Understanding Neck Pain

Almost everyone, including children, will experience some neck pain at some time in their lives. Most people get better, but some continue to have persistent, long-term discomfort or disability. Chronic neck pain can have a huge effect on individuals, families, health care systems and society as a whole.The consequences include overburdened health care services and employees not being able to work for long periods of time.

What does scientific research tell us about neck pain? The good news is that medical science knows more than ever about how common neck pain is, what the causes are, how to figure out what the source of the pain is and which treatments and behaviors will result in the best recovery.

What we know

  1. Neck pain has many different causes and consequences.
  2. Most people’s neck pain will not seriously interfere with their normal activities.
  3. Risk factors for neck pain include
    • poor psychological health
    • smoking
    • exposure to environmental tobacco
    • physical traumas such as vehicle accidents and sport injuries
    • prolonged sedentary positions
    • poor computer and keyboard postures
    • repetitive and precision work
  4. Some kinds of neck pain are preventable. For example, appropriate vehicle head restraints can prevent whiplash injuries in the case of rear-end collisions.
  5. If there has not been a serious injury or there are no signs of disease, X-rays and CT scans are not needed to diagnose the cause of neck pain.

What we don’t know

  1. Why some people recover completely from neck pain and others do not
  2. How to prevent neck pain in children
  3. Which are the best tests to know whether children who have blunt trauma to the head have a serious neck injury
  4. How our culture affects  how we experience neck pain
  5. Why some people respond to certain treatments better than others

Tips for living well with neck pain

 
  • Correct bad work postures and avoid sitting or standing for long periods of time.
  • Practice exercises that will strengthen your neck and shoulders.
  • Eat a healthy diet, quit smoking and get regular moderate exercise.
  • Reduce stress. Enjoy a relaxing activity such as walking, tai chi, music or massage.
  • Discuss the harms and benefits of taking pain medications long-term with your doctor.
  • If neck pain worsens, see your doctor.

Research on Neck Pain

A helpful way to look at neck pain is to consider the seriousness of the injury involved. The following neck pain grading scale may help. It comes from The Bone and Joint 2000-2010 Task Force on Neck Pain and Its Associated Disorders. The results of the task force’s review of neck pain research were published in the Journal of Occupational and Environmental Medicine.

  1. Grade I – No signs of disease or disability.
  2. Grade II – No signs of disease but significant disability.
  3. Grade III – Neurological signs of nerve compression.
  4. Grade IV – Pain with signs of disease such as infection, fracture, tumors, a spinal cord disease or a disease that affects the whole.

Most people who have a whiplash have a Grade II injury. The Task Force found that current research supports the following facts about Grade II Neck Pain:

  • There is no single nonsurgical neck pain treatment that is better than others in helping the pain to get better faster or in getting a better result months later.
  • Treatments which involve the patient being ‘active’ and receiving education about how to manage the pain themselves and to return as soon as possible to normal behaviours are most successful.. Educational videos, treatments involving health care providers working with their hands on specific movements of your neck, exercises, low-level laser therapy, and perhaps acupuncture appeared to have some benefit.
  • Passive treatments such the use of collars or the use of electrical nerve stimulation alone without exercise,have not been shown to help.
  • Health care providers advise use of drugs that work on inflammation and also recommend treatments where they help you with specific movements of your neck.
  • Exercise and increased movement of your neck are often advised.

As no one treatment was seen to be better than others it is recommended that if you are not getting a benefit from one type of therapy you may not wish to continue with it for a long period of time..

Neck pain may be common but it is not simple or always easily treated. The Task Force identified important gaps in scientific knowledge about neck pain and asked for more research on new ways to prevent, diagnose and treat neck pain, especially in children. As well, the team urged scientists to do more research on how cultural beliefs and social practices effect how people experience neck pain. The goal is to lessen the the burden of neck pain on everyone.

References

Haldeman, Scott DC, MD, PhD*; Carroll, Linda PhD†; Cassidy, J David DC, PhD, DrMedSc‡; Schubert, Jon CMA§; Nygren, Åke DDS, MD, DrMedSc. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: Executive Summary, Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S5-7.

Gross A, Miller J, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL. Manipulation or Mobilisation for Neck Pain. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD004249. DOI: 10.1002/14651858.CD004249.pub3.