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Treatment of neck pain

Zacharia Isaac, MD
Section Editor
Steven J Atlas, MD, MPH
Deputy Editor
Howard Libman, MD, FACP


Approximately 10 percent of the adult population has neck pain at any one time. This prevalence is similar to low back pain, but few patients with neck pain lose time from work and less than 1 percent develop neurologic deficits.

The majority of patients, regardless of the etiology of pain, recover with conservative therapy [1]. Those with symptoms severe or persistent enough to require medical attention often present a treatment challenge due to the variability of patient symptoms and physical examination findings, lack of specificity of diagnostic imaging, an extensive differential diagnosis, and a relative lack of evidence-based guidelines for management.

Clinical disorders affecting the cervical spine can be categorized into two basic groups: those that cause significant axial neck pain and those that predominantly cause extremity pain and/or neurological dysfunction. Disorders that cause axial neck pain include cervical strain, internal disc disruption syndrome, cervical facet-mediated pain, cervical "whiplash" syndrome, and myofascial pain. Disorders that cause significant extremity symptoms and/or neurological dysfunction include cervical radiculopathy and cervical spondylotic myelopathy.

Various treatment modalities used to treat axial neck pain are often applied to patients with neck pain accompanied by extremity pain syndromes. Initial treatments directed at a specific cause of axial neck pain have not been shown to lead to improved outcomes compared with non-specific treatments. By contrast, patients with extremity pain with or without neurologic deficit are more likely to have chronic symptoms and require specific surgical intervention. There is no role for surgery for the majority of patients with isolated axial neck pain.

The management of neck-related pain is reviewed here. The evaluation of patients with neck complaints is discussed separately (see "Evaluation of the patient with neck pain and cervical spine disorders").

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Literature review current through: Nov 2017. | This topic last updated: Sep 21, 2017.
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