What are the most common causes of neck pain?
• Cervical strain and/or myofascial pain: must rule out contributing causes such as sleeping difficulties, poor workplace ergonomics, and posture problems.
• Cervical spondylosis (osteoarthritis), discogenic neck pain, or facet joint pain: there is a poor correlation between radiographic abnormalities and whether or not a patient is having neck pain. Lidocaine injection of the facet joints can determine if facet joint arthritis is the pain generator.
• Cervical whiplash syndrome: caused by a traumatic event causing abrupt flexion/extension of the neck usually following a rear end collision. The exact pathology is unclear although injury to articular capsules, ligaments, tendons, muscles and nerves/nerve roots is presumed. Pain can be chronic in 20% to 40% of patients in spite of no abnormality being seen on imaging; 3% to 4% of patients are unable to return to work. Clinical variables associated with prolonged symptoms include severity of post-injury pain, anxiety, catastrophizing, and compensation/legal factors. In contrast, objective measures such as MRI findings and factors related to the collision have not been associated with chronic pain and disability.
