Chronic Neck Pain

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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.

References

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