Patient Information

• NHS Inform - Neck problems self-management-advice
• NHS Inform - Exercises for neck problems
• Managing your neck pain - The Chartered Society of Physiotherapy
• NHS Lothian MSK Self Help Resources Webpage

Definition

Non-specific neck pain is pain or discomfort in the neck and/or shoulder girdle, with or without associated spine related arm symptoms, which is generally non-dermatomal in distribution. In most cases, no specific cause can be found.  

Cervical spondlyosis is a specific term for osteoarthritis of the spine. When causing neck pain, it is managed in the same way as non-specific neck pain.

Typical signs and symptoms

• Pain that is aggravated by movements and activities
• Pain that radiates in a non-dermatomal distribution down the arm, up into the head, into the shoulder or scapula
• Pain associated with paraesthesia or hyperaesthesia, but with no objective loss of sensation or muscle strength

It is common for patients with neck pain to suffer headaches, often referred as occipital pain, and cluster or tension headaches. Any concerning pattern of headaches, consider differential diagnosis.

Incidence and prevalence:

• The estimated lifetime prevalence of a significant episode of neck pain is 40-70%
• In the 2010 Global Burden of Disease Study, neck pain ranked fourth highest for the number of years lived with disability
• Between 33-65% of people recover from an episode of neck pain within one year, but relapses are common
• Neck pain increases from 18-30 years of age through to middle age (50-55 years). In some studies, there is a decrease after 50-55 years of age, whereas other studies report no change or a slight increase.

Risk factors for non-specific neck pain may include:

• Female gender
• History of low back or neck disorders
• Work related factors
  • Low job satisfaction and poorly perceived work support are the major factors
  • May also include office workers and manual labourers; repetitive or precision work
• Sleep problems, sedentary lifestyle
• Obesity, smoking
• Poor general health
• Stress

Prognosis

Most cases of acute neck pain resolve within 2 months. However around half of people continue to have low grade symptoms or recurrences for more than a year. Up to 20% of acute neck pain will go on to become chronic neck pain.

Risk factors for poor outcome

• Female gender, older age
• High baseline pain intensity
• Multiple pain sites
• Poor general health
• Obesity, smoking
• Psychological factors (for example, anxiety, depression, worry).

Other considerations

• Degenerative changes are commonly seen on cervical imaging, and there is little evidence that they are associated with neck pain
• MRI studies show nearly 100% of adults aged >40 years have severe degeneration of at least one cervical level

Differential diagnosis

The differential diagnosis of neck pain is broad but includes trauma and non-musculoskeletal disease processes that can be classified as neoplastic, inflammatory, infectious, vascular, endocrinological or neurological. Refer to relevant section of the pathway for more information