It is important to detect neck pain caused by significant causes (e.g., primary or metastatic cancer) and neck pain associated with neurologic 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]Guzman J, Haldeman, S, Carroll LJ, et al. Clinical practice implications of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders: from concepts and findings to recommendations. Spine (Phila Pa 1976). 2008 Feb 15;33(4 suppl):S199-213.
http://www.ncbi.nlm.nih.gov/pubmed/18204393?tool=bestpractice.com
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 neurologic signs or symptoms (radiculopathy)
Grade 4: Neck pain with major pathology (e.g., fracture, myelopathy, neoplasm, spinal infection).
Epidemiology
Neck pain is a common condition that causes significant disability. The estimated lifetime prevalence of a significant episode of neck pain is 40% to 70%, and the global point prevalence of neck pain is 4.9%.[2]Devereaux MW. Neck pain. Prim Care. 2004 Mar;31(1):19-31.
http://www.ncbi.nlm.nih.gov/pubmed/15110156?tool=bestpractice.com
[3]Hoy D, March L, Woolf A, et al. The global burden of neck pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014 Jul;73(7):1309-15.
http://www.ncbi.nlm.nih.gov/pubmed/24482302?tool=bestpractice.com
Between 33% and 65% of people recover from an episode of neck pain within one year, but relapses are common.[4]Hoy DG, Protani M, De R, et al. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010 Dec;24(6):783-92.
http://www.ncbi.nlm.nih.gov/pubmed/21665126?tool=bestpractice.com
Up to 20% of acute neck pain will go on to become chronic neck pain.[5]Sihawong R, Sitthipornvorakul E, Paksaichol A, et al. Predictors for chronic neck and low back pain in office workers: a 1-year prospective cohort study. J Occup Health. 2016;58(1):16-24.
http://www.ncbi.nlm.nih.gov/pubmed/26498979?tool=bestpractice.com
In the 2010 Global Burden of Disease Study, neck pain ranked fourth highest for the number of years lived with disability.[6]Kim DH, Hinshaw JL, Lubner MG, et al. Contrast coating for the surface of flat polyps at CT colonography: a marker for detection. Eur Radiol. 2014 Apr;24(4):940-6.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996850
http://www.ncbi.nlm.nih.gov/pubmed/24482303?tool=bestpractice.com
Neck pain increases from 18 to 30 years through to middle age (50-55 years).[7]Hogg-Johnson S, van der Velde G, Carroll LJ, et al. The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther. 2009 Feb;32(2 suppl):S46-60.
http://www.ncbi.nlm.nih.gov/pubmed/19251074?tool=bestpractice.com
In some studies, there is a decrease after 50 to 55 years, whereas other studies report no change or a slight increase.[8]Maurer K; U.S. Department of Health, Education, and Welfare. Basic data on arthritis knee, hip and sacroiliac joints in adults ages 25-74 years: United States, 1971-1975. Vital Health Stat 11. 1979 Aug;(213):1-31.
https://www.cdc.gov/nchs/data/series/sr_11/sr11_213.pdf
http://www.ncbi.nlm.nih.gov/pubmed/15810262?tool=bestpractice.com
[9]Makela M, Heiliovaara M, Sievers K, et al. Prevalence, determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol. 1991 Dec 1;134(11):1356-67.
https://academic.oup.com/aje/article/134/11/1356/88722
http://www.ncbi.nlm.nih.gov/pubmed/1755449?tool=bestpractice.com
[10]Bovim G, Schrader H, Sand T. Neck pain in the general population. Spine (Phila Pa 1976). 1994 Jun 15;19(12):1307-9.
http://www.ncbi.nlm.nih.gov/pubmed/8066508?tool=bestpractice.com
[11]van der Donk J, Schouten JS, Passchier J, et al. The associations of neck pain with radiological abnormalities of the cervical spine and personality traits in a general population. J Rheumatol. 1991 Dec;18(12):1884-9.
http://www.ncbi.nlm.nih.gov/pubmed/1795327?tool=bestpractice.com
All epidemiologic studies show women having higher rates of neck pain than men.[4]Hoy DG, Protani M, De R, et al. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010 Dec;24(6):783-92.
http://www.ncbi.nlm.nih.gov/pubmed/21665126?tool=bestpractice.com
[6]Kim DH, Hinshaw JL, Lubner MG, et al. Contrast coating for the surface of flat polyps at CT colonography: a marker for detection. Eur Radiol. 2014 Apr;24(4):940-6.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996850
http://www.ncbi.nlm.nih.gov/pubmed/24482303?tool=bestpractice.com
Injury is a strong predictor of chronic neck pain.[12]Croft PR, Lewis M, Papageorgiou AC, et al. Risk factors for neck pain: a longitudinal study in the general population. Pain. 2001 Sep;93(3):317-25.
http://www.ncbi.nlm.nih.gov/pubmed/11514090?tool=bestpractice.com
This has mainly been described for whiplash; 20% to 40% of whiplash injury patients will go on to have chronic neck pain.[13]Carette S. Whiplash injury and chronic neck pain. N Engl J Med. 1994 Apr 14;330(15):1083-4.
http://www.ncbi.nlm.nih.gov/pubmed/8127339?tool=bestpractice.com
High body mass index, frequent neck extension during the working day, high initial pain intensity, and high psychological job demands are all predictors of chronic neck pain development in office workers.[5]Sihawong R, Sitthipornvorakul E, Paksaichol A, et al. Predictors for chronic neck and low back pain in office workers: a 1-year prospective cohort study. J Occup Health. 2016;58(1):16-24.
http://www.ncbi.nlm.nih.gov/pubmed/26498979?tool=bestpractice.com
Cervical radicular pain has an annual incidence of 63 to 107 cases per 100,000, and incidence peaks in the fourth and fifth decades.[14]Iyer S, Kim HJ. Cervical radiculopathy. Curr Rev Musculoskelet Med. 2016 Sep;9(3):272-80.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958381
http://www.ncbi.nlm.nih.gov/pubmed/27250042?tool=bestpractice.com
Log in or subscribe to access all of BMJ Best Practice