 FACT SHEET No.

18

Neck Pain
Introduction
Neck pain is a common global problem, at least in the industrialized world, and it constitutes an
important cause of disability. The functional task of the cervical spine is to control head movements in
relation to the rest of the body. Since the eyes and the vestibular organs are located in the head,
information from mechanoreceptors in the structures of the neck is crucial for interpreting vestibular
information and for controlling motor tasks that rely on visual information. Neck pain may therefore
also have substantial functional consequences.

Epidemiology and Economics

• Neck pain affects 30–50% of the general population annually.
• 15% of the general population will experience chronic neck pain (>3 months) at some point
in their lives.
• 11–14% of the working population will annually experience activity limitations due to neck
pain.
• Prevalence peaks at middle age, and women are more often affected than men.
• Risk factors with strong evidence include high physical job demands, low social support,
smoking and history of low back pain or neck injury. There is limited evidence that several
other physical and psychological factors such as repetitive work, prolonged periods of neck
flexion and psychological and emotional symptoms constitute risks.

Pathophysiology
The pathophysiology for the majority of neck pain disorders is not clarified. There is evidence for
disturbed oxidative metabolism and elevated levels of pain-generating substances in neck muscles,
suggesting that impaired local muscle circulation or metabolism can be part of the pathophysiology.

Neck pain is also associated with altered coordination of cervical muscles and impaired proprioception
in the neck. Evidence suggests that these phenomena are caused by the pain, but also that they may
aggravate the condition.
_____________________________________________________________________________________________

© Copyright 2017 International Association for the Study of Pain. All rights reserved.

IASP brings together scientists, clinicians, health-care providers, and policymakers to stimulate and support the
study of pain and translate that knowledge into improved pain relief worldwide.
For neck pain with post-traumatic onset, soft-tissue injury can impair information from
mechanoreceptors in the injured tissues, which can cause sensory and motor dysfunctions.

Clinical Features
• Neck pain disorders develop gradually or have a post-traumatic onset.
• Recurrent episodes are common.
• Clinical symptoms associated with neck pain are: pain and stiffness in the neck, headache,
dizziness, and radiating pain to shoulders and the upper limbs.
• Neck pain with post-traumatic onset is associated with a wider range of symptoms including
temporomandibular symptoms, visual and auditory disturbances, sleeping problems, and
cognitive and emotional problems.
• Clinical findings associated with neck pain are: decreased range of cervical movement,
increased fatigability, and decreased pressure pain thresholds of cervical muscles.
• Comorbidities such as anxiety, depression, and multiple pain sites may indicate more severe
disorders and poorer prognosis.

Diagnostic Criteria
• For the majority of neck pain disorders, objective diagnostic criteria are lacking. Therefore,
diagnoses are symptom based.
• Diagnostic magnetic resonance imaging (MRI) is useful for specific disorders such as
radicular pain, myelopathy and for severely injured patients, but is of limited value for the
majority of neck pain disorders.
• Manual provocation tests are useful for determining the involvement of nerve root
compression.
• For neck pain associated with whiplash trauma, a classification system has been proposed
by the Québec Task Force (QTF). It defines five grades that correspond to the severity of the
disorder.

Diagnosis and Treatment

Due to limited knowledge of the pathophysiology of most neck pain disorders, treatment of the cause is
usually not possible. Therefore, treatment and rehabilitation interventions are mainly intended to
reduce symptoms and improve function.
• There is moderate evidence that specific strengthening exercises of the neck,
scapulothoracic and shoulder can reduce pain and improve function in non-specific neck
pain.
• For short-term pain management there is evidence that conservative treatments such as
manipulation, manual therapy and multimodal intervention can be effective.
• Structured patient education and advice to stay active is recommended.
• There is a lack of evidence that any pharmacological treatment is effective except for non-
steroidal anti inflammatory drugs that may be more effective than placebo.
• Neck collar should not be offered in whiplash associated disorders grade I-III

_____________________________________________________________________________________________

© Copyright 2017 International Association for the Study of Pain. All rights reserved.

IASP brings together scientists, clinicians, health-care providers, and policymakers to stimulate and support the
study of pain and translate that knowledge into improved pain relief worldwide.
REFERENCES

1. Cote P, van der Velde G, Cassidy JD, Carroll LJ, Hogg-Johnson S, Holm LW, Carragee EJ, Haldeman S, Nordin M, Hurwitz
EL, Guzman J, Peloso PM. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade
2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008;33(4 Suppl):S60–74.
2. Cote P, Wong JJ, Sutton D, Shearer HM, Mior S, Randhawa K, Ameis A, Carroll LJ, Nordin M, Yu H, Lindsay GM,
Southerst D, Varatharajan S, Jacobs C, Stupar M, Taylor-Vaisey A, van der Velde G, Gross DP, Brison RJ, Paulden M,
Ammendolia C, Cassidy JD, Loisel P, Marshall S, Bohay RN, Stapleton J, Lacerte M, Krahn M, Salhany R. Management
of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury
Management (OPTIMa) Collaboration. Eur. Spine J. 2016;25:2000–2022.
3. Falla D. Neuromuscular control of the cervical spine in neck pain disorders. In: Graven-Nielsen T, Arendt-Nielsen L,
Mense S, editors. Fundamentals of musculoskeletal pain. Seattle: IASP Press; 2008. p. 417–30.
4. Gross AR, Paquin JP, Dupont G, Blanchette S, Lalonde P, Cristie T, Graham N, Kay TM, Burnie SJ, Gelley G, Goldsmith
CH, Forget M, Santaguida PL, Yee AJ, Radisic GG, Hoving JL, Bronfort G. Exercises for mechanical neck disorders: A
Cochrane review update. Man. Ther. 2016;24:25–45.
5. Hogg-Johnson S, van der Velde G, Carroll LJ, Holm LW, Cassidy JD, Guzman J, Cote P, Haldeman S, Ammendolia C,
Carragee E, Hurwitz E, Nordin M, Peloso P. The burden and determinants of neck pain in the general population:
results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine
2008;33(4 Suppl):S39–51.
6. Leaver AM, Refshauge KM, Maher CG, McAuley JH. Conservative interventions provide short-term relief for non-
specific neck pain: a systematic review. J. Physiother. 2010;56:73–85.
7. Manchikanti L, Hirsch JA. Clinical management of radicular pain. Expert Rev. Neurother. 2015;15:681–693.
8. McLean SM, May S, Klaber-Moffett J, Sharp DM, Gardiner E. Risk factors for the onset of non-specific neck pain: a
systematic review. J Epidemiol Community Health 2010;64:565–572.
9. Vasseljen O, Woodhouse A, Bjorngaard JH, Leivseth L. Natural course of acute neck and low back pain in the general
population: The HUNT study. Pain 2013;154:1237–1244.

About the International Association for the Study of Pain®

IASP is the leading professional forum for science, practice, and

education in the field of pain. Membership is open to all professionals
involved in research, diagnosis, or treatment of pain. IASP has more
than 7,000 members in 133 countries, 90 national chapters, and 20
Special Interest Groups.

As part of the Global Year Against Musculoskeletal Pain, IASP offers a series of Fact Sheets that cover
specific topics related to postsurgical pain. These documents have been translated into multiple
languages and are available for free download. Visit www.iasp-pain.org/globalyear for more
information.

_____________________________________________________________________________________________

© Copyright 2017 International Association for the Study of Pain. All rights reserved.

IASP brings together scientists, clinicians, health-care providers, and policymakers to stimulate and support the
study of pain and translate that knowledge into improved pain relief worldwide.