Neck pain. Primary care work-up of acute and chronic symptoms

Acute or chronic neck pain can arise from degenerative processes, musculoskeletal trauma, or structural changes. For all patients presenting with neck pain, determining the presence of radiculopathy or myelopathy is an important step in initial assessment. Depending on the duration of pain, the work-up should include appropriate use of traditional and advanced imaging studies. For cases that do not suggest traumatic, structural, or rheumatologic origins, alternate considerations should include stress, depression, and--because of its increased incidence in older persons--cancer. Nonsteroidal anti-inflammatory agents, mild oral analgesics, and short-term corticosteroid therapy are the mainstays of treatment, although physical therapy and traction can be helpful for some patients. The presence of a herniated disk, cord compression (severe stenosis), tumor, or other structural lesion may require surgical decompression.