Patients With Severe Neck Pain Need Better Treatment, UK

Brunel University calls for national guidelines to ease misery of UK's estimated 19 million neck pain sufferers -



Current clinical treatment for severe neck pain prolongs distress and results in unnecessary sick leave, according to a study
from Brunel University. The research, one of the world's first studies to characterise neck pain and its consequences,
indicates that neck pain is often treated in isolation even though the sufferer may have other complaints.



The lack of understanding about the correct way to treat complex neck pain has led Brunel University to call for national
guidelines to ease the misery of the UK's estimated 19 million neck pain sufferers. The guidelines will also alleviate the
cost to business of avoidable sick days being taken by neck pain sufferers who are currently being given inappropriate
treatment. A multidisciplinary approach has been called for.


Neck Pain Study


The research by Brunel University's School of Health Sciences and Social Care and the Arthritis Centre at Northwick Park
Hospital was conducted amongst 173 people who had been referred to a rheumatology clinic. Nearly a quarter of those
questioned had severely disabling neck pain, which had resulted in them taking an average of 30 weeks off sick from during
their working lives, equating to considerable cost implications to employers. In addition, almost half, (47 per cent) had
taken sick leave for neck pain at some point during their working career.


The research found that although neck pain is commonly complicated by other physical and psychological complaints, patient
diagnoses did not take these factors into account. Results showed that 89 per cent of patients reported suffering from at
least one other condition. Eighty eight per cent of patients reported another musculoskeletal condition, whilst other
conditions reported included gastro-intestinal, respiratory and cardiac diseases. Over one-third (38 per cent) were given
neck pain as a sole diagnosis and the high degree of other conditions found in this study were not reflected in the working
clinical diagnosis reported back to the general practitioner after consultation.


The study also identified the significant impact of psychological distress on neck pain sufferers. The sleep patterns of 75
per cent of patients were disturbed by neck pain and those who reported sleep disturbance were significantly more disabled
than those who did not. The level of pain experienced made 60 per cent of subjects feel tearful and 42 per cent reported
that the pain made them cry.


Call for National Guidelines


According to Professor Lorraine H De Souza, head of Brunel University's School of Health Studies and Social Care, "Neck pain
is the 'poor cousin of back pain' but is estimated to affect up to 40 per cent of the adult population over the course of a
year. Unlike other forms of musculoskeletal pain such as back pain, there are no accepted national guidelines for the
classification or medical management of neck pain - and little is known about the disability caused by neck pain in the UK."
















The researchers of this study recommend the following five steps for improving the clinical management of neck pain:


-- Management of neck pain requires a bio-psychosocial model of care that includes recognising features related to trauma or
to lifestyle, including work.


-- Patients presenting with neck pain should be asked about other spinal sites of pain.


-- Patients presenting with either lower back or neck pain should have the whole spine examined in order to give appropriate
advice or therapy.


-- Patients demonstrating psychological distress need appropriate management e.g. medication for pain modulation or
psychological support. Such individuals may be better managed in a multidisciplinary rehabilitation programme.


-- Improving sleep may result in reduction of a patient's suffering. The fact that many wake with neck pain and stiffness
should point clinicians to unsatisfactory pillows or sleeping positions. Recommendations on pillows, such as those that
offer firm support for the neck lordos, or long-acting analgesics may be helpful.


Professor Lorraine H De Souza concludes, "Our study suggests that neck pain referred to hospital is commonly accompanied by
other physical and emotional conditions and unless treatment addresses all symptoms, patients' pain and distress is not
appropriately managed. The total amount of sickness absence due to neck pain reported by the patients in this study suggests
significant economic implications. Clearly more research needs to be conducted to determine the size of the problem and ways
of tackling it."


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Vanessa Green

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