The patterns and treatment protocols associated with neck pain
Chronic neck pain, like low back pain, is common and difficult to treat
Neck pain is a debilitating condition that has a high prevalence throughout the general population, with some estimates claiming it affects 30-50% of adults every year. To make matters worse, roughly 50-85% of those who experience neck pain never rid themselves of symptoms completely, with some going on to experience chronic, impairing pain. Similar to chronic low back pain (LBP), chronic neck pain is usually unresponsive to treatment and costly for all parties involved, as figures show heath-care utilization and medical costs for spine conditions are continuing to increase steadily. Strangely enough, this increase in costs has not correlated with improvements in neck-related health. One possible reason for this may be related to clinicians not making treatment recommendations based on clinical guidelines. In addition, there is limited information on health care treatment protocols and whether those administering it are actually following current evidence available. Therefore, a study was conducted that sought to describe health care use for chronic neck pain and compare current patterns of use with the best available evidence for care of the condition.
Wide range of households surveyed to find specific candidates
The main source of data came from telephone surveys performed in North Carolina, with the ideal subject being someone with chronic impairing neck pain only who did not also have chronic impairing back pain. Chronic, impairing neck pain was defined as pain and activity limitations nearly every day for the past three months or more than 24 episodes of pain in the past year, with each episode limiting activity for one day or more. A total of 9,924 adults were rostered for the study, and 5,357 households with one or more adults 21 or older were contacted, of which 3,276 had one or more adults with a history of back and/or neck pain. Of these, 2,809 individuals were randomly selected and interviewed for more details on their neck/back pain history. Subjects were asked about their demographics, health, health care use (provider, treatments, tests), and pain symptoms. Results were then compiled to create a clearer picture of patterns.
Too much testing, physician variation, not enough effective treatments
Of the 2,809 subjects interviewed, 135 reported having chronic impairing neck pain only, which served as the study group. Figuring this into the total number of adults rostered, the point prevalence of chronic impairing neck pain was determined to be 2.2% of the population of North Carolina. Of the 135 subjects, 79.3% had at least one provider visit for their neck problem in the past year, with most seeking one or more physician types. A total of 72% of care seekers went to a primary care physician, 40% saw a chiropractor and 35.2% saw a physical therapist, which both also had the highest mean number and range of visits per provider (average of 17 visits to PT or chiropractor in the past year). Patients also saw orthopedic surgeons (31.6%), neurosurgeons (29.1%) and neurologists (22.8%). Tests were fairly prevalent for most subjects, with 45% having plain radiographs, 30% having MRIs and 24% having CT scans in the past year. The majority of subjects (56.3%) reported taking over the counter non-steroidal anti-inflammatory drugs (NSAIDs) and many took strong or weak narcotics, despite the lack of definitive findings for their effectiveness. The use of treatments varied substantially, with superficial heat, cold, therapeutic exercise, massage and manipulation being used most commonly. Of these, exercise and manipulation had the best evidence for effectiveness, yet only 53% and 37% of subjects, respectively, were prescribed these interventions. Heat, cold and massage, on the other hand, had unclear or inconclusive results, but were still prescribed just as much, and in some cases, more than other treatments.
These figures show that there is too much variation in the types of providers used, the tests administered (which often don't provide anything beneficial), and too many narcotics prescribed, while a number of ineffective treatments are implemented and effective ones overlooked. Therapeutic exercise administered through physical therapists is a proven treatment with evidence to support it, but just over a majority (53%) of subjects were prescribed it. Health-care providers should focus more on the evidence available for treatment of chronic neck pain while making decisions, and perhaps patients won't continue to jump through hoops and endure unnecessary protocols to treat their pain. This study clearly underscores the concept of utilizing evidence-based interventions for the best outcomes.
-As reported in the Nov. '10 edition of Arthritis Care & Research