A Pain In The Neck!

Neck Pain

Neck pain, also known as cervicalgia, occurs when there is a disturbance that affects the balance between muscle strength and flexibility in the cervical spine, which in turn affects the normal operation of the cervical spine.¹ If the pain additionally radiates from the neck to the upper extremities, it is called cervicobrachalgia.²

Neck pain is among the four most frequently reported musculoskeletal disorders, with one out of every five adults who have no previous history of neck pain reporting a new episode within a period of one year.^3,4 On estimation, greater than 80% of individuals will be affected by neck pain and its related disorders in their lifetime. It has also been found that around 30-50% of the general adult population are affected by neck pain every year.⁴ Moreover, neck pain has an average prevalence of 10% at any one time, and an average prevalence of 25% monthly.³ For most people, their course of neck pain will have a positive outcome and can be resolved. However, about 23% of individuals will be affected by another later episode of neck pain after recovering from a previous episode.⁴

The neck pain may or may not radiate to the shoulders and upper arms. Other signs and symptoms of neck pain include having difficulty in moving the neck, and normal or slightly decreased passive range of motion of the neck. Other symptoms that may be present in those with stress-related neck pain include dizziness, having ringing in the ears, fatigue, nausea and concentration lapses.² Although the presentation of neck pain is usually ill-defined and unclear, it is important to recognize serious key symptoms that may indicate malignance, infection, and other potentially life-threatening conditions.^5,6 Such symptoms include severe, intractable pain, especially if it is worse at night, and gait disturbances.^5,6 Intense pain over a vertebral body may indicate malignancy or compression fractures, while the presence of localized tenderness along with fever indicates a high possibility of infection.⁵ Other symptoms such as fever, night sweats, and unexpected weight loss may indicate malignancy or infections.⁶

For neck pain and associated disorders without any signs or symptoms of major structural pathology and neurological problems, the non-invasive treatments recommended include the use of structured patient education along with: exercise, use of muscle relaxants for short time, or multimodal care.⁴

Patient education involves clinicians informing patients about the nature and management of neck pain. Clinicians also encourage patients to remain active and inform them of their recovery period through patient education. The exercises used for treatment depends on the type of neck pain present.⁴ For neck pain lasting for less than 3 months, range of motion exercise is recommended. Such exercise involves gentle, controlled movement of the neck and shoulder taught by a healthcare professional.  For neck pain lasting longer than 3 months, a combination of range of motion exercise and strengthening exercise is recommended.⁴

With respect to medication, there has been little evidence for the effectiveness of NSAIDs for neck pain lasting shorter than 3 months. However, for such cases, there is some evidence for the short term usage of muscle relaxants (cyclobenzaprine).⁴ In reverse, for long term sufferers of neck pain, there is little evidence for the use of muscle relaxants, but there is some evidence for the short term usage of NSAIDs. In both cases, patients should be informed of the possible significant adverse side effects of the medications.⁴

Multimodal care for neck pain should include both range of motion exercise and manual therapy. Many studies have found such combinations to more effective in treating neck pain than other methods.^4,7,8 The manual therapy used include the mobilization or manipulation of the cervical and/or thoracic spine as required.⁴

Invasive treatment methods for neck pain such as injections and surgery may be considered in certain pathological conditions.⁹ However, most of these methods currently do not have substantial evidence. For example, there is contrasting evidence for epidural corticosteroid injections for radiculopathy. In addition, surgery may be effective in the short term, but it has been found to be ineffective in the long term for a majority of patients with radiculopathy or myelopathy.¹⁰

It has been found that 27% of patients seek chiropractic treatment for neck or cervical problems. Therefore, chiropractic is inherent in the treatment of neck pain. Much evidence have been found supporting the utilization of chiropractic methods to treat neck pain, with the common side effects being generally self-limiting and trivial.^11,12,13 The main method used by chiropractors to treat neck pain are spinal manipulation and mobilization. Evidence suggests that spinal manipulation and mobilization are effective in treating both acute and chronic neck pain when used in conjunction with other forms of treatment such as exercise and patient education. These methods are also effective for both short term and long term benefit.¹¹ In addition, another study has found that the use of manipulation and/or mobilization in combination with exercise to treat neck pain resulted in increased function, reduced pain, as well as decrease in its perceived effect.¹² Hence, chiropractic is suitable for the treatment of neck pain and is superior to other treatment types when use in combination with prescribed exercise.

References:

1. Zeigelboim BS, Fonseca VR, Mesti JC, Gorski LP, Faryniuk JH, Marques JM. Neurotological Findings at a Health Unit for Adults with Cervicalgia. International Archives of Otorhinolaryngology. 2016;20(2):109-13. doi: 10.1055/s-0036-1572563
2. Bahr R, 1957, Mæhlum S. Clinical guide to sports injuries. Champaign, IL: Human Kinetics; 2004
3. McLean SM, May S, Klaber-Moffett J, Sharp DM, Gardiner E. Risk factors for the onset of non-specific neck pain: a systematic review. J Epidemiol Community Health (1979-) [serial on the Internet]. 2010 [cited 2017 Jan 18];64(7):565-72. Available from: http://www.jstor.org.libproxy.murdoch.edu.au/stable/40794038
4. Côté P, Wong JJ, Sutton D, Shearer HM, Mior S, Randhawa K, et al. Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J. 2016;25(7):2000-22. doi: 10.1007/s00586-016-4467-7
5. Karnath BM. Identifying the Musculoskeletal Causes of Neck Pain. J Musculoskelet Med [serial on the Internet]. 2012 [cited 2017 Jan 18];29(3):82. Available from: http://www.rheumatologynetwork.com/articles/identifying-musculoskeletal-causes-neck-pain
6. Clinical: Red Flag Symptoms – Neck pain. GP [serial online]. 2012 [cited 2017 Jan 18]:26. Available from: General OneFile. http://find.galegroup.com
7. Gross AR, Kay TM, Kennedy C, Gasner D, Hurley L, Yardley K, et al. Clinical practice guideline on the use of manipulation or mobilization in the treatment of adults with mechanical neck disorders. Man Ther [serial online]. 2002 [2017 Jan 19];7(4):193-205. Available from: ScienceDirect. http://www.sciencedirect.com/
8. Gross AR, Kay T, Hondras M, Goldsmith C, Haines T, Peloso P, et al. Manual therapy for mechanical neck disorders: a systematic review. Man Ther [serial online]. 2002 [2017 Jan 20];7(3):131-49. Available from: ScienceDirect. http://www.sciencedirect.com/
9. C Carragee EJ, Hurwitz EL, Cheng I, Carroll LJ, Nordin M, Guzman J, et al. Treatment of neck pain – Injections and surgical interventions: Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders. Spine [serial online]. 2008[2017 Jan 20];33(4):S153-69. Available from: ScienceDirect. http://www.sciencedirect.com/
10. Cohen S. Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clin Proc [serial online]. 2015 [2017 Jan 20];90(2):284-99. Available from: ProQuest. http://search.proquest.com
11. Bryans R, Decina P, Descarreaux M, Duranleau M, Marcoux H, Potter B, et al. Evidence-based guidelines for the chiropractic treatment of adults with neck pain. JManipulative Physiol Ther. 2014;2013;37(1):42-63. doi: 1016/j.jmpt.2013.08.010
12. Plastaras CT, Schran S, Kim N, Sorosky S, Darr D, Chen MS, et al. Complementary and Alternative Treatment for Neck Pain: Chiropractic, Acupuncture, TENS, Massage, Yoga, Tai Chi, and Feldenkrais. Phys Med Rehabil Clin N Am [serial online]. 2011 [2017 Jan 20];22(3):521-37. Available from: ScienceDirect. http://www.sciencedirect.com/
13. Bronfort G, Haas d, M, Evans RL, Bouter LM. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J [serial online]. 2004 [2017 Jan 20];4(3):335-56. Available from: ScienceDirect. http://www.sciencedirect.com/