Sammendrag

It is important to detect neck pain caused by significant causes (e.g., primary or metastatic cancer) and neck pain associated with neurological compromise. The diagnostic approach to neck pain has not been as well studied as back pain, but a similar approach is recommended.

Definitions

Neck pain can be considered in 4 categories as follows: [1]

• Grade 1: No signs of major pathology and little interference with daily activities

• Grade 2: No signs of major pathology but may impact daily activities

• Grade 3: Neck pain with neurological signs or symptoms (radiculopathy)

• Grade 4: Neck pain with major pathology (e.g., fracture, myelopathy, neoplasm, spinal infection).

Epidemiology

The prevalence of neck pain is less than that of back pain; therefore, neck pain is not as well studied as back pain. [2] The estimated lifetime prevalence of a significant episode of neck pain is 40% to 70%. [3] In a national survey in the US, 5.9% of respondents had neck pain for "most days for at least 1 month", compared with 10.5% with back pain. [4] A Finnish survey found a lifetime prevalence of 71%, with 13.5% of women and 9.5% of men having neck pain for >3 months. [5] Another survey from Norway found 34.4% had neck pain in the past year and 13.8% had neck pain for >6 months. [6] Up to 20% to 40% of acute neck pain will go on to become chronic neck pain. [7]

Neck pain increases from 18 to 30 years of age through to middle age (50-55 years). In some studies, there is a decrease after 50 to 55 years of age, whereas other studies show a slight increase or stability. [4] [5] [6] [8] All epidemiological studies show women having higher rates of neck pain than men. [4] [5] [6] [8] [9]

There is increased risk of chronic neck syndrome in workers in "clerical and services", industry, and agriculture versus professionals. This association was seen in adults aged 30 to 65 years but was not statistically significant for adults >65 years. [5] The incidence of cervical radiculopathy in one study was found to be 83.2 per 100,000. [10]

Injury is a strong predictor of chronic neck pain. [5] This has mainly been described in whiplash; 20% to 40% of whiplash injury patients will go on to have chronic neck pain. [7]

Mental stress has been found to be a weak predictor of neck pain. [5] Perceived inadequacy and level of injury were also found to be predictors of neck pain. [8]