Neck Solutions

The Bone and Joint Task Force on Neck Pain and Its Associated Disorders

From: SPINE Volume 33, Number 4S, pp S5–S7

The Task Force on Neck Pain and Its Associated Disorders is an initiative of the United Nations and the World Health Organization with the purpose of informing and empowering people with neck pain or who are at risk of developing neck pain. They hope to change attitudes and beliefs about neck pain and its prevention, diagnosis, treatment, and management.

Key Findings From the Task Force

Epidemiology of Neck Pain
• Most people can expect to experience some neck pain in their lifetimes, although for the majority, neck pain will not seriously interfere with normal activities.
• Depending on the case definitions used, the 12 month prevalence of neck pain ranged from 12.1% to 71.5% in the general population, and from 27.1% to 47.8% in workers. However, neck pain with associated disability was less common: 12 month prevalence estimates ranged from 1.7% to 11.5% in the general population.
• Each year, between 11% and 14.1% of workers reported being limited in their activities because of neck pain. Neck pain was common in all occupational categories, and the results of the Ontario cohort study suggest that workerfs compensation data significantly underestimate the burden of neck pain in workers.
• The number of persons seeking health care in emergency rooms for traffic-related Whiplash associated disorders (WAD) has been increasing over the past 3 decades.

Risk Factors for Neck Pain

• Analysis of risk factors for neck pain suggest that this disorder has a multifactorial etiology. Nonmodifiable risk factors for neck pain included age, gender, and genetics. There is no evidence that common degenerative changes in the cervical spine are a risk factor for neck pain.
• Modifiable risk and protective factors for neck pain include smoking, exposure to environmental tobacco, and physical activity participation. In the workplace high quantitative job demands, low social support at work, sedentary work position, repetitive work, and precision work increased the risk of neck pain. However, there is a lack of evidence that workplace interventions were effective in reducing the incidence of neck pain in workers.
• Eliminating insurance payments for pain and suffering, and improving benefits disability costs were both associated with a lower incidence of whiplash claims and faster recovery from symptoms. Devices aimed at limiting head extension during rear-end collisions were found to have a preventive effect.

Course and Prognosis for Neck Pain

• Most people with neck pain do not experience a complete resolution of symptoms. Between 50% and 85% of those who experience neck pain at some initial point will report neck pain again 1 to 5 years later. These numbers appear to be similar in the general population, in workers and after motor vehicle crashes.
• The prognosis for neck pain also appears to be multifactorial. Younger age was associated with a better prognosis, whereas poor health and prior neck pain episodes were associated with a poorer prognosis. Poorer prognosis was also associated with poor psychological health, worrying, and becoming angry or frustrated in response to neck pain. Greater optimism, a coping style that involved self-assurance, and having less need to socialize, were all associated with better prognosis.
• Specific workplace or physical job demands were not linked with recovery from neck pain. Workers who engaged in general exercise and sporting activities were more likely to experience improvement in neck pain. Postinjury psychological distress and passive types of coping were prognostic of poorer recovery in WAD. There is evidence that compensation and legal factors are also prognostic for poorer recovery from WAD.

A new conceptual model for the course and care of neck pain.

• The model is centered on persons with neck pain or who are at risk for neck pain. The model describes neck pain as an episodic occurrence over a lifetime with variable recovery between episodes. It outlines the options available to deal with neck pain; the factors that determine available options, choices, and consequences; and the short and long term impacts of neck pain.

A New Classification System for Neck Pain: For the subset of individuals who seek clinical care, the Neck Pain Task Force recommends a 4-grade classification system of neck pain severity that is intended to help in the interpretation of scientific evidence. The new system will also help people with neck pain, researchers, clinicians, and policy makers in framing their questions and decisions:

• Grade I neck pain: No signs or symptoms suggestive of major structural pathology and no or minor interference with activities of daily living; will likely respond to minimal intervention such as reassurance and pain control; does not require intensive investigations or ongoing treatment.
• Grade II neck pain: No signs or symptoms of major structural pathology, but major interference with activities of daily living; requires pain relief and early activation/intervention aimed at preventing long-term disability.
• Grade III neck pain: No signs or symptoms of major structural pathology, but presence of neurologic signs such as decreased deep tendon reflexes, weakness, and/or sensory deficits; might require investigation and, occasionally more invasive treatments.
• Grade IV neck pain: Signs or symptoms of major structural pathology, such as fracture, myelopathy, neoplasm, or systemic disease; requires prompt investigation and treatment.

When choosing treatments to relieve grades I and II neck pain, patients and their clinicians should consider the potential side effects and personal preferences regarding treatment options.

Preventing Neck Pain

Preventive efforts are best directed at reducing major injuries and dealing effectively with neck pain to avoid the development of disabling neck pain.