The nature of neck pain in a private pain clinic in the United States.

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.

[1]  L. D. De Souza,et al.  Neck pain and disability: A cross‐sectional survey of the demographic and clinical characteristics of neck pain seen in a rheumatology clinic , 2004, International journal of clinical practice.

[2]  Paris Jean Aicardi,et al.  Diseases of the Nervous System: Clinical Neuroscience and Therapeutic Principles , 2004, European Child & Adolescent Psychiatry.

[3]  N. Bogduk,et al.  The Neuromuscular Disease Center: www.neuro.wustl.edu/neuromuscular , 2003, Journal of neurology, neurosurgery, and psychiatry.

[4]  P. Watson,et al.  Clinical Pain Management: Chronic Pain , 2002 .

[5]  L. Manchikanti,et al.  Prevalence of cervical facet joint pain in chronic neck pain. , 2002, Pain physician.

[6]  N. Bogduk,et al.  Occipital Headaches Stemming From the Lateral Atlanto-Axial (C1-2) Joint , 2002, Cephalalgia : an international journal of headache.

[7]  G. Bashford,et al.  Diagnostic cervical zygapophyseal joint blocks for chronic cervical pain , 2001 .

[8]  S. A. Grubb,et al.  Cervical discography: clinical implications from 12 years of experience. , 2000, Spine.

[9]  N Bogduk,et al.  Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. , 1996, The New England journal of medicine.

[10]  S. Fukui,et al.  Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami , 1996, Pain.

[11]  Susan M. Lord,et al.  Chronic Cervical Zygapophysial Joint Pain After Whiplash: A Placebo‐Controlled Prevalence Study , 1996, Spine.

[12]  K. Schellhas,et al.  Cervical Discogenic Pain: Prospective Correlation of Magnetic Resonance Imaging and Discography in Asymptomatic Subjects and Pain Sufferers , 1996, Spine.

[13]  N. Bogduk,et al.  The Prevalence of Chronic Cervical Zygapophysial Joint Pain After Whiplash , 1995, Spine.

[14]  M. Janssen,et al.  A Correlation of Cervical Magnetic Resonance Imaging and Discography/Computed Tomographic Discograms , 1994, Spine.

[15]  N. Bogduk,et al.  Third occipital nerve headache: a prevalence study. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[16]  P Dreyfuss,et al.  Atlanto‐Occipital and Lateral Atlanto‐Axial Joint Pain Patterns , 1994, Spine.

[17]  N. Bogduk,et al.  On the nature of neck pain, discography and cervical zygapophysial joint blocks , 1993, Pain.

[18]  A. Aromaa,et al.  Prevalence, determinants, and consequences of chronic neck pain in Finland. , 1991, American journal of epidemiology.

[19]  H. Valkenburg,et al.  The associations of neck pain with radiological abnormalities of the cervical spine and personality traits in a general population. , 1991, The Journal of rheumatology.

[20]  N. Bogduk,et al.  Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. , 1990, Spine.

[21]  J. Lawrence.  Disc degeneration. Its frequency and relationship to symptoms. , 1969, Annals of the rheumatic diseases.

[22]  Don King,et al.  NECK AND ARM PAIN. , 1964 .

[23]  N. Bogduk.  Neck pain and whiplash , 2008 .

[24]  J. Seres.  Long-term follow-up of patients treated with cervical radiofrequency neurotomy for chronic neck pain. , 1999, Neurosurgery.

[25]  A. Croft.  Neck pain in the general population. , 1995, Spine.

[26]  F. Regli,et al.  [Cervical pain]. , 1985, Revue medicale de la Suisse romande.

[27]  L HULT,et al.  Cervical, dorsal and lumbar spinal syndromes; a field investigation of a non-selected material of 1200 workers in different occupations with special reference to disc degeneration and so-called muscular rheumatism. , 1954, Acta orthopaedica Scandinavica. Supplementum.