Medical Associates Clinic

 Quality Care Close To Home

Central  South  Dakota Medical News
The Clinical View
by P.E. Hoffsten, M.D.
29 May 2002

A PAIN IN THE NECK

     Of all the many complaints for which patient’s seek medical attention, neck pain is relatively common.  About half of the population has a musculoskeletal pain in their neck that limits their function sometime during their life.  The problem can originate from falls or injuries or sometimes simply the strain of everyday life.  We have all seen that determined posture when one “bows their neck” while challenging another individual.   If one considers the stress a person’s neck is experiencing at that time, it would be no wonder their neck hurts.

       When a person seeks medical attention for musculoskeletal neck pain, physicians generally prescribe an anti-inflammatory medication such as Motrin, Aspirin or Aleve. Alternatively, simple pain medications such as Tylenol or Darvon (propoxyphene) are helpful for some individuals.  Most of the time, rest, local application of heating pad, and the above medications will resolve the problem especially if it is due to injury.

     If the neck pain persists, physicians will frequently refer the patient to a physical therapist.  They can help with various exercises, local application of heat and massage that is effective in some patients.

       In our society,  another alternative that many individuals take advantage of,  is the chiropractor.   Their approach and treatment is derived from a different school of thought from the classical physician.  Over the years, there has been controversy about what type of treatment works best for individuals with musculoskeletal neck pain.

     A very reliable medical journal called The Annals of Internal Medicine is published every two weeks by a group called the American College of Physicians.  This is a group of internists who originally were comprised of university professors.  Today, the American College of Physicians is made up of internal medicine physicians who have passed various examinations and met several other criteria.  The letters FACP after your doctor’s name means that he has gone the extra mile in training.  The articles that appear in the Annals in Internal Medicine are credible, reliable information.

     With this background, an article that appeared in that journal in the past week has special meaning. Specifically, a group of physicians evaluated how well patients with musculoskeletal neck pain responded to either their usual physician care, physical therapy, or chiropractic care.  The patients were evaluated seven weeks after their complaints had initially occurred.  At that time, it was found that seven out of ten individuals who went to a chiropractor were relived of their symptoms.  Only 50% of those individuals using physical therapy, were successfully free of symptoms.  I am ashamed to say it, but only 36% of the patients treated by medical doctors were free from symptoms.  This study involved 180 patients who were randomly assigned to each type of treatment.  The answer is very clear.  Chiropractors do twice as well with musculoskeletal neck pain as doctors do.

     Musculoskeletal neck pain means that there is no nerve or spinal cord damage in the neck.  Of all the people that have pain in their neck, it is relatively rare that the pain is due to a pinched nerve or a compression of the spinal cord.  The study mentioned above did not include individuals that had this type of problem but in my experience, separating those individuals who have musculoskeletal pain from those who have pain originating from pinched nerves is not all that difficult.  The need for MRI scans or CAT scans of the neck is relatively unusual.  In those situations, where a nerve pinch  or cord compression is felt possible special x-rays may need to be taken and surgical intervention considered but this is very unusual.

     As we all know, muscular pain is relatively common when the muscles in our neck are strained or injured.  Generally, the problem will clear by itself with rest and an anti-inflammatory drug.  In those situations where the problem doesn’t clear quickly, the chiropractors do a whole lot better with this type of problem than do medical physicians or physical therapists.  It has been my experience that the chiropractors have been able to separate out those people who they can help from those who might need more extensive x-ray type of evaluation and possibly surgical intervention.

     I will probably get drummed out of the corps or defrocked for writing this column but the article appeared in our own Annals of Internal Medicine published by the internal medicine doctors.