Determinants, characteristics and treatment of neck pain in a tertiary care hospital in Kerala

Liya Roslin Joseph


Background: This study was undertaken to study the determinants, clinical characteristics and treatment pattern of neck pain in patients attending outpatient department of Physical medicine and Rehabilitation in a tertiary care hospital.

Methods: Study comprehended single patient visit. Data regarding patient demographics, characteristics of neck pain and clinical diagnosis, drugs prescribed to each patient were recorded in a pre prepared proforma. Clinician’s opinion about patient’s X-ray of cervical spine and the data regarding alternative treatment modalities were also noted. Data analysis was done with the help of excel 2007 and SPSS 16 statistical software.

Results: Among 170 patients included in the study 38.8% of patients were in the age group of 40-49 years with M:F ratio-1:2.9. 98.8% of patients experienced radiation of neck pain to one or both arms. Neck pain also was associated with numbness in arm (82.4%), forearm (61.8%) or hand (59.4%) and neck stiffness (99.4%). Half of the study population were found to have neurological deficit. 98.2% of patients had positive radiological evidence for neck pain. Cervical spondylosis (85.9%) was the most commonly observed cause for neck pain. All patients received pharmacotherapy with NSAIDS and muscle relaxants. Diclofenac was the most commonly prescribed NSAID. 45% of the patients received alternative and complementary treatments for neck pain.

Conclusions: NSAIDs and central skeletal muscle relaxants are the commonly prescribed medications and alternative treatments like spinal manipulation and physiotherapy appears to be beneficial in patients with neck pain.


Cervical spondylosis, Neckpain, NSAIDs, Skeletal muscle relaxants

Full Text:



Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006;15:834-48.

Strine TW, Hootman JM. US national prevalence and correlates of low back and neck pain among adults. Arthritis Rheum. 2007;57:656-65.

Son KM, Cho NH, Lim SH, Kim HA. Prevalence and risk factor of neck pain in elderly Korean community residents. J Korean Med Sci. 2013;28:680-6.

Kääriä S, Laaksonen M, Rahkonen O, Lahelma E, Leino-Arjas P. Risk factors of chronic neck pain: a prospective study among middle-aged employees. Eur J Pain. 2012;16:911-20.

US Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310:591-608.

Zhen PC, Zhu LG, Gao JH, Yu J, Feng MS, Wei X et al. Clinical observation on improvement of motion range of cervical spine of patients with cervical spondylotic radiculopathy treated with rotation-traction manipulation and neck pain particles and cervical neck pain rehabilitation exercises. Zhongguo Gu Shang. 2010;23(10):750-3.

Furlan JC, Kalsi-Ryan S, Kailaya-Vasan A, Massicotte EM, Fehlings MG. Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases. J Neurosurg Spine. 2011;14(3):348-55.

Wang MC, Kreuter W, Wolfla CE, Maiman DJ, Deyo RA. Trends and variations in cervical spine surgery in the United States: Medicare beneficiaries, 1992 to 2005. Spine. 2009;34(9):955-61.

Hirpara KM, Butler JS, Dolan RT, O'Byrne JM, Poynton AR. Nonoperative Modalities to Treat Symptomatic Cervical Spondylosis. Adv Orthop. 2011;20(11):29-48.

May S, Gardiner E, Young S, Klaber-Moffett J. Predictor variables for a positive long-term functional outcome in patients with acute and chronic neck and back pain treated with a McKenzie approach: a secondary analysis. J Man Manip Ther. 2008;16:155-60.

Murphy DR, Coulis CM, Gerrard JK. Cervical spondylosis with spinal cord encroachment: should preventive surgery be recommended. Spine J. 2010;10(10):916-7.

Lipetz JS, Lipetz DI. Disorders of the cervical spine. In DeLisa, Joel A, Gans, Bruce M editors. Physical Medicine and Rehabilitation: Principles and Practice. 4th Edition, Lippincott Williams and Wilkins. 2005;1(27):610-33.

Trenga AP, Singla A, Feger MA, Abel MF. Patterns of congenital bony spinal deformity and associated neural anomalies on X-ray and magnetic resonance imaging. J Child Orthop. 2016 Aug;10(4):343-52.

Okada E, Matsumoto M, Fujiwara H, Toyama Y. Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers. Eur Spine J. 2011 Apr;20(4):585-91.

Lad SP, Patil CG, Berta S, Santarelli JG, Ho C, Boakye M. National trends in spinal fusion for cervical spondylotic myelopathy. Surg Neurol. 2009;71(1):66-9.

Flood J. The role of acetaminophen in the treatment of osteoarthritis.Am J Manag Care. 2010;16:S48-54.

Childers MK, Borenstein D, Brown RL, Gershon S, Hale ME, Petri M et al. Low-dose cyclobenzaprine versus combination therapy with ibuprofen for acute neck or back pain with muscle spasm: a randomized trial. Curr Med Res Opin. 2005;21(9):1485-93.

Borenstein DG. Chronic neck pain: how to approach treatment. Curr Pain Headache Rep. 2007;11(6):436-9.

Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015;90(2):284-99.

Bronfort G, Evans R, Anderson A, Svendsen KH, Bracha Y, Grimm, RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012;156:1-10.