Epidemiology of Neck Pain

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What is Neck Pain?

Neck Pain is defined by the Global Burden of health 2010 Study as "pain in the neck with or without pain referred into one or both upper limbs that lasts for at least one day"[1]

Neck pain occurs commonly throughout the world and causes substantial disability and economic cost. The pain and disability associated with neck pain have a large impact on individuals and their families, communities, healthcare systems and businesses[2]

The Global Burden of Neck Pain

Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, neck pain ranked 4th highest in terms of disability as measured by YLDs, and 21st in terms of overall burden[1][2]. From 1990-2010 Disability-Adjusted Life Years (DALYs) as a result of neck pain increased from 23.9 million in 1990 to 33.6 million (47%). This has been attributed to population growth (30%) and population ageing (17%).

With improved child survival and ageing populations throughout the world, especially in low- income and middle-income countries, the number of people experiencing neck pain is likely to increase substantially over the coming decades[2]. Approximately half of all individuals will experience a clinically important neck pain episode over the course of their lifetime.[3]

DALYs due to neck pain are higher in women than in men and highest in the 40–45 years age group.[1]

Prevalence

There is substantial variance in the reported prevalence rates of neck pain most likely as a result of variation in the definition of neck pain and the lack of homogeneity in the studies[3][4].

As a point of reference, epidemiological studies have reported:

Childs et al[6] reported that at any given time, 10% to 20% of the population reports neck problems, with 54% of individuals having experienced neck pain within the last 6 months.

Prevalence is generally higher in women than in men[2][3][6][7], higher in high-income countries compared with low- and middle-income countries,[2][7] higher in urban areas compared with rural areas[7] and peaks at around 45 years of age[2]

Rates of recurrence and chronicity of neck pain are high[6]. Most people with neck pain do not experience a complete resolution of symptoms, with between 50% and 85% of those who experience neck pain reporting neck pain again 1 to 5 years later[8]. Childs et al[6] suggest that 30% of patients with neck pain will develop chronic symptoms and 37% of individuals who experience neck pain will report persistent problems for at least 12 months. In chronic conditions, the course may be stable or fluctuating, but in most cases can best be classified as recurrent, characterised by periods of relative improvement followed by periods of relative worsening[9].  

Risk Factors

Risk factors for neck pain share similarities with other musculoskeletal conditions such as genetics, psychopathology (eg, depression, anxiety, poor coping skills, somatisation), sleep disorders, smoking, and sedentary lifestyle.[5]

Unique risk factors for neck pain include a history of neck pain[10], trauma (eg, traumatic brain and whiplash injuries) and certain sports injuries (eg, wrestling, ice hockey, football).[5] Although certain occupations such as office and computer workers, manual labourers, and health care workers, have been found in some studies to have a higher incidence of neck pain, the major workplace factors associated with the condition are low job satisfaction and perceived poor workplace environment.[5] 

The Economic Burden

The economic burden due to disorders of the neck is high, and includes costs of treatment, lost wages, and compensation expenditures[6]. Disability related to neck pain and related reoccurrences can significantly impact on workforce productivity and the economics of households and communities. The economic burden of neck pain is second only to low back pain in workers’ compensation claims in the United States and in Sweden, neck and shoulder problems account for 18% of all disability payments[6]. One study reported the total cost of NP in the Netherlands in 1996 was estimated to about 1% of the total health care expenditure or 0.1% of the Dutch gross domestic product[11]

Relevance to Physiotherapy

Although most acute episodes resolve spontaneously, more than a third of affected people still have low grade symptoms or recurrences more than one year later[12]. For managing neck pain the strongest evidence is for exercise[12]. Physiotherapists and Physical Therapists have a detailed understanding of the cervical spine, related pain mechanisms and exercise prescription which makes them well placed to be the experts to help individuals with neck pain return to normal function, therefore reducing this global burden of neck pain. Cervical spine related musculoskeletal disorders account for approximately 25% of the patients seen in outpatient physical therapy in the United States[13].

References

  1. 1.0 1.1 1.2 1.3 Wang, H., Naghavi, M., Allen, C., Barber, R.M., Bhutta, Z.A., Carter, A., Casey, D.C., Charlson, F.J., Chen, A.Z., Coates, M.M. and Coggeshall, M., 2016. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015Lancet388(10053), pp.1459-1544.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Damian Hoy, Lyn March, Anthony Woolf, Fiona Blyth, Peter Brooks, Emma Smith, Theo Vos, Jan Barendregt, Jed Blore, Chris Murray, Roy Burstein, Rachelle Buchbinder. The global burden of neck pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014;73:1309–1315
  3. 3.0 3.1 3.2 Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. European spine journal. 2006 Jun 1;15(6):834-48.
  4. 4.0 4.1 Haldeman S, Carroll L, Cassidy JD. Findings from the bone and joint decade 2000 to 2010 task force on neck pain and its associated disorders. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. 2010;52:424-427
  5. 5.0 5.1 5.2 5.3 Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. InMayo Clinic Proceedings 2015 Feb 28 (Vol. 90, No. 2, pp. 284-299). Elsevier.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Childs, J.D., Cleland, J.A., Elliott, J.M., Teyhen, D.S., Wainner, R.S., Whitman, J.M., Sopky, B.J., Godges, J.J., Flynn, T.W., Delitto, A. and Dyriw, G.M., 2008. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy AssociationJournal of Orthopaedic & Sports Physical Therapy38(9), pp.A1-A34.
  7. 7.0 7.1 7.2 Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Practice & Research Clinical Rheumatology. 2010 Dec 31;24(6):783-92.
  8. Kenneth Olson. The Cervical Spine. Chapter 6 In: Olson, K. Manual Physical Therapy of the Spine. Elsevier, 2015.
  9. Haines T, Gross A, Burnie SJ, Goldsmith CH, Perry L. Patient education for neck pain with or without radiculopathy. The Cochrane database of systematic reviews. 2009;CD005106.
  10. Croft PR, Lewis M, Papageorgiou AC, Thomas E, Jayson MI, Macfarlane GJ, Silman AJ. Risk factors for neck pain: a longitudinal study in the general population. Pain. 2001 Sep 30;93(3):317-25.
  11. Borghouts JA, Koes BW, Vondeling H, Bouter LM. Cost-of-illness of neck pain in The Netherlands in 1996. Pain. 1999;80:629–636.
  12. 12.0 12.1 Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ. 2017 Aug 14;358:j3221.
  13. Jette A, Delitto A: Physical therapy treatment choices for musculoskeletal impairments, Phys Ther 77(2):145–154, 1997.