How serious is your neck pain?

Even with a thorough medical workup, it can be tough to identify the precise cause of neck pain. When there is no clear explanation for neck pain, the goal of treatment is to ease discomfort and restore normal function.

A number of medical specialists treat neck pain, including orthopedic surgeons, neurologists, and rheumatologists. It is always a good idea to start off with your primary care doctor. She or he can help rule out some common causes of neck pain and can refer you to the specialist that will likely be most helpful.

When neck pain is annoying or interferes with quality of life, it is certainly serious to the sufferer. The Neck Pain Task Force—which represents a number of specialties and institutions—recommends a classification system for neck pain based on medical history and physical exam. It is intended to help physicians screen for urgent conditions and to guide appropriate testing and treatment. These are the neck pain classifications:

• Grade 1: No signs of a major underlying problem (such as fracture) and little interference with daily activities.

Recommendation: No further imaging or laboratory tests are needed. The patient should remain as active as possible.

• Grade 2: No signs of a major underlying problem, but neck pain does interfere with daily activities.

Recommendation: In the early stages, additional imaging or laboratory tests are not necessary; treatment should focus on short-term management of symptoms.

• Grade 3: Neck pain with neurological signs or symptoms, such as nerve compression.

Recommendation: Focus should be on short-term management of symptoms; close monitoring; and CT, MRI, or electrodiagnostic tests in patients with severe or progressive symptoms.

• Grade 4: Neck pain with a major underlying problem such as fracture, myelopathy, tumor, or infection.

Recommendation: Test as needed to quickly determine the underlying problem and treat appropriately.

For more information on managing neck and shoulder pain, purchase Neck and Shoulder Pain by Harvard Medical School.