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 3.6%.[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]Safiri S, Kolahi AA, Hoy D, et al. Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ. 2020 Mar 26;368:m791.
https://www.bmj.com/content/368/bmj.m791
http://www.ncbi.nlm.nih.gov/pubmed/32217608?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
Progression of chronic neck pain is reported in 17% to 40% of patients with acute 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
[6]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
In the Global Burden of Disease 2016 study, lower back and neck pain ranked as the most common cause of disability globally (including North America) among people ages 25-64 years.[7]GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1545-602.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31678-6/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/27733282?tool=bestpractice.com
Systematic analysis of the Global Burden of Disease Study 2017 found that prevalence of neck pain increases with age up to 70-74 years, at which point prevalence decreases.[3]Safiri S, Kolahi AA, Hoy D, et al. Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ. 2020 Mar 26;368:m791.
https://www.bmj.com/content/368/bmj.m791
http://www.ncbi.nlm.nih.gov/pubmed/32217608?tool=bestpractice.com
Epidemiologic studies indicate that women have higher rates of neck pain than men.[3]Safiri S, Kolahi AA, Hoy D, et al. Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ. 2020 Mar 26;368:m791.
https://www.bmj.com/content/368/bmj.m791
http://www.ncbi.nlm.nih.gov/pubmed/32217608?tool=bestpractice.com
[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
[8]Palacios-Ceña D, Albaladejo-Vicente R, Hernández-Barrera V, et al. Female gender is associated with a higher prevalence of chronic neck pain, chronic low back pain, and migraine: results of the Spanish National Health Survey, 2017. Pain Med. 2021 Feb 23;22(2):382-95.
https://academic.oup.com/painmedicine/article/22/2/382/5961453
http://www.ncbi.nlm.nih.gov/pubmed/33164071?tool=bestpractice.com
[9]Kazeminasab S, Nejadghaderi SA, Amiri P, et al. Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord. 2022 Jan 3;23(1):26.
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04957-4
http://www.ncbi.nlm.nih.gov/pubmed/34980079?tool=bestpractice.com
Among office workers, high body mass index, frequent neck extension during the working day, high initial pain intensity, and high psychologic job demands are all predictors of 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
Incidence of cervical radiculopathy ranges from 0.83 to 1.79 per 1000 person-years and peaks in the fourth and fifth decades.[10]Mansfield M, Smith T, Spahr N, et al. Cervical spine radiculopathy epidemiology: a systematic review. Musculoskeletal Care. 2020 Dec;18(4):555-67.
http://www.ncbi.nlm.nih.gov/pubmed/32710604?tool=bestpractice.com
[11]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
Approximately 20% to 40% of whiplash injury patients will go on to have chronic neck pain.[6]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
[12]Elliott JM, Noteboom JT, Flynn TW, et al. Characterization of acute and chronic whiplash-associated disorders. J Orthop Sports Phys Ther. 2009 May;39(5):312-23.
https://www.jospt.org/doi/10.2519/jospt.2009.2826
http://www.ncbi.nlm.nih.gov/pubmed/19411765?tool=bestpractice.com
Precollision health and psychologic distress have been identified as predictors of chronic neck pain following acute whiplash trauma.[13]Osterland TB, Kasch H, Frostholm L, et al. Precollision medical diagnoses predict chronic neck pain following acute whiplash trauma. Clin J Pain. 2019 Apr;35(4):304-14.
http://www.ncbi.nlm.nih.gov/pubmed/30829733?tool=bestpractice.com
[14]Atherton K, Wiles NJ, Lecky FE, et al. Predictors of persistent neck pain after whiplash injury. Emerg Med J. 2006 Mar;23(3):195-201.
http://www.ncbi.nlm.nih.gov/pubmed/16498156?tool=bestpractice.com
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