Advancesinthediagnosisandmanagementofneckpain

Neck pain is one of the top five chronic pain conditions globally, ranking fourth as a cause of disability in the United States. Despite its enormous burden, neck pain receives significantly less research funding than low back pain. Nearly half of people with chronic neck pain have mixed neuropathic-nociceptive symptoms or predominantly neuropathic symptoms, making accurate diagnosis and appropriate treatment challenging. Most acute episodes resolve spontaneously within two months, but more than a third of affected people continue to have symptoms or recurrences more than one year later.

This comprehensive state-of-the-art review analyzed the epidemiology, diagnosis, and treatment of neck pain by searching multiple databases including Medline, Embase, and Cochrane Reviews. The authors examined evidence for various treatment approaches including pharmacological interventions, procedural treatments, exercise, and complementary therapies. They prioritized systematic reviews and clinical trials, particularly larger randomized studies, while also including case reports where higher-grade evidence was lacking.

The review found that neck pain affects 7.6% of people at any given time, with lifetime prevalence reaching 48.5%. Women are more likely to experience neck pain, with peak prevalence in middle age. Risk factors include genetics, psychosocial factors, sleep problems, smoking, and sedentary lifestyle. For treatment, muscle relaxants and NSAIDs show effectiveness for acute neck pain.

Among complementary treatments, exercise has the strongest evidence, with weaker support for massage, acupuncture, yoga, and spinal manipulation. For specific conditions like cervical radiculopathy and facet arthropathy, epidural steroid injections and radiofrequency denervation have weak evidence of benefit. Surgery is more effective than conservative treatment in the short term but not long term for most patients.

This review highlights significant gaps in neck pain research and treatment. The finding that neck pain research is underfunded relative to its burden suggests a need for increased research investment. The weak evidence base for many treatments commonly used in clinical practice indicates that treatment decisions often rely on extrapolation from back pain studies or expert opinion. For patients, this means that conservative approaches like exercise and physical therapy should be first-line treatments, while more invasive procedures should be reserved for cases where conservative management fails.

The similar long-term outcomes between surgical and conservative treatments for most neck conditions support a watchful waiting approach before considering surgery.