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Neck pain is a common complaint. The prevalence is approximately between 75% and 80% in the U.S. population. Fortunately, acute neck pain has a very favorable prognosis, with 80% of cases resolved within 2 years.1 But 20% of cases are estimated not to improve and of these, 5% are characterized by severe disabling chronic neck pain.2 The International Association for the Study of Pain (IASP) describes chronic cervical spine pain as follows: Pain perceived as arising from anywhere within the region bounded superiorly by the superior nuchal line, inferiorly by an imaginary transverse line through the tip of the first thoracic spinous process, and laterally by sagittal planes tangential to the lateral borders of the neck.3 The potential sources of neck pain are derived from those structures that have abundant nociceptive innervation, which include the cervical zygapophysial (facet) joints (including atlantoaxial and atlanto-occipital), posterior neck muscles, cervical intervertebral discs, vertebral bodies, anterior and posterior ligaments, dura mater of cervical spine, prevertebral muscles, carotid and vertebral arteries, and the transverse ligament.4 The paucity of nociceptors in ligamentous structures makes them less likely to cause pain. The neck is a very mobile structure and is, therefore, susceptible to trauma in addition to wear and tear. It is further burdened by the weight of the head and rests on a relatively fixed thorax.


The evaluation of neck pain is based upon history, physical examination, radiologic, and laboratory tests. In the assessment of acute pain, history is of paramount importance in that it offers clues to potentially rare but serious disorders (Table 37-1).

TABLE 37-1

Classification of Neck Pain

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