- Neck pain
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Neck pain [[Image: |220px|center]]
A parti-colored guinea pig suffering from Torticollis, or wry neck
ICD-10 M54.2 ICD-9 723.1 DiseasesDB 23260 MedlinePlus 003025 MeSH D019547 Neck pain (or cervicalgia) is a common problem, with two-thirds of the population having neck pain at some point in their lives.[1]
Neck pain, although felt in the neck, can be caused by numerous other spinal problems. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the nerves emanating from the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back.
The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The top three joints in the neck allow for most movement of your neck and head. The lower joints in the neck and those of the upper back create a supportive structure for your head to sit on. If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.
Neck pain may also arise from many other physical and emotional health problems.
Contents
Differential diagnosis
Neck pain may come from any of the structures in the neck including: vascular, nerve, airway, digestive, and musculature / skeletal or be referred from other areas of the body.[2]
Major and severe causes of neck pain include:
- Carotid artery dissection
- Head and neck cancer
- Referred pain from acute coronary syndrome
- Infections: retropharyngeal abscess, epiglottitis, etc.[3]
- Spondylosis - degenerative arthritis and osteophytes
- Spinal stenosis – a narrowing of the spinal canal
- Spinal disc herniation – protruding or bulging discs, or if severe prolapse.
The more common and lesser neck pain causes include:
- Stress – physical and emotional stresses
- Prolonged postures – many people fall asleep on sofas and chairs and wake with sore necks
- Minor injuries and falls – car accidents, sporting events and day to day minor injuries
- Referred pain – mostly from upper back problems
- Over-use – muscular strain is one of the most common causes
- Whiplash
- Herniated disc[4]
- Pinched nerve
Although the causes are numerous, most are easily rectified by either professional help or using self help advice and techniques.
More causes include poor sleeping posture, torticollis, head injury, rheumatoid arthritis, Carotidynia, congenital cervical rib, mononucleosis, rubella, certain cancers, ankylosing spondylitis, cervical spine fracture, esophageal trauma, subarachnoid hemorrhage, lymphadenitis, thyroid trauma, and tracheal trauma.
Treatment
Treatment of neck pain depends on the cause. For the vast majority of people, neck pain can be treated conservatively. Recommendations which may help alleviate symptoms include applying heat or cold.[5] Other common treatments could include medication, body mechanics training, ergonomic reform, or physical therapy.
Conservative treatment
Exercise plus joint mobilization and/or joint manipulation (spinal adjustment) has been found to be beneficial in both acute and chronic mechanical neck disorders.[6] Neither mobilization or manipulation without exercise however has been found to be helpful.[7][8] Mobilization is equivalent to manipulation.[9] Ultrasound has been shown not to be efficacious.
Medication
Analgesics such as acetaminophen or NSAIDs are recommended for pain.[10] Muscle relaxants such as cyclobenzaprine have not been found to be useful and are therefore not recommended.[11] Over the counter topical creams and patches containing counterirritants have little evidence to support efficacy.
Surgery
Surgery is usually not indicated for most mechanical causes of neck pain. If neck pain is the result of instability, cancer, or other disease process surgery may be necessary. Surgery is usually not indicated for "pinched nerves" or herniated discs unless there is spinal cord compression or pain and disability have been protracted for many months and refractory to conservative treatment such as physical therapy.
Prognosis
About one-half of episodes resolve within one year.[1] About 10% of cases become chronic.[1]
References
- ^ a b c Binder AI (2007). "Cervical spondylosis and neck pain". BMJ 334 (7592): 527–31. doi:10.1136/bmj.39127.608299.80. PMC 1819511. PMID 17347239. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1819511.
- ^ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. pp. 46. ISBN 1-4051-4166-2.
- ^ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. pp. 47. ISBN 1-4051-4166-2.
- ^ Dr. Kevin Yip (2009). A Guide to Common Orthopaedic Problems. Singapore, Mass: Singapore Sports and Orthopaedic Clinic. pp. 180. ISBN 1-4051-4166-2.
- ^ Garra, Gregory; Singer, Adam J. et al. (2010). "Heat or Cold Packs for Neck and Back Strain: A Randomized Controlled Trial of Efficacy". Academic Emergency Medicine 17 (5): 484–9. doi:10.1111/j.1553-2712.2010.00735.x. PMID 20536800.
- ^ "BestBets: Manipulation and/or exercise for neck pain?". http://www.bestbets.org/bets/bet.php?id=857.
- ^ Gross AR, Hoving JL, Haines TA et al. (2004). Gross, Anita. ed. "Manipulation and mobilization for mechanical neck disorders". Cochrane database of systematic reviews (Online) (1): CD004249. doi:10.1002/14651858.CD004249.pub2. PMID 14974063.
- ^ Hoving JL, Koes BW, de Vet HC et al. (2002). "Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial". Ann. Intern. Med. 136 (10): 713–22. PMID 12020139.
- ^ Gross A, Miller J, D'Sylva J et al. (2010). Gross, Anita. ed. "Manipulation or mobilisation for neck pain". Cochrane Database Syst Rev (1): CD004249. doi:10.1002/14651858.CD004249.pub3. PMID 20091561.
- ^ "UpToDate Inc.". http://www.uptodate.com/online/content/topic.do?topicKey=spinaldi/6765&selectedTitle=2~143&source=search_result#28.
- ^ Khwaja SM, Minnerop M, Singer AJ (January 2010). "Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial". CJEM 12 (1): 39–44. PMID 20078917.
External links
Pain and nociception By region/system HEENTCardiovascular systemSore throat · PleurodyniaMusculoskeletalNeurologicCongenital insensitivity to pain · HSAN (Type I, II congenital sensory neuropathy, III familial dysautonomia, IV congenital insensitivity to pain with anhidrosis, V congenital insensitivity to pain with partial anhidrosis) · Neuralgia · Pain asymbolia · Pain disorder · Paroxysmal extreme pain disorder · Allodynia · Chronic pain · Hyperalgesia · Hypoalgesia · Hyperpathia · Phantom pain · Referred painUrogenitalGastrointestinalProctalgiaUpper · LowerTests Related concepts Dorsopathies / spinal disease (M40–M54, 720–724, 737) Deforming dorsopathies OtherSpondylopathy inflammatory: Spondylitis (Ankylosing spondylitis) · Sacroiliitis · Discitis · Spondylodiscitis · Pott diseaseBack pain Intervertebral disc disorder M: JNT
anat(h/c, u, t, l)/phys
noco(arth/defr/back/soft)/cong, sysi/epon, injr
proc, drug(M01C, M4)
Categories:- Head and neck
- Pain
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