Chronic Neck Pain: Difference between revisions

Revision as of 14:12, 27 June 2021

Chronic neck pain is defined when neck pain has persisted for more than three months. Around 20-40% of patients with acute neck pain continue on to have chronic neck pain.

Aetiology

See also: Causes and Sources of Neck Pain

Idiopathic Neck Pain

Idiopathic neck pain refers to neck pain that arose insidiously, i.e. in the absence of a specific inciting event or other explanation. Anatomically the muscles, discs, and joints of the cervical spine are all possible nociceptive generators, however there there is a lack of research into the pathophysiology of how pain might arise from these structures

Muscles

Muscle sprain as a cause of neck pain fits better in the acute setting rather than the chronic setting, as muscle injuries heal quickly. Muscle pain has been hypothesised to be a cause of chronic pain using terms such as muscle spasm, chronic muscle ischaemia, and trigger points. However there is no agreed method of diagnosis.

In chronic neck pain there is often muscle dysfunction. There is reduced activity of the deep cervical flexor muscles (longus cervicis and capitis), increased activity of the superficial flexors (sternocleidomastoid), and increased activity of the accessory neck muscles (anterior scalenes and trapezius). The reasons for this pattern is unclear but it is likely a secondary phenomenon, rather than the primary cause of pain.

Intervertebral Discs

With age there is disc dehydration and osteophytosis, however this has not been shown to be linked to pain. Without trauma, it is not clear why a disc should become painful, or if indeed it does at all.

Synovial Joints

The most likely source of nociception in chronic idiopathic neck are the synovial joints of the neck. These are the facet joints, atlanto-axial joints, and atlanto-occipital joints. However, imaging findings of osteoarthritis of the synovial joints don't correlate with pain, and so diagnosis is made with diagnostic local anaesthetic injections.

Post-traumatic Beck Pain

Main article: Chronic Post-Traumatic Neck Pain

Psychological Factors

There is no evidence to support the view that chronic neck pain, whether post-traumatic or not, is secondary to somatization, conversion disorder, malingering, hypochondriasis, or due to secondary gain. A psychosocial label is not falsifiable, i.e. it cannot be refuted, and so it a belief rather than a valid diagnosis. For many patients a biomedical diagnosis cannot be made, but the Musculoskeletal Medicine view is generally that this is due to the infancy of research in this area, rather than the primary cause being nebulous psychosocial factors.

@@ Line 2: / Line 2: @@
 ==Aetiology==
+{{See also|Causes and Sources of Neck Pain}}
+=== Idiopathic Neck Pain ===
+Idiopathic neck pain refers to neck pain that arose insidiously, i.e. in the absence of a specific inciting event or other explanation. Anatomically the muscles, discs, and joints of the cervical spine are all possible nociceptive generators, however there there is a lack of research into the pathophysiology of how pain might arise from these structures
+'''Muscles'''
+Muscle sprain as a cause of neck pain fits better in the acute setting rather than the chronic setting, as muscle injuries heal quickly. Muscle pain has been hypothesised to be a cause of chronic pain using terms such as muscle spasm, chronic muscle ischaemia, and trigger points. However there is no agreed method of diagnosis.
+In chronic neck pain there is often muscle dysfunction. There is reduced activity of the deep cervical flexor muscles (longus cervicis and capitis), increased activity of the superficial flexors (sternocleidomastoid), and increased activity of the accessory neck muscles (anterior scalenes and trapezius). The reasons for this pattern is unclear but it is likely a secondary phenomenon, rather than the primary cause of pain.
+'''Intervertebral Discs'''
+With age there is disc dehydration and osteophytosis, however this has not been shown to be linked to pain. Without trauma, it is not clear why a disc should become painful, or if indeed it does at all.
+'''Synovial Joints'''
+The most likely source of nociception in chronic idiopathic neck are the synovial joints of the neck. These are the facet joints, atlanto-axial joints, and atlanto-occipital joints. However, imaging findings of osteoarthritis of the synovial joints don't correlate with pain, and so diagnosis is made with diagnostic local anaesthetic injections.
+=== Post-traumatic Beck Pain ===
+{{Main|Chronic Post-Traumatic Neck Pain}}
+=== Psychological Factors ===
 There is no evidence to support the view that chronic neck pain, whether post-traumatic or not, is secondary to somatization, conversion disorder, malingering, hypochondriasis, or due to secondary gain. A psychosocial label is not [https://en.wikipedia.org/wiki/Falsifiability falsifiable], i.e. it cannot be refuted, and so it a belief rather than a valid diagnosis. For many patients a biomedical diagnosis cannot be made, but the Musculoskeletal Medicine view is generally that this is due to the infancy of research in this area, rather than the ''primary'' cause being nebulous psychosocial factors.
 [[Category:Cervical Spine]]