Chronic Neck Pain

Original Editor - Your name will be added here if you created the original content for this page.

Top Contributors - Axel Antoine, Laura Ritchie, Kim Jackson, Rachael Lowe, Simisola Ajeyalemi, Evan Thomas, George Prudden, Joris Servranckx, Eva Roose1, WikiSysop, Claire Knott, Lauren Lopez, Jess Bell, Olajumoke Ogunleye and Admin  

Search Strategy

Databases Searched: Pubmed, Pedro
Keyword Searches: Chronic neck pain AND physical therapy, Chronic neck pain AND Manual Therapy, Chronic neck pain AND stretching, Chronic neck pain AND massage, chronic neck pain AND yoga

Definition/Description

The International Association for the Study of Pain (IASP) in its classification of chronic pain defines cervical spinal pain as pain perceived anywhere in the posterior region of the cervical spine, from the superior nuchal line to the first thoracic spinous process [17]. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders describes neck pain as pain located in the anatomical region of the neck with or without radiation to the head, trunk, and upper limbs (Guzman J. et al., 2008) It defines the posterior neck region from the superior nuchal line to the spine of the scapula and the side region down to the superior border of the clavicle and the suprasternal notch [17]. Chronic neck pain is described as an often-widespread sensation with hyperalgesia in the skin, ligaments, and muscles on palpation and in both passive and active movements in neck and shoulder area (Ylinen J, 2007) [17]. Another type of classification proposed by IASP is based on the duration of neck pain. Acute neck pain usually lasts less than 7 days, subacute neck pain lasts more than 7 days but less than 3 months, and chronic neck pain has duration of 3 months or more.

Clinically Relevant Anatomy

For a structure to be a potential source of pain, it must be innervated. The posterior neck muscles and the cervical zygapophysial joints are innervated by the cervical dorsal rami. The lateral atlanto-axial joint is innervated by the C2 ventral ramus, and the atlanto-occipital joint is supplied by the C1 ventral ramus. The median atlanto-axial joint and its ligaments are supplied by the sinuvertebral nerves of C1-3. These nerves also supply the dura mater of the cervical spinal cord. The innervation of the prevertebral and lateral muscles of the neck are innervated by branches of the cervical ventral rami. Because they are innervated, all of the muscles, synovial joints, and intervertebral disks of the neck are potential sources of neck pain, along with the cervical dura mater and the vertebral artery. It has been shown that noxious stimulation of the cervical zygapophysial joints causes neck pain and referred pain (Dwyer A. et al., Aprill C. et al.). Pain from muscles innervated by a particular segment should be perceived in the same location as pain from articular structures innervated by the same segment. A study showed that stimulation of upper cervical muscles could produce pain in the head (Cyriax J.)18.

Epidemiology /Etiology

Chronic neck pain is a common disease in general population and employees. Chronic neck pain can occur one year after the initial episodes and it has been found in 60% tot 80% of employees. The incidence of chronic neck pain was higher in women (15%) then men (9%). Women have the highest incidence at the age of 45 and men at the age of 60. [1] Fejer et al also found that the prevalence is higher in women. Scandinavian people reported more neck pain than Europe or Asia. [2]

According to S. Kääriä et al, the strongest predictors for women are earlier acute neck pain and chronic low back pain. Other predictors are:
- high physical workload
- intermediate and high work-related emotional exhaustion
- experiencing and having earlier experienced bullying at work
- common mental disorders
- rare to occasional and frequent sleep problems
- overweight and obesity
The predictors for men are:
- chronic low back pain
- acute neck pain
- manual class as compared with managers and profes- sionals
- high work-related emotional exhaustion
- frequent sleep problems [1]

Diagnostic Procedures

The most common neck pain in a physician’s office is nonspecific. And it is usually caused by daily activities. The differential diagnosis of neck pain is focused on mechanical and non-mechanical. Chronic neck pain is when the complaints are longer than three months and this can be a mechanical or non-mechanical cause. Possible factors that can lead to chronicity are: fear ,catastrophizing , depression and anxiety.[19] The table below shows the possible causes of neck pain. [3]

Mechanical	Infections
Nontraumatic	Osteomyelitis
Neck Strain	Discitis
Postural	Meningitis
Tension	Herpes Zoster
Torticollis (acquired)	Lyme Disease
Spondylosis* (degenerative arthritis)
Myelopathy*	Neurologic
Cervical Fracture* (see neoplasm)	Peripheral Entrapment
	Brachial Plexitis
Traumatic	Neuropathies
Whiplash Syndromes*	Reflex Sympathetic Dystrophy
Disc Henation*
Neck Sprain	Referred
Sports (Stinger*)	Thoracic Outlet Syndrome
	Pancoast Tumor
Non Mechanical	Esophagitis
Rheumatologic/Inflammatory	Angina
Rheumatoïd Arthritis	Vascular Dissection
Ankylosing Spondylitis	Carotidynia
Fibromyalgie
Polymyalgia Rheumatic	Miscellaneous
Reiter Syndrome	Sarcoidosis
Psoriatic Arthritis	Paget Disease
Neoplastic
Osteoblastoma
Osteochondroma
Giant Cell Tumor
Metastases
Hemangioma
Multiple Myeloma
Chondrosarcoma
Glioma
Syringomyelia
Neurofibroma

• With or without radiculopathy

References

References will automatically be added here, see adding references tutorial.