The epidemiology of neck pain: what we have learned from our population-based studies
From: JCCA 2003; 47(4):284–290
Background: There are few population-based studies on the epidemiology of neck pain in the general population. Since the mid 1980’s, we have witnessed a slow, but constant
increase in the amount of attention paid to the problem of neck pain in the general population. The growing interest in neck pain is mainly linked to the escalating disability burden and compensation costs associated with neck pain related to automobile collisions and occupational injuries. As a result, epidemiologists started to investigate the magnitude, causes and prognosis of neck pain in the population.
Purpose: To synthesize the findings of two large population-based studies of the epidemiology of neck pain and whiplash.
Study Design and Methods: We conducted two population-based cohort studies of neck pain and its related disability. First, the Saskatchewan Health and Back Pain Survey was designed to determine the prevalence and factors associated with neck pain in randomly selected adults. Second, we conducted a cohort study of the incidence and prognosis of whiplash and studied whether a change in the insurance system from tort to no-fault was related to a reduction in the number of whiplash claims and faster recovery.
Results: In 1995, the six-month prevalence of neck pain was 54.2% and 4.6% of adults experienced disabling neck pain in the previous six-months. Neck pain was associated with education, comorbidities, smoking, self-reported general health and a history of neck injury in a motor vehicle collision. The incidence of treated and/or compensated whiplash injury was reestimated at 834/100,000 adults in 1994, and dropped by 28% to 98/100,000 adults in 1995, after tort reform. Compared to tort, the median time-to-recovery was more than 230 days faster under no-fault. The strongest predictors of recovery were age, gender, education, injury severity, lawyer involvement and type of initial care provider.
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Age-Related Prevalence of Facet-Joint Involvement in Chronic Neck and Low Back Pain
From: Pain Physician 2008; 11:1:67-75
Background: Spinal pain is common in all age groups. While the research has focused primarily on incidence and prevalence in younger working adults, there is evidence that spinal pain is one of the most frequent complaints in older persons and is
responsible for functional limitations. While facet arthrosis is a common radiographic finding, which has been suggested to be a potential cause of spinal pain, nearly 10% of all adults show signs of degeneration by the time they reach age 30. Radiographic
changes of osteoarthritis have been shown to be equally common in patients with and without low back or neck pain. The studies of low back pain have shown the prevalence of facet joint involvement to be approximately 15% to 45%. However, age related prevalence of facet joint neck pain has not been studied.
Objective: To assess age-related prevalence and false-positive rates of facet joint involvement in chronic spinal pain using controlled comparative local anesthetic blocks.
Design: Retrospective analysis of 424 patients, divided into 6 groups based upon age (Group I: aged 18 – 30 years, Group II: aged 31 – 40 years, Group III: aged 41 – 50 years, Group IV: aged 51 – 60, Group V: 61 – 70 years, and Group VI: greater than 70 years of age).
Results: The prevalence of cervical facet joint-related pain was the lowest (33%) in Group VI and highest (42%) in Group I. False-positive rates for cervical facet joint blocks ranged from 39% (Group III) to 58% (Group V) with an overall false-positive rate of 45%. The prevalence of facet joint involvement in lumbar spinal pain ranged from 18% (in Group II) to 44% (in Group IV), with significant differences noted when Group II and Group III were compared to other groups and with higher rates in Group V.
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Canadian Medical Association Journal 2001;164(8):1182-7
Neck pain is a common problem in ambulatory medical practice. Slightly more than 50% of adults experience neck pain at some time. In daily practice, it is useful and practical to deal with every patient with neck pain using an organized approach. I have found that thinking through the following series of points is helpful in organizing the management of patients with neck pain. In most cases of neck pain, no clear-cut underlying definable pathology can be identified. These patients should be managed conservatively, with the aim of preventing disability and controlling symptoms. In a minority of cases, pain can be the result of varied pathology. It is important to identify the pathology early so that these patients can be managed properly without undue consequence.
Cervical problems can be divided into 2 main groups: those arising mainly from the joints and associated ligaments and muscles of the neck and those involving the cervical nerve roots or the spinal cord.
The pathologic causes of these problems are
- injury or degeneration affecting muscles or ligaments, soft-tissue strain (the term cervical spondylosis is commonly used for these conditions)
- inflammation, for example, rheumatoid arthritis, ankylosing spondylitis
- infection, for example, discitis, epidural abscess, meningitis
- infiltration, for example, metastatic carcinoma, osteoid osteoma, spinal cord tumours
Group 1: Cervical problems arising mainly from neck joints and associated ligaments and muscles:
- Patients complain of pain and stiffness
- Pain is a deep, dull aching sensation and often episodic
- Patients have a history of excessive or unaccustomed activity or of sustaining an awkward posture
- There is no history of specific injury
- Ligament and muscle pain are localized and asymmetric
- Pain from upper cervical segments is referred toward the head; pain from lower segments, to the upper limb girdle
- Symptoms are aggravated by neck movement and relieved by rest
Group 2: Cervical problems involving the cervical nerve roots or the spinal cord
- Patients complain of significant root pain
- Pain is sharp and intense and is often described as a burning sensation
- Pain may radiate to the trapezial and periscapular areas or down the arm
- Patients complain of numbness and motor weakness in a myotomal distribution
- Headache may occur if the upper cervical roots are involved
- Symptoms often become more severe with neck hyperextension
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From: BMJ 10 march 2007; Volume 334; 527-531
Most patients who present with neck pain have non specific (simple) neck pain, with a postural or mechanical basis. Causative factors are poorly understood and are usually multifactorial, including poor posture, anxiety, depression, neck strain, and sporting or occupational activities. Neck pain after whiplash injury also fits into this category, provided no bony injury or neurological deficit is present. When mechanical factors are prominent, the condition is often referred to as “cervical spondylosis,” although the term is often applied to all non-specific neck pain. Mechanical and degenerative factors are more likely to be present in chronic neck pain.
In cervical spondylosis, degenerative changes start in the intervertebral discs with osteophyte formation and involvement of adjacent soft tissue structures. Many people over 30 show similar abnormalities on plain radiographs of the cervical spine, however, so the boundary between normal ageing and disease is difficult to define. Even severe degenerative changes are often asymptomatic, but can lead to neck pain, stiffness, or neurological complications.
Plain radiographs of the cervical spine may show a loss of normal cervical lordosis, suggesting muscle spasm, but most other features of degenerative disease are found in asymptomatic people and correlate poorly with clinical symptoms. Magnetic resonance imaging of the cervical spine is the investigation of choice if more serious pathology is suspected, as it gives detailed information about the spinal cord, bones, discs, and soft tissue structures.
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Structural, Psychological, and Genetic Influences on Low Back and Neck Pain: A Study of Adult Female Twins
From: Arthritis & Rheumatism (Arthritis Care & Research) Vol. 51, No. 2, April 15, 2004, pp 160–167
Genetic factors have an important influence on back and neck pain reporting in women. These factors include the genetic determinants of structural disc degeneration and an individual’s inherited tendency toward psychological distress. MRI changes are the strongest predictor of low back pain.
Objective. To assess genetic and environmental influences on low back and neck pain in a classic twin design and to examine the extent to which these are explained by structural changes seen on magnetic resonance imaging (MRI) and psychological and lifestyle variables.
The emphasis of studies of the epidemiology of back pain to date has been on occupational and environmental factors. In general, these have confirmed modest effects of weight, height, smoking, and occupation, and psychological factors similar to those seen in this study. Psychological factors and previous pain experience also emerge as the most important in longitudinal studies that have examined risk factors for new episodes of pain. By contrast, data on genetic risk factors for pain are limited.
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Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain
From: Ann Intern Med. 2002;136:713-722.
Background: Neck pain is a common problem in the general population, with point prevalences between 10% and 15%. It is most common at approximately 50 years of age and is more common in women than in men. Neck pain can be severely disabling and costly, and little is known about its clinical course. Limited range of motion and a subjective feeling of stiffness may accompany neck pain, which is often precipitated or aggravated by neck movements or sustained neck postures. Headache, brachialgia, dizziness, and other signs and symptoms may also be present in combination with neck pain. Although history taking and diagnostic examination can suggest a potential cause, in most cases the pathologic basis for neck pain is unclear and the pain is labeled nonspecific.
Objective: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. Conservative treatment methods that are frequently used in general practice include analgesics, rest, or referral to a physical therapist or manual therapist. Physical therapy may include passive treatment, such as massage, interferential current, or heat applications, and active treatment, such as exercise therapies. Physical therapists can specialize in passive manual or hands on techniques, including mobilization or manipulation (high-velocity thrust techniques), also referred to as manual therapy. According to the International Federation of Orthopedic Manipulative Therapies, “Orthopedic manipulative (manual) therapy is a specialization within physical therapy and provides comprehensive conservative management for pain and other symptoms of neuro-musculo-articular dysfunction in the spine and extremities”. (more…)
The effects of neck pain, posture and balance on whiplash patients with chronic neck pain.
From: Postural control deficit in acute QTF grade II whiplash injuries. Gait Posture, 2007 Dec 14.
STUDY DESIGN: Experimental in vivo study.
OBJECTIVE: The objective was to investigate the balance control in patients with acute QTF grade II whiplash injuries of the cervical spine.
SUMMARY OF BACKGROUND DATA: Posture measurement in chronic pain patients after whiplash injuries of the neck has revealed an impaired regulation of balance. However, so far it is unclear if this is caused by the accident or other factors that are associated with the pain chronification process.
METHODS: 40 patients with acute QTF grade II whiplash injuries and 40 healthy matched controls were examined on a posturography platform. The stability index ST(Sigma) and the Fourier analysis FA(Sigma) (0.10-1.00Hz) were established for eight standing positions and sum scores were calculated. The pain index was established using a visual analog scale ranging from 0 to 100. A follow-up examination was conducted for the patients after 2 months.
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