明确导致颈部疼痛的原因（例如原发性或转移瘤）和其合并的神经损害情况是非常重要的。 对于颈部疼痛的诊断方法目前还不及腰背部疼痛研究的深入，但推荐类似的诊断方式。
定义
颈部疼痛可分为以下4类[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
流行病学
颈痛是导致严重残疾的常见疾病。估计颈痛显著发作的终身患病率为 40%-70%，颈痛的全球时点患病率为 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
有 33%-65% 的颈痛发作患者在一年内恢复，但复发很常见。[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
高达 20% 的急性颈痛会发展为慢性颈痛。[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
在 2010 年全球疾病负担研究中，颈痛的伤残损失寿命年数排名第 4。[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
从18至30岁阶段到中年人群（50-55岁），颈部疼痛的发生率是增加的。[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
一些研究显示，颈痛的发生在 50-55 岁之后有所减少，而其他研究显示其发病率没有变化或有轻微上升。[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 or 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
所有的流行病学研究显示，女性颈部疼痛的发生率高于男性。[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
损伤因素是慢性颈部疼痛的一个重要预测因素。[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
此种情况主要出现于颈部挥鞭样损伤；20%～40% 的挥鞭样损伤将逐渐发展为慢性颈部疼痛。[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
高体重指数、在工作日频繁伸展颈部、较高的初始疼痛强度和较高的心理工作要求都是导致上班族慢性颈痛的预测指标。[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
颈椎神经根疼痛的年发病率为 63/100,000-107/100,000，且在 30-39 岁和 40-49 岁发病率最高。[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
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容