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Introduction
Neck pain is a common condition and a leading cause of disability worldwide. 1 2 Despite the enormous burden that neck pain exacts on society, it attracts only a fraction of the research money and publicity given to back pain. 3 In this article, we explore the epidemiology, diagnosis, and treatment of neck pain. Emphasis is given to controversial topics and treatments that are most commonly used and investigated (such as integrative and interventional treatments), with particular attention paid to areas that are most relevant to academics and specialists.
Sources and selection criteria
In February 2017, we searched the Medline database, Embase, Google Scholar, and the Cochrane Database of Systematic Reviews using the search terms "cervical pain", "neck pain", "cervical radiculopathy", "cervical radicular pain", and "cervical myelopathy", with no restrictions. For individual sections, key words relating to the relevant topics (for example, facet joint, epidural steroid injections, physical examinations, antidepressants, acupuncture, and surgery) were identified and cross referenced with the initial search terms using the above databases. We considered animal and experimental studies, systematic and other reviews, meta-analyses, clinical trials, and for certain sections in which higher grade evidence was lacking (such as treatment and complications) case reports and case series. Systematic reviews and clinical trials, particularly larger randomized studies, were prioritized over lower grade evidence. We also obtained additional articles by examining reference lists.
Epidemiology
Neck pain has a high prevalence in developed countries. One systematic review estimated mean point, annual, and lifetime prevalence rates of 7.6% (range 5.9-22.2%), 37.2% (range 16.7-75.1%), and 48.5% (range 14.2-71%), respectively. 1 According to the Global Burden of Disease 2010 study, neck pain is the fourth most common cause of disability in the United States, after back pain, depression, and other musculoskeletal disorders. 2 Women are more likely to experience neck pain, with peak prevalence occurring in middle age. 1 4 A recent review estimated that the annual cost of low back and neck pain was $87.6bn (£67.8bn; €77.2bn) in the US, ranking third behind diabetes and heart disease. 5
Risk factors
Several risk factors predispose to the development of neck pain, including psychopathology, genetics, sleep problems, smoking, obesity, sedentary lifestyle, previous neck pain, trauma, back pain, and poor general health. 6 7 8 9 Sports and...