Neck Pain

From Anvita Health Wiki

Contents 1 Etiology 2 Epidemiology 3 Clinical-manifestations 4 Diagnostic-procedures 5 Radiology 6 Management 7 More General Terms 8 References

Etiology

• neck muscle strain or sprain
• trauma
• torticollis
• cervical spondylosis
• radiculopathy
• cervical myelopathy
• chronic pain syndrome
• rheumatoid arthritis
• spondyloarthropathy - ankylosing spondylitis
• giant cell arteritis
• polymyalgia rheumatica
• Paget's disease
• fibromyalgia
• neoplasm
• vertebral osteomyelitis
• meningitis
• referred pain:

• temporomandibular joint
• bursitis, tendonitis or arthritis of the shoulder
• reflex sympathetic dystrophy
• thoracic outlet syndrome
• bronchogenic carcinoma
• coronary artery disease
• aortic dissection
• peptic ulcer disease
• pancreatitis
• cholecystitis
• salivary gland disease

• psychological

Epidemiology

• very common problem in adults

Clinical-manifestations

• tenderness, loss of motion of neck & shoulder
• neck pain without neck tenderness, loss of neck motion or pain with neck movement suggests referred pain
• nuchal rigidity suggest meningitis
• polyradiculopathy suggests neoplasm, infection or widespread spondylosis
• bowel or bladder dysfunction or lower extremity numbness, weakness, hyperreflexia or hypotonicity or ataxia suggests myelopathy

• Caution: Never force a neck when evaluating range of motion

Diagnostic-procedures

• electromyography ( EMG)
• nerve conduction studies

Radiology

• cervical radiographs ( & lateral) may demonstrate evidence of neoplasm, osteomyelitis, fracture or traumatic subluxation
• odontoid view in cases of trauma or suspected rheumatoid arthritis
• bone scan may demonstrate osteomyelitis or neoplasm
• magnetic resonance imaging ( MRI) is better than CT for soft tissue imaging; used for preoperative imaging
• computed tomography ( CT) is used for preoperative imaging

Management

• prognosis

• most cases are self limited with 70% resolving within 1 month

• relative rest

• cervical pillow [4]
• soft cervical collar
• cervical traction (not uniformly accepted)

• pharmacologic agents

• analgesics

• acetaminophen
• non-steroidal anti-inflammatory agents
• aspirin
• narcotic analgesics

• muscle relaxants

• cyclobenzaprine ( Flexeril)
• benzodiazepines
• methocarbamol ( Robaxin)

• increased spending on pharmaceuticals has not resulted in corresonding improvement in functional status [5]
• no benefit in adding muscle relaxant to NSAID [6]

• physical modalities: ice, heat, ultrasound
• physical therapy with improvement in pain [3]

• home exercise more effective than medication [9]

• spinal manipulation [9], manual manipulation [2]

• muscular & articular mobilization techiques & coordination or stabilization techniques
• performed by chiropractors, osteopaths, physical therapists
• more effective than medication [9]

• trigger point & epidural injections
• surgery

• myelopathy
• instability with neurologic abnormalities or severe pain
• severe radicular pain with definable lesion not responding to weeks of conservative therapy

More General Terms

• pain [odyn-]

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 735-36
2. Journal Watch 22(12):94, 2002 Hoving JL et al Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial. Ann Intern Med 136:713, 2002 PMID: [1]
   - Posner J et al Neck pain. Ann Intern Med 136:758, 2002 PMID: [2]
3. Journal Watch 25(4):35, 2005 Klaber Moffett JA, Jackson DA, Richmond S, Hahn S, Coulton S, Farrin A, Manca A, Torgerson DJ. Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients' preference. BMJ. 2005 Jan 8;330(7482):75. Epub 2004 Dec 07. PMID: [3]
4. Helewa A et al, Effect of therapeutic exercise and sleeping neck support on patients with chronic neck pain: A randomized clinical trial. J Rheumatol 2007, 34:151 PMID: [4]
5. Martin BI et al, Expenditures and health status among adults with back and neck problems. JAMA 2008, 299:656 PMID: [5]
6. Khwaja SM et al Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: A randomized controlled trial. CJEM 2010 Jan; 12:39 PMID: [6]
7. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
8. Garra G et al. Heat or cold packs for neck and back strain: A randomized controlled trial of efficacy. Acad Emerg Med 2010 May; 17:484. PMID: [7]
9. Bronfort G et al Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial Annals of Internal Medicine 2012, 156(1):1-10 <PubMed> PMID: [8] <Internet> [9]
   - Walker BF and French SD Pain in the Neck: Many (Marginally Different) Treatment Choices Annals of Internal Medicine 2012, 156(1):52-53 <PubMed> PMID: [10] <Internet> [11]
10. National Guideline Clearinghouse
    - ACR Appropriateness Criteria chronic neck pain American College of Radiology ngc-guideline: [12]
    - Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. ngc-guideline: [13]

neck pain