Neck pain
Other names	Cervicalgia
Illustration of a person with neck pain
Specialty	Neurosurgery

Neck pain, also known ascervicalgia, is a common problem, with two-thirds of the population having neckpain at some point in their lives.^[1]

Because there is not a universally accepted classification for neck pain, it is difficult to study the different types of pain. In 2020, neck pain was the second most common cause of disability in the United States and cost $100 billion in health care spending.^[2]

Nightlyrotator cuff impingement may lead to an asymptomatic shoulder impingement, leading to neck pain.^[3] Neck pain can be caused by other spinal problems, and may arise from muscular tightness in both the neck and upper back, or pinching of the nerves emanating from thecervical vertebrae.^[4]

The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain.^[5] If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.

As of 2020^[update], neck pain affected about 203 million people globally, with females having higher prevalence.^[6]

Neck pain may come from any of the structures in the neck including:vascular,nerve,airway, digestive, and musculature / skeletal, or be referred from other areas of the body.^[7]

Common and lesser neck pain causes include:

• Stress – physical and emotional stresses
• Prolongedpostures – many people fall asleep on sofas and chairs and wake up with sore necks.
• Minor injuries and falls – car accidents, sporting events, and day to day injuries that are really minor.
• Referred pain – mostly from upper back problems
• Over-use – muscular strain is one of the most common causes
• Whiplash
• Pinched nerve

Major and severe causes of neck pain (roughly in order of severity) include:

• Carotid artery dissection
• Referred pain fromacute coronary syndrome
• Head and neck cancer
• Infections, including:
  • Meningitis of several types including sudden onset of severe neck or back pain particularly in teens and young adults which may be fatal if not treated quickly
  • Retropharyngeal abscess
  • Epiglottitis^[7]
• Spinal disc herniation – protruding or bulgingdiscs, or if severeprolapse.
• Spondylosis –degenerative arthritis andosteophytes
• Spinal stenosis – a narrowing of thespinal canal

Although the causes are numerous, most are easily rectified by either professional help or usingself help advice and techniques.

More causes can include: poor sleeping posture,torticollis,head injury,motor vehicle accidents,rheumatoid arthritis,Carotidynia, congenitalcervical rib,mononucleosis,rubella, certain cancers,ankylosing spondylitis, cervical spine fracture, esophageal trauma,subarachnoid hemorrhage,lymphadenitis,thyroid trauma, andtracheal trauma.^[8]

Treatment of neck pain depends on the cause. For the vast majority of people, neck pain can be treated conservatively.^[9]

Recommendations in which it helps alleviate symptoms include applying heat or cold.^[10] Other common treatments could include medication, body mechanics training,ergonomic reform, andphysical therapy. Treatments may also include patient education, but existing evidence shows a lack of effectiveness.^[11]

Analgesics such as acetaminophen orNSAIDs are generally recommended for pain.^[12] A 2017systemic review, however found that paracetamol was not efficacious and thatNSAIDs provide a marginal improvement compared to placebo, but not enough to beclinically significant. The study found thenumber needed to treat (NNT) for NSAIDs in patients with spinal pain was 6, meaning you would need to give 6 separate patients the medication for 1 to feel a clinically significant positive effect. The authors of this review cite the side effect profile ofNSAIDs when compared to placebo as another reason that more research and better drugs are needed.^[13]

Muscle relaxants may also be recommended.^[12] However, one study showed that one muscle relaxant calledcyclobenzaprine was not effective for treatment of acute cervical strain (as opposed to neck pain from other etiologies or chronic neck pain).^[14]

Surgery is usually not indicated for mechanical causes of neck pain. If neck pain is the result of instability, cancer, or other disease, surgery may be necessary.^[15][16] Surgery is usually not indicated for "pinched nerves" orherniated discs unless there isspinal cord compression or pain and disability have been protracted for many months and refractory to conservative treatment such asphysical therapy.^[17]

Exercise plusjoint manipulation has been found to be beneficial in both acute and chronic mechanical neck disorders.^[18] In particular, specific strengthening exercise may improve function and pain.^[19] Motor control using cranio-cervical flexion exercises has been shown to be effective for non-specific chronic neck pain.^[20] Both cervical manipulation and cervical mobilization produce similar immediate-, and short-term changes.^[21] Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate to long-term follow-up.^[21] Thoracic manipulation may also improve pain and function.^[21][22]

Low-level laser therapy has been shown to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients that experience chronic neck pain.^[23] Low quality evidence suggests thatcognitive-behavioural therapy may be effective at reducing pain in the short-term.^[24] Massaging the area may provide immediate and short-lived benefits, but long term effects are unknown.^[25] There is a lack of high-quality evidence to support the use of mechanicaltraction, and side effects include headaches, nausea and injury to tissue.^[26] Radiofrequency denervation may provide temporary relief for specific affected areas in the neck.^[27]Transcutaneous electrical nerve stimulation (TENS), the noninvasive use of electrical stimulation on the skin, is of unclear benefit in chronic neck pain.^[28]

Neck pain affects about 330 million people globally as of 2010 (4.9% of the population).^[29] It is more common in women (5.7%) than men (3.9%).^[29]It is less common thanlow back pain.^[30]

About one-half of episodes resolve within one year, and approximately 10% become chronic.^[1]

Prevalence of neck pain in the population suggests it is a common condition.^[1][29] For cervicalgia associated with bad posture the treatment is usually corrective in nature (i.e. ensure shoulders are in one line above the hips) and relating to interventions that provideergonomic improvement.^[31]There is also growing research in how neck pain caused by mobile devices (seeiHunch) can be prevented using embedded warning systems.^[32][33]

• "6 Ways to Ease Neck Pain" atHarvard Medical School
• "Neck pain-Symptoms and causes" atMayo Clinic

• Human head and neck
• Pain

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