Anthony S. Russell
Department of Rheumatic Diseases, University of Alberta, Edmonton, Alberta, Canada
Neck pain is second only to low back pain as the most common musculoskeletal disorder inpopulation surveys and primary care, and, like low back pain, it poses a signiﬁcant health andeconomic burden, being a frequent source of disability. While most individuals with acute neck pain do not seek health care, those that do account for a disproportionate amount of health carecosts. Furthermore, in the setting of the whiplash syndrome, neck pain accounts for signiﬁcantcosts to society in terms of insurance and litigation, and days lost from work. Much neck pain isnot attributable to a speciﬁc disease or disorder and is labelled as ‘soft-tissue’ rheumatism ormuscular/mechanical/postural neck pain. Most chronic neck pain is attributed to whiplash injury,another enigmatic diagnosis. Despite decades of research and posturing to explain chronic neck pain on the basis of a speciﬁc disease or injury, and despite increasingly sophisticated radiologicalassessment, little advance has been made in either achieving a speciﬁc structural diagnosis or,more importantly, in reducing the health and economic burden of chronic neck pain. There issome evidence, however, that measures which address the psychosocial factors that promotepain chronicity, and shift the patient’s view away from injury and disease to more benignperspectives on their condition, may be helpful. This chapter considers brieﬂy the magnitude of the neck pain problem, our limitations in understanding it from a traditional medical perspective,and suggestions for therapeutic and societal approaches that appear more likely to be helpful.
neck pain; whiplash injuries; chronic pain.
The problem with neck pain is that it does not end there. Neck pain, especially chronicneck pain, is often accompanied by a host of other symptoms whose association isdifﬁcult to explain on a physiological basis alone. Neck pain is often just one feature of nebulous syndromes like chronic whiplash, myofascial pain syndrome, ﬁbromyalgia,cervicobrachial syndrome, et cetera. Chronic neck pain also brings with it the spectreof litigation (e.g. whiplash issues) and disability claims. In addition there is a tendencyfor over-investigation and over-treatment, often as a result of the level of a patient’sdistress at the failure of the medical community to provide helpful answers. In thischapter, we deal with the fact that the epidemiology of neck pain clearly indicates thisto be a major health and economic burden, but the traditional diagnostic approachbased on history, physical examination, and investigations provides little solution formost patients. We argue that much of this endemic musculoskeletal problem is
1521-6942/03/$ - see front matter
2003 Elsevier Science Ltd. All rights reserved.Best Practice & Research Clinical RheumatologyVol. 17, No. 1, pp. 57–70, 2003