Episode Of Neck Pain Research Articles

Patterns of initial treatment and subsequent care escalation among medicare beneficiaries with neck pain: a retrospective cohort study.

To compare long-term care escalation encounters among three care patterns for new episodes of neck pain among Medicare beneficiaries. We examined Medicare claims spanning a four-year period for beneficiaries with new episodes of neck pain beginning in 2019. All patients were continuously enrolled under Medicare parts A, B, and D and aged 65-99years. We calculated the cumulative frequency and propensity- weighted rate ratios for escalated care encounters across three distinct, index-visit related neck pain treatment cohorts: 1) Spinal manipulative therapy; 2) Primary care without prescription analgesics within 7days; 3) Primary care with prescription analgesics within 7days. When compared to the primary care without analgesics cohort, the spinal manipulative therapy cohort was associated with a 64% lower rate (RR 0.36, 95% CI 0.35,0.37) for long-term care escalation encounters, while the primary care with prescription analgesics cohort was associated with an 8% higher rate (RR 1.08; 95% CI 1.05,1.10). Initial spinal manipulative therapy was associated with a significant reduction in downstream care escalation encounters among Medicare beneficiaries with new episodes of neck pain. Our study contributes to a growing body of evidence supporting the integration of non-pharmacological care strategies for neck pain management.

Ozonucleolysis in cervical radiculopathy – Pakistan experience.

BACKGROUND AND PURPOSE
 Direct injection of Oxygen-Ozone in the cervical discs has proved to be the effective alternative to surgery in patients with cervical disc herniation in many countries around the world. We report our experience with ozonucleolysis with patients effected by pain incervical region (brachialgia)due to disc herniation including post-operative recurrence or disc prolapse.
 
 METHODS
 6000 patients were treated with single session of Oxygen-Ozone therapy from 2005-2020. All the patients had CT or MRI evidence of cervical disc prolapse with clinical signs of cervical nerve root compression. The procedure was performed under angiofluoroscopy using 22/23 G spinal needle without anesthesia. All the patients received intradiscal injection n of Oxygen-Ozone mixture at Ozone concentration of 30 µgm/ml. Among these patients 4500 were males and 1500 were females between the ages of 20-70 years. Therapeutic outcome was assessed 8 week after treatment by using modified MacNab method.
 
 RESULTS
 A satisfactory therapeutic outcome was obtained. 60% of the patients showed complete recovery with resolution of symptoms. 20% of the patients complained of occasional episodic neck pain and arms pain with no limitation of occupational activity. 5% of cases showed some improvement. 5% of cases had insufficient or noimprovement and went for surgery. 10% of cases never turned up after the first visit.
 
 CONCLUSION
 Intradiscal injection of Ozone for herniated cervical disc has revolutionized percutaneous approach to nerve root diseases making it safer, cheaper and easier to repeat than treatments currently in use.

The 5-Year Course of Neck Pain Among Natural Disaster Survivors: The Association of Prior Neck Pain with New Episodes of Neck Pain.

Neck pain is a common health problem among both the general population and natural disaster survivors. However, the long-term course of neck pain has rarely been reported. The aim of this study was to elucidate the 5-year course of neck pain among survivors of the Great East Japan Earthquake (GEJE) by assessing the association of neck pain 2 and 4 years after the disaster with that at 7 years. Longitudinal study. A panel study was conducted on GEJE survivors (n = 1,821) through the administration of a self-reported questionnaire at 2 (first time point), 4 (second time point), and 7 years (third time point) after the disaster. Multivariate logistic regression analyses were performed to assess the association between prior neck pain and subsequent neck pain. The rates of neck pain at the first, second, and third time points were 20.7%, 21.1%, and 20.1%, respectively. Neck pain at the first time point was significantly associated with neck pain at the third time point (adjusted odds ratio [95% confidence interval]: 5.96 [4.53-7.83]). Furthermore, neck pain at the first and second time points was significantly associated with neck pain at the third time point (adjusted odds ratio [95% confidence interval]: 5.71 [4.19-7.78] for neck pain at either time point; 15.94 [10.99-23.12] for neck pain at both time points; P for trend <0.001). Prior neck pain was significantly associated with neck pain 5 years later, and the effect was stronger with an increase of prior neck pain episodes. Clinicians should base their selection of treatment method on an individual's history of neck pain.

Factors associated with headache and neck pain among telecommuters \u2013 a five days follow-up

BackgroundThe current sanitary crisis brought on by the COVID-19 recently forced a large proportion of workers to adopt telecommuting with limited time to plan transition. Given that several work-related risk factors are associated with headache and neck pain, it seems important to determine those associated with headache and neck pain in telecommuters.The main objective of this study was to identify which telecommuting and individual associated factors are related with headache and neck pain occurrence in telecommuters over a five days follow-up. The second objective was to evaluate the impact of wearing a headset on headache and neck pain intensity in telecommuters.MethodsOne hundred and sixty-two participants in telecommuting situation were recruited. Baseline assessment included sociodemographic data, headache and neck pain-related disability (6-item Headache Impact Test (HIT-6) and Neck Bournemouth Questionnaire (NBQ)), headache and neck pain frequency and intensity as well as questions about the wearing of a headset (headset wearing, headset type and headset wearing hours). A prospective data collection of headache, neck pain and headset wearing was conducted using daily e-mail over a 5-day follow-up. A stepwise multivariate regression model was performed to determine associated factors of headache or neck pain occurrence during the follow-up. A t-test was conducted to assess the impact of headset wearing on headache and neck pain intensity during the follow-up.ResultsRegarding headache, the stepwise multivariate regression model showed that the HIT-6 score was associated with future headache occurrence in telecommuters (OR (95% CI) = 1.094 (1.042–1.148); R2 = 0.094; p < 0.001). For neck pain, the stepwise multivariate regression showed that the NBQ score was related to future neck pain occurrence in telecommuters (OR (95% CI) = 1.182 (1.102–1.269); R2 = 0.182; p < 0.001). T-test showed no difference between participants that wore a headset and participant that did not wore a headset on mean headache (p = 0.94) and neck pain (p = 0.56) intensity during the five days follow-up.ConclusionAlthough several work-related risk factors are associated with headache and neck pain in workers, telecommuting did not present the same risks. Working set-up did not have a significant impact on headache and neck pain as headache-related disability was the only associated factor of future headache episodes and neck-pain related disability was the only associated factor of future neck pain episodes. Also, wearing a headset had no impact on headache and neck pain in telecommuters.

Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis.

What is the effectiveness of interventions that aim to prevent a new episode of neck pain? Systematic review and meta-analysis of randomised, controlled trials. People without neck pain at study entry. Any intervention aiming to prevent a future episode of neck pain. New episode of neck pain. Five trials including a total of 3852 individuals met the inclusion criteria. The pooled results from two randomised, controlled trials (500 participants) found moderate-quality evidence that exercise reduces the risk of a new episode of neck pain (OR 0.32, 95% CI 0.12 to 0.86). One of the meta-analysed trials included some co-interventions with the exercise. There was low-quality evidence from three randomised, controlled trials (3352 participants) that ergonomic programs do not reduce the risk of a new neck pain episode (OR 1.00, 95% CI 0.74 to 1.35). This review found moderate-quality evidence supporting the effectiveness of an exercise program for reducing the risk of a new episode of neck pain. There is a need for high-quality randomised, controlled trials evaluating interventions to prevent new episodes of neck pain. PROSPERO CRD42017055174. [de Campos TF, Maher CG, Steffens D, Fuller JT, Hancock MJ (2018) Exercise programs may be effective in preventing a new episode of neck pain: a systematic review. Journal of Physiotherapy 64: 159-165].

Risk factors for episodic neck pain in workers: a 5-year prospective study of a general working population.

Development of neck pain (NP) in workers has a multifactorial etiology and depends on both individual and workplace factors. The aim of this study was to investigate risk factors for episodic NP in a large diverse sample of active workers. A prospective study based on the surveillance program implemented by the French Public Health Agency in the Loire Valley region. Between 2002 and 2005, 3710 workers were included. Between 2007 and 2010, 2332 workers responded to a follow-up questionnaire which assessed: (1) musculoskeletal symptoms (Nordic questionnaire) and (2) individual and work-related risk factors. Associations between episodic NP in 2007 (i.e., free subjects at baseline and who suffered at least 8days during the preceding 12months) and individual and work-related risk factors at baseline were studied using logistic regression modeling, stratified by sex. Among the 1510 workers (914 men, 596 women) still active at follow-up, 10.4% (8.4-12.4) of men and 14.6% (11.8-17.4) of women declared episodic NP. Among men, work pace dependence of guests or permanent hierarchical controls were risk factors of NP [OR=1.8 (1.1-2.8) and OR=2.1 (1.3-3.3), respectively]. Among women, the combination of sustained/repeated arm abduction with high physical perceived exertion was the strongest risk factor for NP [OR=3.5 (1.7-7.2)]; age and paced work were also predictors for NP in women. NP results from complex relationships between individual and work-related variables. High physical workload, awkward postures, and poor organizational environment together with age differently predicted episodic NP according to the sex.

Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain.

ObjectiveTo examine patients seeking care for neck pain to determine associations between the type of provider initially consulted and 1-year health care utilization.Patients and MethodsA retrospective cohort of 1702 patients (69.25% women, average age, 45.32±14.75 years) with a new episode of neck pain who consulted a primary care provider, physical therapist (PT), chiropractor (DC), or specialist from January 1, 2012, to June 30, 2013, was analyzed. Descriptive statistics were calculated for each group, and subsequent 1-year health care utilization of imaging, opioids, surgery, and injections was compared between groups.ResultsCompared with initial primary care provider consultation, patients consulting with a DC or PT had decreased odds of being prescribed opioids within 1 year from the index visit (DC: adjusted odds ratio [aOR], 0.54; 95% CI, 0.39-0.76; PT: aOR, 0.59; 95% CI, 0.44-0.78). Patients consulting with a DC additionally demonstrated decreased odds of advanced imaging (aOR, 0.43; 95% CI, 0.15-0.76) and injections (aOR, 0.34; 95% CI, 0.19-0.56). Initiating care with a specialist or PT increased the odds of advanced imaging (specialist: aOR, 2.96; 95% CI, 2.01-4.38; PT: aOR, 1.57; 95% CI, 1.01-2.46), but only initiating care with a specialist increased the odds of injections (aOR, 3.21; 95% CI, 2.31-4.47).ConclusionInitially consulting with a nonpharmacological provider may decrease opioid exposure (PT and DC) over the next year and also decrease advanced imaging and injections (DC only). These data provide an initial indication of how following recent practice guidelines may influence health care utilization in patients with a new episode of neck pain.

Both positive and negative beliefs are important in patients with spine pain: findings from the Occupational and Industrial Orthopaedic Center registry

Background ContextNegative beliefs are known to influence treatment outcome in patients with spine pain (SP). The impact of positive beliefs is less clear. PurposeWe aimed to assess the influence of positive and negative beliefs on baseline and treatment responses in patients with SP. Study Design/SettingA retrospective cross-sectional and longitudinal analysis of prospectively collected data of outpatient physical therapy patients with SP was carried out. Questionnaires administered before and during treatment included the STarT Back distress scale (negative beliefs), and expectation and self-efficacy questions (positive beliefs). Patient SamplePatients with SP with a baseline assessment and follow-up assessment comprised the study sample. Outcome MeasurePerceived disability was measured using the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI). A clinical meaningful change (minimum clinically important difference [MCID]) was defined as decrease in ODI or NDI of ≥30%. MethodsWe used the Akaike Information Criterion from the first imputed dataset of the prediction model to select predictor variables. Prediction models were fitted to the outcome variables. ResultsIn the cross-sectional analysis, 1,695 low back pain (LBP) episodes and 487 neck pain (NP) episodes were analyzed. STarT Back Screening Tool (SBST)-distress was positively associated with perceived disability in both LBP (beta 2.31, 95% confidence interval [CI] 1.75–2.88) and NP (beta 2.57, 95% CI 1.47–3.67). Lower self-efficacy was negatively associated with more perceived disability for LBP (beta 0.50, 95% CI 0.29–0.72) but not for NP, whereas less positive expectations was associated with more perceived disability in NP (beta 0.57, 95% CI 0.02–1.12) but not in LBP. In the longitudinal analysis, 607 LBP episodes (36%) and 176 (36%) NP episodes were included. SBST-distress did not predict treatment outcome in spine patients. In LBP, patients with a lower positive expectation were less likely to experience an MCID in perceived disability (odds ratio [OR] per point increase 0.89, 95% CI 0.83–0.96), and there was a similar trend in NP (OR per point increase 0.90, 95% CI 0.79–1.03). In patients with LBP, lower self-efficacy at baseline was associated with a higher likelihood that an MCID was achieved (OR per point increase 1.09, 95% CI 1.01–1.19). In NP, self-efficacy was not included in the final model. ConclusionsOur study demonstrates that both negative and positive beliefs are associated with perceptions of disability. However, in this study, only positive beliefs were associated with treatment outcome.

Immediate symptom response to manual therapy treatment for neck pain is related to rate and extent of recovery

Background:Manual therapies are commonly used in the management of neck pain to relieve symptoms, restoremobility and hasten recovery. Common practice in manual therapy is using immediate treatment responses to inform both treatment progression and prognosis. Within-session changes in symptoms have been shown to correlate with self-reported recovery rate. This study sought a detailed profile of the trajectory of recovery of neck pain treated with manual therapy and further information about the predictive value of withinsession improvements. Purpose:The aim of this studywas to describe the clinical course of a new episode of neck pain during a course of manual therapy treatment and to explore whether the early responses to treatment were related to longer term outcomes. Methods:Analysis of treatment responses and recovery in participants from two arms of a manual therapy randomised controlled trial. Participants were 181 people with a new episode of neck pain, treated with a course of mobilisation or manipulation of the neck on four occasions over two weeks. The clinical course during the episode of care was described using average preand post-treatment pain scores (numerical rating scale 0–10) for each occasion of treatment. Repeated measures t-test was used to compare scores within and between sessions. The relationships between immediate treatment effects and time taken to recover and the Global Perceived Effect (GPE) of treatment at 3 months were explored using multivariate regression analyses. Results: On each occasion of treatment, pain scores significantly decreased with the smallest average withinsession change 1.4 (95%CI 1.2 to 1.5). There was also small but statistically significant increases in average pain scores of up to 0.7 (95%CI 0.4 to 1.0) between treatment sessions without regression to the preceding pre-treatment level. The change in pain scores after the first treatment session was independently associated with high GPE scores at three months (B= 0.2, 95%CI 0.01 to 0.4). There were also significant univariate associations between the within-session changes in pain and the time taken to recover from the episode of neck pain. However, these associations were not independent of duration of symptoms, self-rated general health, or the presence of headache. Conclusion(s): These results indicate that people with neck pain who are treated with manual therapy experience a pattern of recovery of symptoms that coincides with the occasions of treatment and features improvement within sessions and slight relapse between sessions. These results also demonstrate that improvements in symptoms within a treatment session are associatedwith a faster rate of recovery from an episode of neck pain and with patient’s overall perception of the benefits of treatment at 3-month follow up. Implications:Manual therapists can use the information in this study to assist their patients’ understanding of the trajectory of their recovery from a new episode of neck pain. In particular, it is helpful for patients to understand that slight relapses between treatment sessions are the normand not necessarily an indicator of poor outcome.These results also assist clinical reasoning in manual therapy practice by demonstrating a predictive value of short term treatment responses.

The clinical significance of immediate symptom responses to manual therapy treatment for neck pain: Observational secondary data analysis of a randomized trial

The objective was to explore aspects of symptom responses to manual therapy treatment for neck pain. An observational secondary data analysis of a randomized trial was conducted. 181 participants seeking care from a physiotherapist or chiropractor for a new episode of neck pain were included. Outcome variables included recovery-time and participant-perceived effect of treatment (GPE) at 3-months. There was a significant reduction of ≥1.4 points (95%CI 1.2–1.5) in pre- and post-treatment pain scores at each occasion of treatment. There was also small but significant increases in pain of ≤0.7 points (95%CI 0.4–1.0) between each treatment session, without regression to the preceding pre-treatment level. The relationships between immediate post-treatment effects and longer-term outcomes were explored using multivariate regression analyses. There was significant univariate association between recovery time and cumulative post-treatment changes in pain from the second, third and fourth (Exp(B) = 1.2) treatment sessions, as well as the presence of post-treatment headache (Exp(B) = 0.7) and other minor adverse symptoms (Exp(B) = 0.6). There was significant univariate association between GPE at 3-months and cumulative pain responses from first (B = 0.2), second (B = 0.3), third (B = 0.3) and fourth (B = 0.4) treatment sessions. The change in pain after session 1 was independently associated with GPE (B = 0.2). There was a consistently significant difference of ≥0.7 points (95%CI 0.43–0.89) in the different methods of reporting pain. Our results showed that manual therapy for neck pain involves a “two-steps forward, one-step back” recovery pattern. Whilst minor adverse events are undesirable, they do not seem to be significantly associated with long-term recovery.

People seeking treatment for a new episode of neck pain typically have rapid improvement in symptoms: an observational study

What is the clinical course of a new episode of non-specific neck pain in people who are treated with multimodal physical therapies in a primary care setting? Observational study with 3-month follow-up, run in conjunction with a randomised trial. 181 adults who consulted a physiotherapist or chiropractor for a new episode of nonspecific neck pain. Time to recover from the episode of neck pain, time to recover normal activity, and pain and neck-related disability at three months. Clinical and demographic characteristics were investigated as potential predictors of recovery. Within 3 months, 53% of participants reported complete recovery from the episode of neck pain. On a scale from 0 (none) to 10 (worst), pain improved from 6.1 (SD 2.0) at baseline to 2.5 (SD 2.1) at 2 weeks and to 1.5 (SD 1.8) at 3 months. On a scale from 0 (none) to 50 (worst), disability improved from 15.5 (SD 7.4) at baseline to 5.4 (SD 6.4) at 3 months. Faster recovery was independently associated with better self-rated general health, shorter duration of symptoms, being a smoker, and absence of concomitant upper back pain or headache. Higher disability at 3 months was independently associated with higher disability at baseline, concomitant upper or lower back pain, older age, and previous sick leave for neck pain. People who seek physical treatments for a new episode of neck pain in this primary care setting typically have high pain scores that improve rapidly after commencing treatment. Although almost half of those who seek treatment do not recover completely within three months, residual pain and disability in this group is relatively low. Physiotherapists should reassure people with a new episode of neck pain that rapid improvement in symptoms is common, modifying this advice where applicable based on risk factors.

Normative score and cut-off value of the Neck Disability Index

BackgroundNeck pain is a common health problem that restricts activities of daily living. The Neck Disability Index (NDI) was developed to assess disability in patients with neck pain. The normative score and the cut-off value are mandatory to assess an individual patient or a certain patient group for clinically important neck pain with disability, by distinguishing it from nonsignificant pain. The objective of the present study was to determine the normative score and the cut-off value of the NDI. MethodsA total of 1,200 participants who registered with an internet research company were interviewed on the website about their episodes of neck pain during the previous 4 weeks, and completed the online NDI questionnaire. If the participants reported neck pain, they were also asked about the disability in activity of daily living it caused, and the presence of associated symptoms in upper limbs. Disability was defined according to the consensus study on the standardization of back pain definitions. The normative score was determined by calculating the mean in the participants, and the cut-off value was determined by the receiver-operating characteristic curve analysis. ResultsThe prevalence of neck pain was 37.8 %. Demographic data of the participants also indicated that they were representative of the normal population in Japan. The mean score was 6.98, and the median was 2. The NDI score was higher in middle age, and at its peak in the 50s age group (50–59 years of age). The female mean was significantly higher. The NDI score was higher in those with upper limb symptoms. We have determined the cut-off value of the NDI to detect neck pain associated with disability to be 15. ConclusionsThe normative score and the cut-off value of the NDI were determined. Our cut-off value is potentially useful in evaluating the therapeutic effectiveness of various interventions for neck pain.

The age- and sex-specific occurrence of bothersome neck pain in the general population – results from the Stockholm public health cohort

BackgroundNeck pain is very common but the occurrence of bothersome neck pain is not well described. Therefore our objective was to report on the prevalence and incidence of, as well as the rate of recovery from, bothersome neck pain in men and women of different ages in the general population.MethodsWe used data from a recently conducted population-based cohort study, comprising 23,794 individuals in Stockholm County, Sweden. Study participants were surveyed with a self-administered questionnaire in 2002/2003 and 2007, and information on episodes of neck pain was gathered at baseline and at follow-up. We then measured bothersome neck pain in 2005 and 2006 retrospectively in 2007 using the follow-up questionnaire.ResultsThe one-year prevalence of bothersome neck pain for at least seven consecutive days was 25% (95% confidence interval (CI): 24–25) among women and 16% (95% CI: 15–16) among men, peaking in individuals aged 30–59 years. The one-year incidence proportion of bothersome neck pain was 7% (95% CI: 6–7) among women, and 4% (95% CI: 4–5) among men. Women recovered more infrequently than men. The one-year incidence proportion of recovery (of at least one year duration) was 11% (95% CI: 10–12) among women and 14% (95% CI: 12–16) among men.ConclusionBothersome neck pain is most common in middle-aged individuals. Women are more likely than men to have and to develop bothersome neck pain, and less likely to recover from such pain. Younger men and women have a higher incidence, but recover more often from bothersome neck pain than older individuals.

In response to: Dunning J. How about an honorable mention for cervical and thoracic thrust manipulation? A passing mention would be more appropriate

In response to: Dunning J. How about an honorable mention for cervical and thoracic thrust manipulation? A passing mention would be more appropriate

Characteristics of a new episode of neck pain

We report on the demographic and clinical characteristics of patients seeking manual therapy care for a new episode of non-specific neck pain and report on characteristics associated with higher levels of pain and disability in these patients. Demographic and clinical data were collected from patients who enrolled in a clinical trial of manipulation for neck pain. A profile of these patients was formulated using descriptive statistics. Multivariate linear regression models were used to describe the relationship between patient characteristics and severity of pain and disability. Patients with a new episode of non-specific neck pain reported pain intensity of 6.1 ± 2.0 (mean ± SD) on a 0–10 numerical scale and disability scores of 15.7 ± 7.4 (Neck Disability Index/50). Sixty-three percent had a prior history of neck pain. Concomitant symptoms were highly prevalent including upper limb pain (80%), headache (65%), upper back pain (64%), lower back pain (39%), dizziness (31%) and nausea (23%). There was a strong association between pain intensity and disability (p < 0.01). More severe pain was also associated with not having concomitant back pain (p = 0.01) More severe disability was also associated with poor general health (p < 0.01), nausea (p < 0.01), smoking, (p = 0.02) low SF-12 mental health score (p = 0.02), and shorter duration of symptoms (p = 0.03). Patients with a new episode of neck pain, and deemed suitable for treatment with neck manipulation reported moderately high intensity pain and disability with widespread and frequent concomitant symptoms.

Ten-year survey reveals differences in GP management of neck and back pain

Clinical guidelines provide similar recommendations for the management of new neck pain and low back pain (LBP) but it is unclear if general practitioner's (GP) care is similar. While GP's management of LBP is well documented, little is known about GP's management of neck pain. We aimed to describe GP's management of new neck pain and compare this to GP's management of new LBP in Australia between April 2000 and March 2010. All GP-patient encounters for a new (i.e. first visit to any medical practitioner) neck pain or LBP problem were compared in terms of treatment delivered, referral patterns and requests for laboratory and imaging investigations. General practitioners in Australia have managed new neck pain and LBP problems at a rate of 3.1 and 5.8 per 1,000 GP-patient encounters, respectively. GP's primarily utilised medications, in particular non-steroidal anti-inflammatory drugs, to manage new neck and LBP problems and referred approximately 25% of all patients for imaging. Patients with new neck pain are more frequently managed using physical treatments and were referred more often to allied health professionals and specialists. In comparison, patients with new LBP were managed more frequently with medication, advice, provision of a sickness certificate and ordering of pathology tests. This is the first time GP management of a new episode of neck pain has been documented using a nationally representative sample and it is also the first time that the management of back and neck pain has been compared. Despite guidelines endorsing a similar approach for the management of new neck pain and LBP, in actual clinical practice Australian GPs manage these two conditions differently.

Pain in the Neck: Many (Marginally Different) Treatment Choices

Excerpt in absence of an abstract Neck pain is a highly prevalent and costly symptom. Available studies estimate that the 1-year incidence of neck pain ranges from 10.4% to 21.3%, with a higher incidence noted in office and computer workers. Although between 33% and 65% of people recover from an episode of neck pain within 1 year, relapses are common (1). The prevalence is generally higher in women than in men, higher in high-income countries than in low- or middle-income countries, and higher in urban areas than in rural areas. Many factors influence the onset and course of neck pain, including such nonmodifiable risk factors as age, sex, and genetics. Modifiable factors include exposure to tobacco and poor psychological health (2). Of note, cervical disc degeneration is not an identified risk factor (2). Few population-based studies have been done on the economic burden of neck pain, but a 1996 Dutch study (3) estimated the total costs to be $686 million, which represented approximately 1% of total health care expenditures and 0.1% of the gross domestic product of the Netherlands. Thus, it seems that the economic burden of neck pain is substantial in the Netherlands and perhaps in other high-income countries.

The epidemiology of neck pain

Neck pain is becoming increasingly common throughout the world. It has a considerable impact on individuals and their families, communities, health-care systems, and businesses. There is substantial heterogeneity between neck pain epidemiological studies, which makes it difficult to compare or pool data from different studies. The estimated 1 year incidence of neck pain from available studies ranges between 10.4% and 21.3% with a higher incidence noted in office and computer workers. While some studies report that between 33% and 65% of people have recovered from an episode of neck pain at 1 year, most cases run an episodic course over a person's lifetime and, thus, relapses are common. The overall prevalence of neck pain in the general population ranges between 0.4% and 86.8% (mean: 23.1%); point prevalence ranges from 0.4% to 41.5% (mean: 14.4%); and 1 year prevalence ranges from 4.8% to 79.5% (mean: 25.8%). Prevalence is generally higher in women, higher in high-income countries compared with low- and middle-income countries and higher in urban areas compared with rural areas. Many environmental and personal factors influence the onset and course of neck pain. Most studies indicate a higher incidence of neck pain among women and an increased risk of developing neck pain until the 35-49-year age group, after which the risk begins to decline. The Global Burden of Disease 2005 Study is currently making estimates of the global burden of neck pain in relation to impairment and activity limitation, and results will be available in 2011.

A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain

Leaver AM, Maher CG, Herbert RD, Latimer J, McAuley JH, Jull G, Refshauge KM. A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain. Objective To determine whether neck manipulation is more effective for neck pain than mobilization. Design Randomized controlled trial with blind assessment of outcome. Setting Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia. Participants Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner. Interventions Participants were randomly assigned to receive treatment with neck manipulation (n=91) or mobilization (n=91). Patients in both groups received 4 treatments over 2 weeks. Main Outcome Measure The number of days taken to recover from the episode of neck pain. Results The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization (hazard ratio=.98; 95% confidence interval, .66–1.46). Conclusions Neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.

Neck Strength and EMG Activity in Fighter Pilots with Episodic Neck Pain

Neck pain is common in fighter pilots due to repeated exposure to high +Gz loads, but studies comparing neck function in symptomatic and healthy fighter pilots are lacking. This study compared neck strength and EMG activity during maximal isometric contractions in a sitting position in the sagittal and coronal planes in neck pain (SP), asymptomatic fighter pilots (AP), and healthy, male, non-pilot subjects (NPS). There were 9 SP, 10 AP, and 8 NPS, all males, who performed maximal isometric neck contractions on a specific dynamometer. Surface EMG activity was recorded bilaterally over the sternocleidomastoid and paraspinal muscles. EMG amplitude during side bending was normalized to that measured in the sagittal plane. SP exhibited lower side-bending strength than AP (17-19%, P < 0.05). In addition, SP and NPS exhibited lower left side-bending-to-extension torque ratios (20% and 14%, respectively, P < 0.05) than AP. Similar activation level of neck flexors and extensors during side bending was found in SP and AP, whereas EMG activity of the extensors was higher than the flexors in NPS (+48%, P < 0.05). In addition, antagonistic EMG activity was higher in AP compared to NPS (26% vs. 41%, respectively, P < 0.05). Our results suggest altered muscle function in SP compared with AP in the coronal but not in the sagittal plane. Further, AP appeared to be more efficient in the coronal plane with reference to neck extension than NPS, suggesting that some adaptations occurred due to flight exposure. These findings may have clinical implications for the management and the follow-up of neck pain in fighter pilots.