Neck pain is defined as pain in the region of the occipital area
up to the first thoracic vertebra. When pain is indicated outside
this region, it is called neck pain with irradiation, for example,
to the head (cervicogenic headache) or upper
arm (whether or not radicular).
A distinction is made between trauma-related neck pain (Whiplash Associated Disorders) and neck pain due to cervical degenerative disorders. However, this distinction has no aetiological base. Since the aetiology is frequently unknown, a distinction is made based on reason and the anatomical source of the neck pain.
Innervated structures in the neck are a potential source of pain, such as the vertebrae, intervertebral discs, facet joints, uncovertebral joint, ligaments and muscles.
Signs and symptoms
The most frequent complaint is pain originating from the facet joints and is usually located unilaterally with no irradiation to the shoulder. The pain is provoked by static load conditions. With painful and restricted motion, rotation and backward flexion is indicated.
Besides neurological active and passive motion, examination (rotations, forward and backward flexion) is indicated. Segmental examination of the cervical spine can trace the painful segment.
Additional Somatic Diagnostics
When necessary, a cervical X-ray (two or three views) can be made to exclude osseous tumours or fractures.
When the pain has a neurological aetiology, MRI or CT scans should be performed. In daily practice, cervical test discography is of no use. It can provide information about the source of the pain, but has no therapeutic consequences for the patient.
Additional Psycho-cognitive Diagnostics
- RAND-36 (quality of life)
- VAS-Pain (maximal, minimal, actual, average/week)
- PCS (catastrophising)
- HADS (fear and depression)
Whether or not somatic treatment is indicated is based on the pain diagnosis. Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.
- Psychological Treatment
- Depression Treatment
- Cognitive-Behavioural Treatment
- Rehabilitation Treatment
- Non-steroid Anti-inflammatories (short period)
- Manual/Musculoskeletal Medicine (only segmental mobilisation)
Interventional Pain Treatments