Patient Information
- NHS Inform – Neck problems self-management-advice
- NHS Inform – Exercises for neck problems
- Managing your neck pain – The Chartered Society of Physiotherapy
- NHS Lothian MSK Self Help Resources Webpage
Definition
Non-specific neck pain is pain or discomfort in the neck and/or shoulder girdle, with or without associated spine related arm symptoms, which is generally non-dermatomal in distribution. In most cases, no specific cause can be found.
Cervical spondylosis is a specific term for osteoarthritis of the spine. When causing neck pain, it is managed in the same way as non-specific neck pain.
Typical signs and symptoms
- Pain that is aggravated by movements and activities
- Pain that radiates in a non-dermatomal distribution down the arm, up into the head, into the shoulder or scapula
- Pain associated with paraesthesia or hyperaesthesia, but with no objective loss of sensation or muscle strength
It is common for patients with neck pain to suffer headaches, often referred as occipital pain, and cluster or tension headaches. Any concerning pattern of headaches, consider differential diagnosis.
Incidence and prevalence:
- The estimated lifetime prevalence of a significant episode of neck pain is 40-70%
- In the 2010 Global Burden of Disease Study, neck pain ranked fourth highest for the number of years lived with disability
- Between 33-65% of people recover from an episode of neck pain within one year, but relapses are common
- Neck pain increases from 18-30 years of age through to middle age (50-55 years). In some studies, there is a decrease after 50-55 years of age, whereas other studies report no change or a slight increase.
Risk factors for non-specific neck pain may include:
- Female gender
- History of low back or neck disorders
- Work related factors
- Low job satisfaction and poorly perceived work support are the major factors
- May also include office workers and manual labourers; repetitive or precision work
- Sleep problems, sedentary lifestyle
- Obesity, smoking
- Poor general health
- Stress
Prognosis
Most cases of acute neck pain resolve within 2 months. However around half of people continue to have low grade symptoms or recurrences for more than a year. Up to 20% of acute neck pain will go on to become chronic neck pain.
Risk factors for poor outcome
- Female gender, older age
- High baseline pain intensity
- Multiple pain sites
- Poor general health
- Obesity, smoking
- Psychological factors (for example, anxiety, depression, worry).
Other considerations
- Degenerative changes are commonly seen on cervical imaging, and there is little evidence that they are associated with neck pain
- MRI studies show nearly 100% of adults aged >40 years have severe degeneration of at least one cervical level
Differential diagnosis
The differential diagnosis of neck pain is broad but includes trauma and non-musculoskeletal disease processes that can be classified as neoplastic, inflammatory, infectious, vascular, endocrinological or neurological. Refer to relevant section of the pathway for more information
M.A & P.A – 14-05-26
Who can refer:
- All primary care clinicians i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners
- Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP Where To Find Us – Musculoskeletal Physiotherapy)
- Secondary care consultants and associated teams
- MSK physiotherapists are able to escalate/refer to advanced practice physiotherapists underpinned by agreed pathways and processes MSK physiotherapy within NHS Lothian (services included in pilot only) – Cervical spine pathway | Right Decisions
Who to refer:
- All routine cases of cervical spine pain and cervical spine related arm symptoms who have not responded to initial primary care management within a 4-6 week period and do not have the presence of significant red flags nor have suspected inflammatory spinal pain – see sections serious cervical spine conditions and other considerations and inflammatory spinal pain
- Cervical Spine related arm symptoms- Consider earlier referral in cases intractable symptoms and/ or developing motor deficit but without significant red flags
- Non-specific cervical spine pain in the absence of a dominant psychological component who have not received recent physiotherapy for their condition or who have received physiotherapy previously for their condition but;
- have experienced a substantial change in their presentation
- require assistance with achieving a functional goal
- wish further assessment and considerations of management options
- have clinical features suggestive of an underlying specific cause for their cervical spine pain, in which further investigation would guide management (other than serious spinal pathology).
- Additional information regarding imaging available for xray and MRI found at radiology ref help spine Plain X-Rays – RefHelp
Who not to refer:
- Patients who have the presence of significant red flags/ suspicion of serious cervical spine condition or have suspected inflammatory spinal pain – see link Serious cervical spine conditions (Red Flags) – RefHelp
- Age <16
- Chronic cervical spine pain with a significant psychological / psychiatric / drug addiction element/ pain causing significant distress & disability, no planned referral to another speciality for diagnosis or treatment of pain – see Chronic pain Chronic Pain – RefHelp.
How to refer:
- For all cases of routine cervical spine pain / spine related arm symptoms– refer via SCI Gateway Referral “AHP-Physiotherapy” then choose local site.
- This single referral will gain access to the full multidisciplinary NHS Lothian integrated back pain pathway. Any subsequent investigation/ surgical opinion/ pain service referral will be made within the service
- Please include all relevant details on your referral to allow the appropriate initial triage of the patient. Initial triage will occur within MSK Physiotherapy and if appropriate will be passed to spinal advanced practice physiotherapy service.
- Please signpost patients to Integrated Spinal Service Webpage for patient information.
Other information
For all routine cases of cervical spine pain and cervical spine related arm symptoms who meet the criteria under “who to refer”, referral to other specialities including Orthopaedics, Neurosurgery, Neurology & Rheumatology is not indicated. Once within the service patients will be able to access all the multidisciplinary services that are required for their problem including physiotherapy, investigation, surgical opinion and pain clinic opinion. There will be no need for patients to return to their GP to seek additional referrals or investigations for the cervical spine problem. The service is underpinned by agreed pathways, escalation criteria and multidisciplinary clinics.
For further information see associated sections
Link to NHS Lothian patient internet site including patient information resources – Neck Pain – Musculoskeletal Physiotherapy
Link to NHS Inform page cervical spine problems –Neck problems | NHS inform
Link to NHS Inform page- neck conditions Neck and back problems and conditions | NHS inform
Link to NHS Inform page- Exercises for neck problems Exercises for neck muscle and joint problems | NHS inform
Link to intranet site NHS Lothian Integrated Spinal Service Integrated Spinal Service – NHS Lothian | Our Services
