COURSE AND PROGNOSIS

• Most people do not experience a complete resolution of symptoms. Between 50% and 85% of those who experience pain at some initial point will report having it again 1 to 5 years later. These numbers appear to be similar in the general population, in workers and after motor vehicle crashes.

• The prognosis also appears to be multifactorial. Younger age was associated with a better prognosis, whereas poor health and prior episodes of pain in the neck were associated with a poorer prognosis. Poorer prognosis was also associated with poor psychological health, worrying, and becoming angry or frustrated in response to pain in the neck. Greater optimism, a coping style that involved self-assurance, and having less need to socialize, were all associated with better prognosis.

• Specific workplace or physical job demands were not linked with recovery from neck pain. Workers who engaged in general exercise and sporting activities were more likely to experience improvement in neck. Postinjury psychological distress and passive types of coping were prognostic of poorer recovery in Whiplash Associated Disorder. There is evidence that compensation and legal factors are also prognostic for poorer recovery from WAD.

ASSESSMENT

1. The assessment for fracture in the emergency room and the diagnosis of cervical pain with radiculopathy are of value, but there is little evidence that diagnostic procedures for cervical pain without severe trauma or radicular symptoms have validity and utility.

2. Computerized tomography scan has better validity and utility in cervical trauma for high-risk or multi-injured patients.

3. The clinical physical examination is more predictive at excluding a structural lesion or neurologic compression than at diagnosing any specific etiologic condition in patients with cervical pain.

4. Conventional X-rays, as with other forms of arthritis, are considered 'insensitive' in patients with the early osteoarthritis that follows whiplash as surely as night follows day.

5. All other assessment tools such as electrophysiology, imaging, injections, discography, functional tests, and bloods test lack validity and utility.

6. Reliable and valid self-assessment questionnaires given to neck pain patients can provide useful information for management and prognosis.

7. The finding of degenerative changes on imaging has not been shown to be associated with pain in the neck.

8. How bad is the pain?

SLIPPED DISC Arm Pain

Often the deep inescapable ache in the arm is even worse than the neck pain, and it's often bad at night.

A bulge of the disc, impinging on the nerve root is a great challenge to all clinicians, not only chiropractors. Pain from the neck that radiates down the arm needs to be assessed and treated immediately. Left to its own devices this can be a very nasty condition, and allowed to become chronic is to be avoided under all circumstances. SLIPPED DISC Arm Pain ...

CHIROPRACTIC TREATMENT

Treatment is based on getting any fixated joints into motion again, to restore the normal movement of intracapsular fluids that bathe the joint cartilage, thus reducing the risk of inflammation of joints starved of nutrients and oxygen.

For more details follow this link: CHIROPRACTIC NECK PAIN TREATMENT ...

MEDICAL TREATMENT

It is widely acknowledged that getting the patient back to work as soon as possible is very important.

Should this relatively conservative treatment fail (medical research admits that NSAIDs in fact cause many thousands of deaths in the United States, mostly from bleeding ulcers) then more radical nerve root injection, neurotomy and open surgery should be used.

NEW RESEARCH

• 'Alternative' care for cervical pain, research concludes, appeared to be more beneficial than surgical or 'best' usual medical care.

• Educational videos, mobilization, manipulation, exercises, low-level laser therapy, and perhaps acupuncture appeared to have treatment benefit for pain in the neck.

• For both whiplash associated disorders and other cervical pain without radicular symptoms, interventions that focused on REGAINING FUNCTION and RETURNING TO WORK as soon as possible were relatively more effective than interventions that did not have such a focus.

• There is NO EVIDENCE that epidural or selective root injections with corticosteroids decrease the rate of open surgery for neck pain.There is evidence for SHORT TERM symptomatic improvement of radicular symptoms with these treatments.

• Evidence is lacking to support intra-articular steroid injections or radiofrequency neurotomy for cervical pain.

• There is no clear evidence that LONG-TERM OUTCOMES are improved with the SURGICAL TREATMENT of cervical radiculopathy compared with non-operative measures.

• However, relatively rapid and substantial relief of pain and impairment in the SHORT TERM (less than 3 months after surgery) after surgical treatment appears to have been reliably achieved.

NECK PAIN ANATOMY

It is important that we do our utmost to make sure the pain does not continue passed the critical 6 months point. Thereafter, research indicates it is likely to remain a life-long problem.

STROKE

* A similar association was also observed among patients receiving general practitioner services.

* This is likely explained by that patients with a vertebrobasilar artery dissection-related in progress, with the associated neck pain or headache, seek care from either their doctor or chiropractor before having their stroke. Neither their doctor's or chiropractor's care is considered the cause of any ensuing stroke.

For more information about the risks of stroke, click here: STROKE CHIROPRACTIC ...

For a stunning interview with a neurologist who herself had a stroke and, afterwards was able to describe in the most amazing way what was happening, follow this link. Scroll down to HEADACHE AND STROKE. This is one not to miss. Read more: NECK PAIN AND HEADACHE ...

CLASSIFICATION OF NECK PAIN

1. Grade I cervical pain: No signs or symptoms suggestive of major structural pathology and no or minor interference with activities of daily living; will likely respond to minimal intervention such as reassurance and pain control; does not require intensive investigations or ongoing treatment.

2. Grade II cervical pain: No signs or symptoms of major structural pathology, but major interference with activities of daily living; requires pain relief and early activation/intervention aimed at preventing long-term disability.

3. Grade III cervical pain: No signs or symptoms of major structural pathology, but presence of neurologic signs such as decreased deep tendon reflexes, weakness, and/or sensory deficits; might require investigation and, occasionally more invasive treatments.

4. Grade IV neck pain: Signs or symptoms of major structural pathology, such as fracture, myelopathy, neoplasm, or systemic disease; requires prompt investigation and treatment.

PREVENTION of Neck Pain

For example, wearing of seatbelts has been proven to have major prevention benefits in case of motor vehicle accidents.

Seeking treatment for 'minor' neck pain, before the onset of radiating pain, tingling, numbness and weakness in the shoulder, elbow or wrist and hand are important.

Managing headaches without analgesics to prevent kidney failure makes sense.

BONE AND JOINT DECADE

IMPORTANT CONSIDERATIONS @ Neck Pain

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Issue #18: Shoulder Pain / A Walk in the Sun

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Issue #04: Whiplash and the Joints of Luschka / Parsley

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