J Korean Neurosurg Soc.  2017 Jul;60(4):456-464. 10.3340/jkns.2015.0910.003.

Prognostic Factor Analysis for Management of Chronic Neck Pain: Can We Predict the Severity of Neck Pain with Lateral Cervical Curvature?

• Seong HY
• Lee MK
• Jeon SR
• Roh SW
• Rhim SC
• Park JH

• KMID: 2387884
• DOI: http://doi.org/10.3340/jkns.2015.0910.003

Abstract

OBJECTIVE
Although little is known about its origins, neck pain may be related to several associated anatomical pathologies. We aimed to characterize the incidence and features of chronic neck pain and analyze the relationship between neck pain severity and its affecting factors.
METHODS
Between March 2012 and July 2013, we studied 216 patients with chronic neck pain. Initially, combined tramadol (37.5 mg) plus acetaminophen (325 mg) was administered orally twice daily (b.i.d.) to all patients over a 2-week period. After two weeks, patients were evaluated for neck pain during an outpatient clinic visit. If the numeric rating scale of the patient had not decreased to 5 or lower, a cervical medial branch block (MBB) was recommended after double-dosed previous medication trial. We classified all patients into two groups (mild vs. severe neck pain group), based on medication efficacy. Logistic regression tests were used to evaluate the factors associated with neck pain severity.
RESULTS
A total of 198 patients were included in the analyses, due to follow-up loss in 18 patients. While medication was successful in reducing pain in 68.2% patients with chronic neck pain, the remaining patients required cervical MBB. Lateral cervical curvature, such as a straight or sigmoid type curve, was found to be significantly associated with the severity of neck pain.
CONCLUSION
We managed chronic neck pain with a simple pharmacological management protocol followed by MBB. We should keep in mind that it may be difficult to manage the patient with straight or sigmoid lateral curvature only with oral medication.

Keyword

Neck pain; Cervical spine; Lateral curvature; Sigmoid curvature; Medial branch block

MeSH Terms

Acetaminophen
Ambulatory Care Facilities
Colon, Sigmoid
Factor Analysis, Statistical*
Follow-Up Studies
Humans
Incidence
Logistic Models
Neck Pain*
Neck*
Pathology
Tramadol
Acetaminophen
Tramadol

Figure

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  Fig. 1 Management protocol for chronic neck pain. NRS: numeric rating scale.

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  Fig. 2 Patients were classified into four subtypes according to the location of pain. Lower occipital and neck pain was classified as Type I; isolated neck pain as Type II; neck and upper shoulder pain as Type III, lower occipital, neck, and shoulder pain as Type IV.

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  Fig. 3 Cervical curvature classifications.

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  Fig. 4 Detailed result of our treatment protocol in patients. MBB: medial branch block.

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  Fig. 5 A: MRI of 44-year-old male patients. MRI showed degenerative dark signals in multiple disc spaces and degenerative changes at the C4–5 level. B: MRI of 23-year-old male patients. MRI showed degenerative dark signals in multiple disc spaces. MRI: magnetic resonance imaging.

Reference

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