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Abstract & Commentary
Synopsis: Neck pain is common among the general population. Half of those patients who report this symptom have persistent complaints at 1 year. At particular risk for persistent neck pain are those ages 45-59 years, those with chronic low back pain, and patients who ride their bicycles regularly.
Source: Hill J, et al. Spine. 2004;29:1648-1654.
This study was aimed at evaluating the clinical predictors for chronicity among those patients who consult healthcare providers for neck pain. It was designed in 2 phases. The first phase was a baseline survey aimed at identifying a group of patients suffering from neck pain, as well as the characteristics of the pain. The second phase was a 1-year follow-up survey to estimate the persistence of symptoms and any possible links between the patients’ characteristics and the persistence of symptoms. The target population for the baseline survey included 7669 adults, 18-75 years of age, in the United Kingdom, followed in primary care clinics.
The initial assessment included demographic data such as age and gender, as well as specific sociodemographic factors that were categorized according to the Standard Occupational Classification. Other health-related questions such as tobacco use and alcohol intake were noted. Psychological distress was ascertained, as well as occupational factors. Twelve months later, a follow-up survey was mailed to participants specifically inquiring about the quality and intensity of the neck pain and associated factors.
There were 4501 responders to the baseline survey, of whom 4393 answered the question regarding neck pain. Thirty-one percent of adults reported neck pain at baseline. There were 768 replies to the follow-up instrument, and of these, 48% reported neck pain at 1 year.
The 1-year persistence of neck pain showed little difference between genders. However, there were statistically significant differences in the reporting of persistent neck pain across different age groups, with the highest being among those ages 45-59 years. Increased daily alcohol consumption was associated with less persistent pain. Significant risk factors noted to be associated to persistent neck pain included: poor general health, poor psychological health, low back pain, and previous neck injury.
The mean number of years since the neck injury was 12.7 among those reporting neck pain at follow-up. Another interesting risk factor identified in this study was routine cycling.
Comment by Joseph Varon, MD, FACP, FCCP, FCCM
Neck pain remains a common complaint for patients presenting to primary care practices. Trying to estimate the burden of this musculoskeletal problem in the community has been attempted in the past.1,2 However, the study by Hill and colleagues is the first to investigate the prevalence of persistent neck pain, and the risk factors for persistence by prospectively following the study population for 1 year.3
This study is important as it presents interesting and compelling data regarding specific risk factors associated with persistent neck pain. The strongest predictor for persistence was age, being most frequent in adults ages 45-59 years. This is consistent with consultation rates for patients presenting to primary practices with spine complaints.4 One possible explanation for this finding may be that there could be a higher prevalence of structural spine disease in this age group.
On the other hand, the link noted in this paper between comorbidity and neck pain persistence may be explained by underlying predisposition to regional musculoskeletal pain syndromes.5 Patients with concurrent low back pain would be the classic examples.
Interestingly, cycling was observed to be a strong independent risk factor for persistent pain. This can be related to the impact of postures adopted during cycling, repeated vibration, neck rotation required, and the active use of neck extensor muscle groups.
Clinicians caring for patients with persistent neck pain must individually consider each patient, but based on the results of the study by Hill et al, they need to carefully look for comorbid conditions and relate their findings to secondary prevention strategies.
Dr. Varon is a Professor at the University of Texas Health Science Center in Houston, Texas.
1. Lau EM, et al. J Public Health Med. 1996;18:396-399.
2. Urwin M, et al. Ann Rheum Dis. 1998;57:649-655.
3. Hill J, et al. Spine. 2004;29:1648-1654.
4. Papageorgiou AC, et al. Spine. 1995;20:1889-1894.
5. Linton SJ. Spine. 2000;25:1148-1156.