Neck pain is almost universal and is a common patient complaint. Although the differential diagnosis is extensive, most symptoms are from biomechanical sources, such as axial neck pain, whiplash-associated disorder (WAD), and radiculopathy.
Most symptoms abate quickly with little intervention. There is relatively little high-quality treatment evidence available, and no consensus on management of axial neck pain or radiculopathy. A number of general pain management guidelines are applicable to neck pain, and specific guidelines are available on the management of WAD.
The goal of diagnosis is to identify the anatomic pain generator(s). Patient history and examination are important in distinguishing potential causes and identifying red flags. Diagnostic imaging should be ordered only when necessary because of the high incidence of asymptomatic radiographic abnormalities. First-line drug treatments include acetaminophen, cyclo-oxygenase 2–specific inhibitors, or nonsteroidal anti-inflammatory drugs.
Short-term use of muscle relaxants may be considered. Opioids should be used if other treatments are ineffective and continued if improved function outweighs impairment. Adjuvant antidepressants and anticonvulsants should be considered in chronic or neuropathic pain and coincident depression. Epidural steroids should be considered only in radiculopathy. Physical modalities supported by evidence should be used. If symptoms have not resolved in 4 to 6 weeks, re-evaluation and additional workup should be considered.
The human neck is a complex structure that is highly susceptible to irritation. In fact, 10% of people will have neck pain in any given month.1 Potential pain generators include bones, muscles, ligaments, facet joints, and intervertebral discs. Almost any injury or disease process within the neck or adjacent structures will result in reflexive protective muscle spasm and loss of motion. Gradual collapse of the intervertebral discs and degeneration of the facet joints is a universal part of the aging process and, in some people, can lead to nerve or spinal cord impingement. Further, neck mobility is so important to normal human functioning that any disruption in its normal function is quickly noticed.
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| neck pain |
Most symptoms abate quickly with little intervention. There is relatively little high-quality treatment evidence available, and no consensus on management of axial neck pain or radiculopathy. A number of general pain management guidelines are applicable to neck pain, and specific guidelines are available on the management of WAD.
The goal of diagnosis is to identify the anatomic pain generator(s). Patient history and examination are important in distinguishing potential causes and identifying red flags. Diagnostic imaging should be ordered only when necessary because of the high incidence of asymptomatic radiographic abnormalities. First-line drug treatments include acetaminophen, cyclo-oxygenase 2–specific inhibitors, or nonsteroidal anti-inflammatory drugs.
Short-term use of muscle relaxants may be considered. Opioids should be used if other treatments are ineffective and continued if improved function outweighs impairment. Adjuvant antidepressants and anticonvulsants should be considered in chronic or neuropathic pain and coincident depression. Epidural steroids should be considered only in radiculopathy. Physical modalities supported by evidence should be used. If symptoms have not resolved in 4 to 6 weeks, re-evaluation and additional workup should be considered.
The human neck is a complex structure that is highly susceptible to irritation. In fact, 10% of people will have neck pain in any given month.1 Potential pain generators include bones, muscles, ligaments, facet joints, and intervertebral discs. Almost any injury or disease process within the neck or adjacent structures will result in reflexive protective muscle spasm and loss of motion. Gradual collapse of the intervertebral discs and degeneration of the facet joints is a universal part of the aging process and, in some people, can lead to nerve or spinal cord impingement. Further, neck mobility is so important to normal human functioning that any disruption in its normal function is quickly noticed.
