Advances in the diagnosis and management of neck pain

Neck pain imposes a considerable personal and socioeconomic burden—it is one of the top five chronic pain conditions in terms of prevalence and years lost to disability—yet it receives a fraction of the research funding given to low back pain. Although most acute episodes resolve spontaneously, more...

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Bibliographic Details
Published in:BMJ (Online) 2017-08, Vol.358, p.j3221-j3221
Main Authors: Cohen, Steven P, Hooten, W Michael
Format: Article
Language:English
Subjects:
Acupuncture
Acute Pain - diagnosis
Acute Pain - therapy
Anti-inflammatory agents
Back pain
Chronic pain
Chronic Pain - diagnosis
Chronic Pain - therapy
Clinical trials
Complementary Therapies
Denervation
Diagnosis, Differential
Disease
Epidemiology
Exercise
Guidelines as Topic
Humans
Inflammation
Joint surgery
Low back pain
Manipulation, Spinal - methods
Medical diagnosis
Muscle relaxants
Neck
Neck pain
Neck Pain - diagnosis
Neck Pain - physiopathology
Neck Pain - psychology
Neck Pain - therapy
Neuralgia
Nonsteroidal anti-inflammatory drugs
Pain perception
Psychopathology
Radiculopathy - physiopathology
Risk factors
STATE OF THE ART REVIEW
Surgery
Trauma
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Summary:Neck pain imposes a considerable personal and socioeconomic burden—it is one of the top five chronic pain conditions in terms of prevalence and years lost to disability—yet it receives a fraction of the research funding given to low back pain. Although most acute episodes resolve spontaneously, more than a third of affected people still have low grade symptoms or recurrences more than one year later, with genetics and psychosocial factors being risk factors for persistence. Nearly half of people with chronic neck pain have mixed neuropathic-nociceptive symptoms or predominantly neuropathic symptoms. Few clinical trials are dedicated solely to neck pain. Muscle relaxants and non-steroidal anti-inflammatory drugs are effective for acute neck pain, and clinical practice is mostly guided by the results of studies performed for other chronic pain conditions. Among complementary and alternative treatments, the strongest evidence is for exercise, with weaker evidence supporting massage, acupuncture, yoga, and spinal manipulation in different contexts. For cervical radiculopathy and facet arthropathy, weak evidence supports epidural steroid injections and radiofrequency denervation, respectively. Surgery is more effective than conservative treatment in the short term but not in the long term for most of these patients, and clinical observation is a reasonable strategy before surgery.
ISSN:0959-8138
1756-1833
DOI:10.1136/bmj.j3221