Tuesday, February 16, 2016

The Reality Of Neck Pain

By Dr. R. Greg Lusk, DC

Neck pain is a common complaint in healthcare offices.  Whereas 8/10 people will experience low back pain throughout their life, up to 70% of people will experience neck pain.  Thankfully, only 1/10 neck pain sufferers report that it is serious enough to limit their ability to work or enjoy other daily activities.  However, like low back pain, neck pain will commonly recur.  In fact, between 50% to 85% of people will experience neck pain again within 1-5 years of the initial episode and how quickly symptoms improve is variable with each episode.

Due to the global impact of musculo-skeletal complaints, The United Nations and World Health Organization had an initiative from 2000-2010 titled "The Bone and Joint Decade".  A component of this was a Neck Pain Task Force that screened an enormous amount of research, nearly 32,000 citations, on its way to including 552 papers in a summary of best evidence with respect to neck pain.  As stated by the Task Force, "...the most productive use of this review is to inform and empower the public - more specifically people with neck pain or who are at risk of developing neck pain.  The most valuable outcome and contribution will be a change of attitudes and beliefs about neck pain and its prevention, diagnosis, treatment, and management."

Starting with cause, neck pain most often comes out of nowhere and does not involve trauma or a specific mechanism.  In these cases, there are multiple factors that can contribute to developing neck pain.  There are things you cannot change, such as being female, the genetic make-up you inherit from your parents (i.e. if there is a family history of neck pain), and getting older, all of which increase your risk.  However, there are things that increase your risk which are modifiable.  These include smoking, exposure to environmental tobacco, prolonged sedentary positions, repetitive work, and work that is very precision oriented.  Having degenerative changes in the neck, which are often seen on x-ray and are not modifiable with conservative measures, had no supporting evidence as a risk factor for neck pain.  This reminds us that structural changes shown on medical imaging, which are common with many painful conditions, need to be interpreted carefully and not easily scape-goated as the cause of pain.  As for protective factors for neck pain, physical activity participation had a positive influence.

If you have neck pain, how quickly you recover is also dependent on many factors.  Younger age was helpful.  In contrast, poor overall health, a history of neck pain, and poor psychological health were associated with a poorer prognosis.  With respect to the psychological aspect, worrying or becoming angry in response to neck pain, avoiding any activity that causes pain, and receiving only passive treatments were associated with a slower improvement.  Optimism, being confident in your abilities, and taking an active role in therapy, on the other hand, help you resume normal activities more quickly.

Non-surgical treatment options found to have benefit include educational videos, mobilization, manipulation, manual therapy, exercises, low-level laser therapy, and acupuncture.  Manual techniques combined with exercises are superior to hands on only approaches.

As you can see, there are many options which can be used based on appropriateness and personal preference.  Either way, due to its recurring nature, management of neck pain should involve therapies that are effective at managing your symptoms, empower you to take a role in self-management, and aim for prevention.

This article is for general information purposes only and is not to be taken as professional medical advice.

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