Non-specific neck pain +/- referred arm pain

Non specific neck pain (NSNP) is considered to be pain, tension, soreness and/or stiffness in the cervical region with no identifiable cause. It is evoked by noxious stimulation of structures in the cervical spine (Bogduk, 2009).

Cause

In most cases there is no identifiable disease or abnormal anatomical structure (Tsakitzidis et al, 2013).  A number of occupations have been suggested to increase the risk of developing neck pain, including the use of computers in the workplace, static postures or repetitive tasks.

Prevalence

Neck pain is a common musculoskeletal disorder thought to be almost as prevalent as low back pain (Coté et al, 1998). Coté et al (2004) reported 54% of adults suffer from neck pain during any 6 month period, with 4.6% experiencing difficulty with normal daily tasks.

Neck pain has been noted to increase until the age of 65 (Borghouts et al, 1999; Leclerc et al, 1999). However Croft et al (2001) found the greatest incidence of neck pain occurred between the ages of 30 and 45.

Previous neck trauma and a history of low back pain are also prevalent in people complaining of neck pain.

Presentation

Pain or stiffness in the posterior neck region with or without radiation to the occiput, shoulder or scapular region.

Headache is also a common feature.

Studies have shown no correlation between findings of degenerative changes on X-ray, subjective complaints and objective findings in patients with neck pain (Van der Donk et al, 1991; Marchiori & Henderson, 1996; Ylinen et al, 2003; Vas et al, 2006; Hogg-Johnson et al, 2008).

Consider supported self management and conservative treatment.

Progressing as expected (up to 3 Rxs) before discharge or onward referral.

Consider general progression and escalation advice.

Onward referral is not usually considered necessary for NSNP. Most will improve in 4 weeks.

VAN DER DONK, J., SCHOUTEN, J.S., PASSCHIER, J., VAN ROMUNDE, L.K. and VALKENBURG, H.A., 1991. The associations of neck pain with radiological abnormalities of the cervical spine and personality traits in a general population. The Journal of rheumatology, 18(12), pp. 1884-1889. (Link here- link correct as at 12/11/2021)

BOGDUK, N., 2009. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain, 147(1-3), pp. 17-19 (Link here - link correct as at 12/8/21)

BORGHOUTS, J.A., KOES, B.W., VONDELING, H. and BOUTER, L.M., 1999. Cost-of-illness of neck pain in The Netherlands in 1996. Pain, 80(3), pp. 629-636. (Link here - link correct as at 12/8/21)

COTE, P., CASSIDY, J.D. and CARROLL, L., 1998. The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine, 23(15), pp. 1689-1698. (Link here - link correct as at 12/8/21)

COTE, P., CASSIDY, J.D., CARROLL, L.J. and KRISTMAN, V., 2004. The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain, 112(3), pp. 267-273. (Link here - link correct as at 12/8/21)

HOGG-JOHNSON, S., VAN DER VELDE, G., CARROLL, L.J., HOLM, L.W., CASSIDY, J.D., GUZMAN, J., COTE, P., HALDEMAN, S., AMMENDOLIA, C., CARRAGEE, E., HURWITZ, E., NORDIN, M., PELOSO, P. and BONE AND JOINT DECADE 2000-2010 TASK FORCE ON NECK PAIN AND ITS ASSOCIATED DISORDERS, 2008. The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine, 33(4 Suppl), pp. S39-51. (Link here - link correct as at 12/8/21)

MARCHIORI, D.M. and HENDERSON, C.N., 1996. A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability. Spine, 21(23), pp. 2747-2751. (Link here - link correct as at 12/8/21)

TSAKITZIDIS, G., 2013. Non-specific neck pain and evidence-based practice. European Scientific Journal, Vol. 9,(3), pp. 1-19. (Link here - link correct as at 12/8/21)

VAS, J., PEREA-MILLA, E., MENDEZ, C., SANCHEZ NAVARRO, C., LEON RUBIO, J.M., BRIOSO, M. and GARCIA OBRERO, I., 2006. Efficacy and safety of acupuncture for chronic uncomplicated neck pain: a randomised controlled study. Pain, 126(1-3), pp. 245-255. (Link here - link correct as at 12/8/21)

YLINEN, J., TAKALA, E.P., NYKANEN, M., HAKKINEN, A., MALKIA, E., POHJOLAINEN, T., KARPPI, S.L., KAUTIAINEN, H. and AIRAKSINEN, O., 2003. Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. Jama, 289(19), pp. 2509-2516. (Link here - link correct as at 12/8/21)