Impact of Neck and Arm Pain
Impact of Neck and Arm Pain on Overall Health Status
From: Spine 28(17):2030-2035, 2003.
Degenerative conditions of the cervical spine can cause debilitating symptoms of neck and/or arm pain. The lifetime prevalence of neck pain has been estimated to be nearly 67%, with a point prevalence of 22%. Although the financial and social impacts of low back pain have received emphasis, the disability caused by neck and arm pain may also impose a substantial financial burden and a major impact on the lives of those affected. Few studies, however, have examined the impact of neck and/or arm pain on the overall functional and health status of patients. Disability associated with neck and arm pain may extend beyond the patient’s obvious symptoms to affect overall health status. The degree to which overall health is impacted may be an important factor in determining which patients may benefit from more intensive nonoperative and operative treatment.
Results: Patients who presented with both axial and radicular symptoms had the lowest SF-36 scores relative to age and gender norms. These scores were significantly lower than those for patients with only axial or only radicular symptoms across all eight subscales. Scores for patients with only axial pain were significantly lower than for patients with only radicular pain. Patients younger than 40 and those between ages 40 to 60 years were significantly more impacted by their symptoms than patients older than 60 years for all eight scales. PCS scores were similar for acute, subacute, and chronic groups, whereas MCS scores were significantly worse for patients with chronic pain.
Conclusions: Combined neck and arm pain were much more disabling than either symptom alone. Younger patients (younger than 40 or 40-60) were more affected by these symptoms than patients older than 60 years. In addition, as symptom duration increased, a negative impact on mental health was observed, although chronic symptoms did not affect physical health. This study suggests that patients with a significant component of axial pain in conjunction with cervical radiculopathy should be considered the most affected of all patients with cervical spondylosis. Given the evidence that the treatment methods at the disposal of physicians are effective, this study suggests that prompt treatment of these patients may help avoid the harmful effects of chronic symptoms on mental functioning, especially among younger patients who were found to be more impacted by the symptoms.
We compared the differences in the impact of axial (neck) pain alone, radicular (arm) pain alone, and combined axial and radicular pain on overall health status and stratified the data on the basis of patient age and symptom chronicity to determine the differential impact of these symptoms on physical and mental health status in different population groups.
The present study had three important findings. First, patients with combined axial and radicular symptoms had significantly lower SF-36 scores than those patients with either isolated axial or radicular pain. Secondly, patients of working age (i.e., younger than 60) were significantly more impacted by their symptoms than older patients across all eight subscales. Finally, we demonstrated that longer symptom duration was associated with a negative impact on mental health status.
There are a number of reasons why combined axial and radicular symptoms may have had a significantly greater impact on health status. These symptoms usually represent a combination of axial pain with neck motion and neurologic symptoms in the extremities (shooting pains, numbness, weakness, paresthesias). Axial pain alone is more common than radicular pain in the population at a low level of intensity and frequently responds to medications and minor modifications in activity. As a result, many patients are able to adapt to low-intensity symptoms. The addition of radicular symptoms may be associated with a greater degree of axial pain and may be more difficult to assimilate than for patients reporting neck pain alone. Surprisingly, in this study, patients with purely radicular symptoms were the least impaired by their symptoms. It is possible that some patients presenting with radiculopathy alone may have had a nonspinal problem, such as carpal tunnel syndrome, tennis elbow, or a peripheral neuropathy, and may have been less impaired by these symptoms than patients with cervical radiculopathy. In addition, the overall number of patients with arm pain alone was smaller than the other groups, making it more difficult to draw conclusions from the data.
Younger patients are generally healthier and more active; symptoms that impair activities have a much greater impact on a younger, healthier population who are more likely to care for children and/or have a job. In addition, younger patients have greater expectations of their physical capabilities than older individuals. It should be noted that age-gender norms are much lower for older patients, because the elderly have a variety of other medical problems that lower their overall health status. Treating younger patients more expeditiously may therefore be better than waiting for the benign natural history of these spinal disorders to take their course, especially among younger patients with neck and arm pain.
The results of this study suggest that patients with arm pain and neck pain may be the best candidates for more aggressive treatment, because their symptoms have the greatest negative impact on overall health status.
Cervical disc disease is most disabling when it is associated with axial (neck) and radicular (arm) pain. Among all age groups, younger patients were significantly more affected than older patients, relative to age-matched controls.
Chronic neck and arm pain symptoms lasting more than 6 months had a negative impact on overall mental health, which was significantly greater than for patients with symptom duration of less than 6 months.
Based on the results of this study, we believe the best candidates for aggressive nonoperative or operative treatment of symptomatic cervical spondylosis are younger patients with a significant component of neck and arm pain. Although the benign natural history of symptomatic cervical spondylosis (when not associated with myelopathy) would argue against early surgical intervention, the results of this study also suggest that patients with neck and arm pain should be treated relatively expeditiously to avoid the further negative impact on mental health status observed among patients with symptom duration of more than 6 months.
Key Points for Impact of Neck and Arm Pain
- Patients with combined axial and radicular symptoms have lower overall health status than those with either axial or radicular symptoms alone.
- Younger patients are more impacted by neck and arm pain than are older patients.
- As duration of symptoms increases, mental health status is affected, but physical health status remains unchanged.
- Data from the National Spinal Network database were analyzed comparing the relative impact of radicular and axial symptoms associated with disease of the cervical spine on general health as measured by the SF-36 Health Survey. Patients with combined axial and radicular symptoms had the lowest SF-36 scores; younger patients and those with more acute duration of symptoms were also more affected.
