How to treat chronic neck pain

  Chronic neck pain is a type of disease that is characterized by a combination of symptoms such as pain and numbness in the shoulder, neck and upper extremity, and usually lasts for more than 6 months. The disease used to be common in middle-aged and elderly people, but in recent years, with the change of people’s life and work style, the incidence of chronic neck pain is on the rise and the trend of lower age. Since the diagnosis and evaluation of the disease are mainly based on the subjective feelings of patients, and in China, the diagnosis and study of chronic neck pain traditionally fall under the category of cervical and neurogenic cervical spondylosis.  Regarding the prevalence of chronic neck pain in the general population, Hogg-Johnson et al. found in a literature review of the last decade that the prevalence of neck pain in the general population ranged from 0.055/1000 to 213/1000 individuals, and the prevalence of neck injury due to exercise ranged from 0.02/1000 exposed individuals to 21/1000 exposed individuals, with 30% to 50% of Patients with a disease duration of 12 months or more, and about 1.7% to 11.5% of patients with activity limitation due to pain, with more women than men. Risk factors include family history, poor mental health, and smoking, while disc degeneration is not a risk factor for neck pain. carroll et al. identified the factors affecting the prognosis of chronic neck pain through a review of the literature in the last decade, and concluded that the main factors affecting prognosis are psychological factors, such as the patient’s mental health, coordination, and social interaction skills, which can significantly affect the prognosis. A cohort study conducted by Boström et al. with a sample size of 2914 young students aged 18-25 years suggested that chronic pain in the shoulder, neck and upper limb is one of the main risk factors for energy loss in young people, especially in the female population. Cassidy et al. explored the feasibility of using public health interventions to manage chronic neck pain, but concluded that there is currently no evidence to support the use of group-level interventions to effectively manage the condition.  Despite the fact that chronic neck pain is a common clinical problem, there is still a lack of high-quality evidence-based studies that scientifically evaluate the efficacy of various treatments for the condition [5]. The current approach to the treatment of chronic neck pain is mainly derived from clinical experience. Proactive prevention of chronic neck pain includes improving the work environment and promoting the use of a suitable chair to maintain a better posture. In addition, the use of appropriate neck supports and neck exercises during sleep can improve the symptoms of neck pain. In terms of passive treatment, therapies include massage, acupuncture, mechanical traction, and electrotherapy, all of which are considered to have limited efficacy after clinical studies. Non-steroidal analgesic drugs (NSAIDs), myorelaxants and analgesics are the current mainstream treatments. Local injections of analgesic drugs and/or the addition of corticosteroids provide good pain relief. The goal of pharmacological treatment is to relieve pain to help restore normal neck motion. The main indication for surgical treatment, represented by cervical fusion, is for the rare cases where non-surgical treatments have failed.  In terms of traditional/alternative therapies, acupuncture is performed by acupuncturists who needle acupuncture points and apply different needle manipulation techniques, or through electrical and thermal stimulation, as well as moxibustion and injection of herbal extracts at acupuncture points, in order to activate the patient’s own meridian system and obtain pain relief, which has the advantages of good pain relief, safety and few adverse reactions, and has been widely carried out at home and abroad, and its clinical efficacy and mechanism of action have been studied. The clinical efficacy and mechanism of action have been studied. For example, Trinh et al. conducted a meta-analysis of the literature on acupuncture for the treatment of chronic neck pain, searching the literature of RCT and quasi-RCT clinical trials reported up to the end of February 2006 from CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL and other databases, and the inclusion criteria used the Jadad score, and a total of 10 studies were included (661 cases in total, with a mean Jadad score of 2.5. The mean Jadad score was 2.3/5), and control interventions included sham acupuncture and other therapies (exercise, massage, traction, etc.) The results of the study suggest that acupuncture has slightly better short-term efficacy in relieving pain than the control group, and has the advantages of being safe and having mild adverse effects.  For the treatment of chronic neck pain with acupuncture, methods include simple traditional acupuncture, abdominal acupuncture, acupuncture with transcutaneous electrical stimulation, acupuncture injection of herbal preparations, acupuncture combined with herbal treatment, acupuncture combined with physiotherapy, skin acupuncture, pricking, and small needle knife.