NECK PAIN

HOW COMMON IS NECK PAIN? (EPIDEMIOLOGY)

Most people can expect to experience some neck pain in their lifetimes, although for the majority, it will not seriously interfere with normal activities.
During any 12-month it was found in up to 70% of the general population, and up to 48% in workers.
However, pain in the neck with associated DISABILITY was less common: 12-month prevalence ranged up to 11.5% in the general population.
Each year, between 11% and 14.1% of workers reported being limited in their activities because of pain in the neck. It was common in all occupational categories, and the results of the Ontario study suggest that worker's compensation data significantly underestimate the burden of neck pain in workers.
The number of persons seeking health care in emergency rooms for traffic-related Whiplash-associated disorders (WAD) has been increasing over the past 3 decades. What are the symptoms of whiplash?

RISK FACTORS

There is NO EVIDENCE that common degenerative changes in the cervical spine are a risk factor for pain in the neck.
Smoking and exposure to environmental tobacco is a risk factor. The spine like every organ requires oxygen and any decreased oxygen in the blood affects joint healing negatively.
In the workplace high quantitative job demands, low social support at work, sedentary work position, repetitive work, and precision work increased the risk.
Devices aimed at limiting head extension during rear-end collisions were found to have a preventive effect. For more interesting facts about whiplash, click here.

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

* 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.

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

* 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.

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

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

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

CHIROPRACTIC TREATMENT

Chiropractic treatment always begins with a thorough HISTORY and EXAMINATION.

For more details follow this link: CHIROPRACTIC TREATMENT

MEDICAL TREATMENT

Medical treatment of cervical pain is based on the use of anti-inflammatory and muscle relaxing drugs.

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. Anti-inflammatory drugs

Stiff neck and high temperature? A medical emergency.

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.

Anatomy of the neck or cervical spine

For more info about the anatomy of the neck, click here.

STROKE

* There is an association between chiropractic and medical services and subsequent vertebrobasilar artery stroke in persons under 45.

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

* This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke.

For more inforamtion about the risks of stroke, click here.

CLASSIFICATION OF NECK PAIN

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.
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.
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.
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

Prevention of cervical pain is best directed at reducing major injuries and dealing effectively with neck injuries to avoid the development of disabling 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 2000-2010 Task Force on neck pain

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