Neck pain

More than a third of a billion people worldwide have mechanical neck pain of at least three months duration.

Cervical radiculopathy estimated annual incidence is approximately 83 cases per 100,000 persons in myelopathy for per hundred thousand as a result of cervical spondylosis.

Two-thirds of the population have neck pain at some point in their lives.

Annual prevalence rate ranging from 15-50%.

Prevalence rate is higher in females and peaks in middle age.

Associated with several comorbidities including headache, back pain, arthralgias, and depression.

Approximately the fourth leading cause of years lost to disability, ranking behind back pain, depression and arthralgias.

Can be caused by numerous processes.

Associated with depression, anxiety, sleep disorders, poor coping skills skills, somatization, smoking, and sedentary lifestyle.

Probably associated with obesity which may predispose patients to neck pain such as increased systemic inflammation, deleterious structural changes, increased mechanical stress, diminished muscle strength, and iaired balance compared with normal weight people.

May be due to muscular tightness in both the neck and upper back, or pressure on the nerves emanating from the cervical vertebrae.

Neck pain may represent ref2242ed pain from the shoulder girdle and vice versa.

Neck pain may come from any of the structures in the neck including: vascular, nerve, airway, digestive, and musculature / skeletal or can be ref2242ed from other areas of the body.

Differential diagnosis includes: carotid artery dissection, ref2242ed acute coronary syndrome, epiglottitis, retropharyngeal abscess, spondylosis with degenerative arthritis and osteophytes, spinal stenosis, disc herniation, stress, torticollis, head injury, rheumatoid arthritis, subarachnoid hemorrhage, carotid pain, cervical rib, mononucleosis, lymph node enlargement, esophagel trauma, thyroid disease, ankylating spondylitis, tracheal diseases and trauma, injuries, whiplash, prolonged positional changes, and muscular strain.

About one-half of episodes resolve within one year, while 10% of cases become chronic.

Can be categorized by duration: acute, that is less than six weeks, subacute three months or less, and chronic greater than three months duration.

Shorter duration of neck pain is associated with a better prognosis than long-standing pain.

Longer duration of pain is associated with a greater disease burden, with higher baseline pain scores and disability and predicts poorer outcome for spinal pain.

Can be categorized as to etiology: mechanical, neuropathic, or secondary to another cause.

Mechanical pain refers to neck pain arising from the spine or its supporting structures, such as ligaments and muscles.

Neuropathic pain refers to neck pain from injury or disease processes involving the peripheral nervous system, which usually involves mechanical or chemical irritation of nerve roots.

In patients with more severe pain following injury and those with symptoms or signs of cervical radiculopathy have a great likelihood of persistent pain

Most patients with cervical radiculopathy experience alleviation of symptoms over time.

Symptoms arising from spinal cord pathology, a myelopathy, is a form of central neuropathic pain.

Mixed neuropathic pain may occur following laminectomy where degenerated discs in combination with mechanical pain from annular disruption and radicular symptoms from a herniated nucleus pulposus can cause a pain syndrome.

Radicular symptoms from a herniated disc or osteophyte and spinal stenosis are examples of neuropathic pain.

In evaluating neck pain differentiating neuropathic from mechanical pain is an important distinction as it affects treatment decisions.

Most cases of acute pain will resolve within two months, but almost 50% of such patients will have some pain or frequent reoccurrence one year after the presentation.

Treatment of acute pain has little or no effect on its persistence.

Fact is associated with a poor prognosis in acute cervical pain include female gender, older age group, the coexistence of psychosocial pathology, and radical are symptomatology.

Patients with cervical neuropathic pain typically have symptoms ref2242ed to as shooting, electrical, stabbing, or burning.

Cervical mechanical pain patients describe their pain as throbbing or aching.

Cervical neuropathic pain from stenosis or herniated disc is nearly always characterized by radiation into one or both upper extremities, usually in a single dermatome on multi dermatome distribution.

Painful shoulder impingement may occur up to 24% of patients with cervical radiculopathy.

One in 10 patients with cervical radiculopathy have comorbid shoulder pathology.