Advances in the diagnosis and management of neck painBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3221 (Published 14 August 2017) Cite this as: BMJ 2017;358:j3221
All rapid responses
I read with a particular interest the review “Advances in the diagnosis and management of neck pain” by Steven P. Cohen and W. Michael Hooten. It represents an excellent state of the art of diagnosis and treatment of neck pain, except for work adaptation required among patients who are working.[2,3] Indeed, the authors stated the potential occupational factors involved in neck pain by differentiating:
- the axial non-radicular cause corresponding to perceived stress at work (“low job satisfaction and poorly perceived work support”), both associated with onset and poor prognosis and sometimes prolonged active posture (also called tension neck syndrome, or non-specific neck pain).[4,5]
- from the radicular cause that might be related only to extreme biomechanical factors (athletes, aviators/astronauts) or trauma, but not to minor repetitive trauma or carrying loads.[2,6] Stress at work might also be a poor prognosis factor.
Taking these factors into account, the authors should include them in the treatment to avoid recurrence and improve outcomes. In non-radicular cause, management of stress at work is probably effective, as the opposite of decreasing biomechanical loads is not (except for some cases of posture). For radicular cause, considering that work is not a major risk factor, work adaptation should not be recommended, except for extreme conditions where prevention of trauma is important and sometimes a short decrease of constraints for pain management purposes.
1 Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ 2017;358:j3221.
2 Cote P, van der, Cassidy JD, et al. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine Phila Pa 1976 2008;33:S60–74.
3 Roquelaure Y, Petit A. Surveillance médico-professionnelle du risque lombaire pour les travailleurs exposés à des manipulations de charges. Recommandations de Bonne Pratique. ArchMalProfEnviron 2014.
4 Sluiter BJ, Rest KM, Frings-Dresen MH. Criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders. ScandJ Work EnvironHealth 2001;27 Suppl 1:1–102.
5 McLean SM, May S, Klaber-Moffett J, et al. Risk factors for the onset of non-specific neck pain: a systematic review. J Epidemiol Community Health 2010;64:565–72. doi:10.1136/jech.2009.090720
6 Nouri A, Tetreault L, Singh A, et al. Degenerative Cervical Myelopathy: Epidemiology, Genetics, and Pathogenesis. Spine 2015;40:E675-693. doi:10.1097/BRS.0000000000000913
7 Despréaux T, Saint-Lary O, Danzin F, et al. Stress at work. BMJ 2017;357:j2489.
Competing interests: No competing interests