Intended for healthcare professionals

Clinical Review State of the Art Review

Advances in the diagnosis and management of neck pain

BMJ 2017; 358 doi: (Published 14 August 2017) Cite this as: BMJ 2017;358:j3221
  1. Steven P Cohen, professor1 2,
  2. W Michael Hooten, professor3
  1. 1Departments of Anesthesiology and Critical Care Medicine, Neurology and Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21029, USA
  2. 2Uniformed Services University of the Health Sciences, Bethesda, MD 20889 USA
  3. 3Department of Anesthesiology and Perioperative Medicine, Mayo Clinic School of Medicine, Rochester, MN 55905 USA
  1. Correspondence to: S P Cohen scohen40{at}


Neck pain imposes a considerable personal and socioeconomic burden—it is one of the top five chronic pain conditions in terms of prevalence and years lost to disability—yet it receives a fraction of the research funding given to low back pain. Although most acute episodes resolve spontaneously, more than a third of affected people still have low grade symptoms or recurrences more than one year later, with genetics and psychosocial factors being risk factors for persistence. Nearly half of people with chronic neck pain have mixed neuropathic-nociceptive symptoms or predominantly neuropathic symptoms. Few clinical trials are dedicated solely to neck pain. Muscle relaxants and non-steroidal anti-inflammatory drugs are effective for acute neck pain, and clinical practice is mostly guided by the results of studies performed for other chronic pain conditions. Among complementary and alternative treatments, the strongest evidence is for exercise, with weaker evidence supporting massage, acupuncture, yoga, and spinal manipulation in different contexts. For cervical radiculopathy and facet arthropathy, weak evidence supports epidural steroid injections and radiofrequency denervation, respectively. Surgery is more effective than conservative treatment in the short term but not in the long term for most of these patients, and clinical observation is a reasonable strategy before surgery.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors: SPC conceived the design, wrote and reviewed the article and tables, helped with the figures and is guarantor. WMH wrote and reviewed the article and tables and helped with the figures.

  • Funding: Funded in part by the Centers for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences.

  • Competing interests: Both authors have read and understood BMJ policy on declaration of interests and declare that they have none.

  • The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

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