strength and an awareness of body mechanics including good posture.

<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

Chiropractors use their version of spinal manipulation as their primary treatment method, with non-chiropractic use of spinal manipulation gaining more study and attention in mainstream medicine in the 1980s. There is no evidence that chiropractic spinal adjustments are effective for any medical condition, with the possible exception of treatment for lower back pain. The safety of manipulation, particularly on the cervical spine has been debated. Adverse results, including strokes and deaths, are rare.

<span class="mw-page-title-main">McKenzie method</span> Method of physical therapy

The McKenzie method is a technique primarily used in physical therapy. It was developed in the late 1950s by New Zealand physiotherapist Robin McKenzie. In 1981 he launched the concept which he called "Mechanical Diagnosis and Therapy (MDT)" – a system encompassing assessment, diagnosis and treatment for the spine and extremities. MDT categorises patients' complaints not on an anatomical basis, but subgroups them by the clinical presentation of patients.

<span class="mw-page-title-main">Spinal stenosis</span> Disease of the bony spine that results in narrowing of the spinal canal

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

Migraine may be treated either prophylactically (preventive) or abortively (rescue) for acute attacks. Migraine is an complex condition; there are various preventive treatments which disrupt different links in the chain of events that occur during a migraine attack. Rescue treatments also target and disrupt different processes occurring during migraine.

<span class="mw-page-title-main">Pain management in children</span> Medical condition

Pain management in children is the assessment and treatment of pain in infants and children.

References

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  2. ↑ March L, Smith EU, Hoy DG, Cross MJ, Sanchez-Riera L, Blyth F, et al. (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.
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  4. ↑ 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.
  5. ↑ 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.
  6. 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ Carley S (June 2005). "Manipulation and/or exercise for neck pain?". BestBets.
  10. ↑ 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.
  11. ↑ 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.
  12. 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ 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.
  18. ↑ 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.
  19. ↑ 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.
  20. 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.
  21. ↑ Deen H, Bartleson JD (2009). Spine disorders medical and surgical management. Cambridge, UK: Cambridge University Press. p. 3. ISBN   978-0-521-88941-4.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ 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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