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Neck pain is a common clinical problem experienced at some point in life by nearly two-thirds of people. In addition to being a common problem, neck pain is quite disabling, in some countries accounting for nearly as much disability as low back pain. The economic impact of whiplash injuries alone is estimated to be nearly $4 billion.

Neck pain is also quite similar to low back pain in that the etiology is poorly understood and the clinical diagnoses are quite vague. Compared to low back pain, however, which has been the subject of numerous clinical practice guidelines, neck pain has received limited study. The few randomized controlled studies available lack consistency in study design. A review of the National Guidelines Clearinghouse ( demonstrates eight published guidelines on neck pain, pertaining to the use of facet neurotomy, imaging, and selected rehabilitation and therapeutic interventions in neck pain. This chapter reviews the epidemiology and anatomy of neck pain and provides an evidenced-based assessment of the evaluation, diagnosis, and management of this challenging disorder.

Neck pain is most prevalent in middle-aged adults; however, prevalence tends to vary with different definitions of neck pain and with differing methodologies of neck pain surveys. One study, for example, found that the1-year prevalence in adults ranged from 16.7% to 75.1% and rose with longer time periods. Almost 85% of neck pain may be attributed to chronic stress and strains or acute or repetitive injuries associated with poor posture, anxiety, depression, and occupational or sporting risks. The acceleration and deceleration of a whiplash injury may result in cervical sprains or strains, which, in turn, are common causes of neck pain. Radicular neck pain occurs later in life, with an estimated incidence of 10% among 25- to 29-year-olds, rising to 25%-40% in those older than 45 years.

Occupational neck pain is ubiquitous and not limited to any particular work setting. Predictors for occupational neck pain include little influence on the work situation, work-related psychosocial factors, and perceived general tension. Predictors of occupational neck pain include prolonged sitting at work (>95% of the workday), especially with the neck forward flexed 20 degrees or more for more than 70% of the work time.

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Vasseljen O et al: Shoulder and ...

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