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					Neck pain
From Wikipedia, the free encyclopedia

"Pain in the neck" redirects here. For the idiomatic expression, see wikt:pain in the neck.
Neck pain (or cervicalgia) is a common problem, with two-thirds of the population having neck pain at
some point in their lives.[1]

Neck pain, although felt in the neck, can be caused by numerous other spinal problems. Neck pain may
arise due to muscular tightness in both the neck and upper back, or pinching of the nerves emanating from
the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back.
The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck
pain. The top three joints in the neck allow for most movement of the neck and head. The lower joints in
the neck and those of the upper back create a supportive structure for the head to sit on. If this support
system is affected adversely, then the muscles in the area will tighten, leading to neck pain.


Contents
        1 Differential diagnosis
        2 Treatment
             o 2.1 Conservative treatment
             o 2.2 Medication
             o 2.3 Surgery
        3 Epidemiology
        4 Prognosis
        5 References


Differential diagnosis
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.[2]
Major and severe causes of neck pain (roughly in order of severity) include:
     Carotid artery dissection
     Referred pain from acute coronary syndrome
     Head and neck cancer
     Infections: retropharyngeal abscess, epiglottitis, etc.[3]
     Spinal disc herniation – protruding or bulging discs, or if severe prolapse.
     Spondylosis - degenerative arthritis and osteophytes
     Spinal stenosis – a narrowing of the spinal canal
The more common and lesser neck pain causes include:
     Stress – physical and emotional stresses
     Prolonged postures – 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
     Herniated disc[4]
     Pinched nerve

Although the causes are numerous, most are easily rectified by either professional help or using self help
advice and techniques.
More causes include poor sleeping posture, torticollis, head injury, rheumatoid arthritis, Carotidynia,
congenital cervical rib, mononucleosis, rubella, certain cancers, ankylosing spondylitis, cervical spine
fracture, esophageal trauma, subarachnoid hemorrhage, lymphadenitis, thyroid trauma, and tracheal trauma.


Treatment
Treatment of neck pain depends on the cause. For the vast majority of people, neck pain can be treated
conservatively. Recommendations which help alleviate symptoms include applying heat or cold.[5] Other
common treatments could include medication, body mechanics training, ergonomic reform, or physical
therapy.


Conservative treatment
Exercise plus joint mobilization and/or joint manipulation (spinal adjustment) has been found to be
beneficial in both acute and chronic mechanical neck disorders.[6] Both cervical manipulation and cervical
mobilisation produce similar immediate-, and short-term changes; no long-term data are available. [7]
Thoracic manipulation may also improve pain and function.[7][8] 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 with chronic neck pain.[9]


Medication
Analgesics such as acetaminophen or NSAIDs are recommended for pain.[10] Muscle relaxants are often
prescribed and are known to be effective. However, one study showed that one muscle relaxant called
cyclobenzaprine was not effective for treatment of acute cervical strain (as opposed to neck pain from other
etiologies or chronic neck pain).[11] Over the counter topical creams and patches may be effective for some
patients.


Surgery
Surgery is usually not indicated for mechanical causes of neck pain. If neck pain is the result of instability,
cancer, or other disease process surgery may be necessary. Surgery is usually not indicated for "pinched
nerves" or herniated discs unless there is spinal cord compression or pain and disability have been
protracted for many months and refractory to conservative treatment such as physical therapy.


Epidemiology
Neck pain affects about 330 million people globally as of 2010 (4.9% of the population).[12] It is more
common in women (5.7%) than men (3.9%).[12] It is less common than low back pain.[13]


Prognosis
About one-half of episodes resolve within one year.[1] About 10% of cases become chronic.[1]


References
    1.   ^ Jump up to: a b c Binder AI (2007). "Cervical spondylosis and neck pain". BMJ 334 (7592): 527–
         31. doi:10.1136/bmj.39127.608299.80. PMC 1819511. PMID 17347239.
    2.   Jump up ^ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael;
         Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey
         (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass:
         Blackwell Pub./BMJ Books. p. 46. ISBN 1-4051-4166-2.
    3.   Jump up ^ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael;
         Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey
          (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass:
          Blackwell Pub./BMJ Books. p. 47. ISBN 1-4051-4166-2.
    4.    Jump up ^ Dr. Kevin Yip (2009). A Guide to Common Orthopaedic Problems. Singapore, Mass:
          Singapore Sports and Orthopaedic Clinic. p. 180. ISBN 1-4051-4166-2.
    5.    Jump up ^ Garra, Gregory; Singer, Adam J. et al. (2010). "Heat or Cold Packs for Neck and Back
          Strain: A Randomized Controlled Trial of Efficacy". Academic Emergency Medicine 17 (5): 484–
          9. doi:10.1111/j.1553-2712.2010.00735.x. PMID 20536800.
    6.    Jump up ^ "BestBets: Manipulation and/or exercise for neck pain?".
    7.    ^ Jump up to: a b Gross AR (2010). "Manipulation or mobilisation for neck pain". Cochrane
          database of systematic reviews (Online) (1): CD004249. doi:10.1002/14651858.CD004249.pub3.
          PMID 20091561.
    8.    Jump up ^ Huisman PA, Speksnijder CM, de Wijer A (January 2013). "The effect of thoracic
          spine manipulation on pain and disability in patients with non-specific neck pain: a systematic
          review.". Disabil Rehabil. doi:10.3109/09638288.2012.750689. PMID 23339721.
    9.    Jump up ^ Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM (2009). "Efficacy of low-level
          laser therapy in the management of neck pain: a systematic review and meta-analysis of
          randomised placebo or active-treatment controlled trials". Lancet 374 (9705): 1897–1908.
          doi:10.1016/S0140-6736(09)61522-1. PMID 19913903.
    10.   Jump up ^ "UpToDate Inc.".
    11.   Jump up ^ Khwaja SM, Minnerop M, Singer AJ (January 2010). "Comparison of ibuprofen,
          cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial".
          CJEM 12 (1): 39–44. PMID 20078917.
    12.   ^ Jump up to: a b Vos, T (2012 Dec 15). "Years lived with disability (YLDs) for 1160 sequelae of
          289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study
          2010.". Lancet 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMID 23245607.
    13.   Jump up ^ Deen, Hanifa; Bartleson, J. D. (2009). Spine disorders medical and surgical
          management. Cambridge, UK: Cambridge University Press. p. 3. ISBN 0-521-88941-3.




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401 East Carrillo Street,
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PH 805-563-3307 FAX 805-563-0998

Attending Staff

    Alan Moelleken, MD

    Michael Price, MD

    Michael Kenly, MD

    David Lee, MD

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    Alan Moelleken, MD

    Michael Price, MD

    Michael Kenly, MD

    David Lee, MD

    David Pires, DO

    Ken Nisbet, PA-C, MSPAS

    Terry Brightwell, DC

    Jesse Jacobs, PA-C, MSPAS

    Darren Richards, PA-C, MSPAS

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Attending Staff
    Alan Moelleken, MD

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    Michael Kenly, MD

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    Tony Kim, DC

    Adam Sverdlin, DC
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   Ken Nisbet, PA-C, MSPAS

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   Andrew Fairburn, PA-C

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