Regional musculoskeletal conditions: neck pain

Neck pain is second only to low back pain as the most common musculoskeletal disorder in population surveys and primary care, and, like low back pain, it poses a significant health and economic 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 care costs. Furthermore, in the setting of the whiplash syndrome, neck pain accounts for significant costs to society in terms of insurance and litigation, and days lost from work. Much neck pain is not attributable to a specific disease or disorder and is labelled as 'soft-tissue' rheumatism or muscular/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 radiological assessment, 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 is some evidence, however, that measures which address the psychosocial factors that promote pain chronicity, and shift the patient's view away from injury and disease to more benign perspectives 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.