Neck Pain in Primary Care: Prognosis and methodology

Neck pain is one of the most common musculoskeletal complaints in adults in the general population, with an estimated point prevalence of 20.6-22.2% and a 1-year prevalence of 31.4-35.6%. About half of those who experience neck pain consult their general practitioner (GP) for this complaint. In daily practice this means that a GP is consulted about five times a week for an episode of neck pain. The risk of developing neck pain is highest in women and in people of middle age (40-49 years). The etiology of neck pain is largely unknown, but the involvement of genetic factors has been suggested. When patients report that they have neck pain it means that they experience pain with or without stiffness in the region between the back of the head and the shoulders. Most of the episodes of neck pain are of unknown origin, usually referred to as non-specific neck pain.However, GPs have to be alert for specific causes of the neck pain like infection, fracture, rheumatic disease, or malignancy. Therefore, patient history and physical examination should be aimed at evaluating possible signs (“red flags”) of a specific cause like a preceding trauma, unexplained weight loss, neurologic signs of spinal compromise, signs of infection, a previous history of cancer or neck surgery. In case there is no sign of an underlying specific disorder, it is not useful to perform a physical examination of the neck, because the reproducibility and predictive value of physical tests are poor to moderate. The same accounts for additional testing like blood tests or diagnostic imaging: if used in patients with non-specific neck pain they do not add useful information for further management of the patient.

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