J. Fandim1, R. Nitzsche1, L. Costa1, Z. Michaleff2, B. Saragiotto1
1UNICID - Universidade Cidade de São Paulo, Masters and Doctoral Programs in Physical Therapy, São Paulo, Brazil, 2Faculty of Health Sciences and Medicine, Bond University, Institute for Evidence-Based Healthcare, Gold Coast, Australia

Background: Neck pain is an important public health problem ranking fourth in terms of years lived with disability globally. Almost half of the world population will have at least one episode of neck pain in their lifetime. However, there is no recent overview on the epidemiology, diagnosis and treatment of neck pain.

Purpose: To provide an overview of the available evidence on prevalence, costs, diagnosis, prognosis, risk factors, prevention and management in patients with neck pain.

Methods: We conducted searches at Cochrane Library, MEDLINE and EMBASE databases up to July 2020. We included systematic reviews of costs, prevalence, risk factor, prognosis, prognostic factor and interventions in patients with neck pain. We gave preference to Cochrane review when available.

Results: The point prevalence of neck pain is estimated as 8%, 23% for 1-month prevalence, 37% for 1-year prevalence and 48% for lifetime prevalence. Neck pain is more prevalent in woman compared to men in all age groups, high-income countries and urban areas. In the US, low back and neck pain have a high care cost estimated of U$ 135 billion in 2016. The main risk factor with high association for developing neck pain are high body mass index, having history of neck pain and high perception of muscle tension. Patients with neck pain improved rapidly in terms on pain intensity and disability in the six weeks or fully recover up to 12 months. In contrast more than half of patients will have residual symptoms between one to five years of initial episode. There are some evidence to interventions to prevent and management for neck pain patients. There is moderate quality evidence that an exercise program is better than no treatment, and that walking intervention in office workers is positive compared to no intervention to prevent a new episode of neck pain. There is moderate quality evidence for pharmacological treatment that the use of nonsteroidal anti-inflammatory drugs is better compared to placebo for reducing pain in patients with neck pain at immediate term, and lidocaine associated with stretching are effective compared to stretches alone for chronic neck pain. There is moderate quality evidence for physical therapy-based interventions showing that manipulation alone are effective compared to oral medication for reducing pain in acute and subacute neck pain, and that exercise are effective compared to waiting lists for patients with chronic neck pain. There is moderate quality evidence that patient educational are effective compared to no treatment for reducing pain intensity in acute whiplash at short term.

Conclusion(s): The prognosis of neck pain is favorable for the first six weeks but still a large proportion of people tend to develop chronic symptoms. Best evidence supports non-pharmacological interventions (exercise, manual therapy and education) instead of pharmacological interventions.

Implications: Our findings are limited by the small number of studies and poor methodological quality. There is a need for research to better elucidate pain mechanisms, the effectiveness of interventions, and research to enable the early identification of those at risk of poor prognosis or non-recovery.

Funding, acknowledgements: Renato holds a master´s scholarship from CAPES

Keywords: neck pain

Topic: Musculoskeletal: spine

Did this work require ethics approval? No
Institution: UNICID
Committee: Not applicable
Reason: Because it is an narrative review

All authors, affiliations and abstracts have been published as submitted.

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