Pain in the Neck: Many (Marginally Different) Treatment Choices

Neck pain is a highly prevalent and costly symptom.Available studies estimate that the 1-year incidence of neck pain ranges from 10.4 % to 21.3%, with a higher incidence noted in office and computer workers. Although between 33 % and 65 % of people recover from an episode of neck pain within 1 year, relapses are common (1). The prevalence is generally higher in women than in men, higher in high-income countries than in low- or middle-income countries, and higher in urban areas than in rural areas. Many factors influence the onset and course of neck pain, including such nonmodifiable risk factors as age, sex, and genetics. Modifiable factors include exposure to to-bacco and poor psychological health (2). Of note, cervical disc degeneration is not an identified risk factor (2). Few population-based studies have been done on the economic burden of neck pain, but a 1996 Dutch study (3) estimated the total costs to be $686 million, which represented approximately 1 % of total health care expen-ditures and 0.1 % of the gross domestic product of the Netherlands. Thus, it seems that the economic burden of neck pain is substantial in the Netherlands and perhaps in other high-income countries. Clinicians offer various therapies to patients who seek conservative care for neck pain. A search of the Cochrane library revealed systematic reviews on medication (4); man-ual therapies, including manipulation and mobilizatio