The nature of neck pain in a private pain clinic in the United States
One article on PainSci cites Yin 2008: The Complete Guide to Chronic Tension Headaches
PainSci commentary on Yin 2008: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
This study reports on the prevalence of different causes of neck and headache pain diagnosed in a busy spinal pain clinic for two years in the early 2000s, concluding that “a patho-anatomic diagnosis for chronic neck pain can be established in over 80% of patients,” and more specifically they reported facet joint pain in 55% of patients, discogenic pain in 16%, and lateral atlanto-axial joint pain 9%.
This isn’t exactly premium data! It’s all from one place, all filtered through the same professional’s biases and bad habits. The diagnostic accuracy is probably far from perfect, and some critics would undoubtedly argue that the authors’ stats are fanciful, and their diagnoses say more about their biases than their patients’ necks. But Dr. Nikolai Bogduk is a particularly expert source and the data is better than nothing. Even if the percentage of cases where specific diagnosis has been substantially exaggerated, it’s still a noteworthy proportion. And, as they point out, some of their findings are consistent with other research.
(There is an fairly glaring error in the abstract: they write that “a diagnosis remained elusive in only 32%” and yet a specific diagnosis can be made in “80% of patients”? Something’s wrong with that math!)
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVE: To determine the prevalence of different causes of neck pain in a private practice clinic.
DESIGN: A retrospective audit of records.
SETTING: A private spine pain clinic in the state of Washington, USA.
PATIENTS: All consecutive patients, seen between January 2003 and January 2005, in whom a diagnosis of neck pain was made.
INTERVENTIONS: The records of all patients were examined to determine the prevalence of various diagnostic entities determined by history, examination, and invasive test such as controlled diagnostic blocks and provocation discography.
OUTCOME MEASURES: Using different denominators, the prevalence of various conditions was determined in all patients who presented with neck pain, in patients in whom investigations were undertaken, and in patients who completed investigations.
RESULTS: A large proportion of patients (36%) did not pursue investigations, which diluted the crude prevalence of various conditions. A further 17% deferred completing investigations. Among the 46% of patients who completed investigations, the prevalence of zygapophysial joint pain was 55%, discogenic pain was 16%, and lateral atlanto-axial joint pain was 9%. A diagnosis remained elusive in only 32% of those patients who completed investigations.
CONCLUSIONS: In a private practice setting, a patho-anatomic diagnosis for chronic neck pain can be established in over 80% of patients, provided that appropriate investigations are undertaken. The prevalence of cervical zygapophysial joint pain encountered in the present study corroborates the prevalence rates established in academic studies. Cervical discogenic pain does not appear to be common among patients with chronic neck pain.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.