October is Spinal Health Month and recent statistics show that neck pain is a significant contributor to a growing pain problem affecting millions of people each year. In a National Center of Health Statistics survey low back pain was the most common pain reported (27%) with neck pain suffered by 15% of people, the same percentage who experience severe headaches or migraine. Facial ache or pain was another common finding with 4% of people experiencing this phenomenon that is sometimes connected to cervical spinal problems. This survey did only ask about these four different types of pain however as they are thought the most common.
What Causes Pain?
Pain is usually a signal triggered by acute trauma, injury, or disease and can be a useful early warning sign that allows a patient to stop performing a certain action that could cause serious bodily harm. However, the complex signalling pathways involved in pain provide a number of opportunities for things to go wrong and pain to be triggered, or diminished, inappropriately. Receptors in the skin, organs, tissues, and nerves sense pressure, heat, cold, or other potentially damaging stimulus and send an electrical impulse to the nerve fibers and then the spinal cord. Patients with fibromyalgia are thought to have a heightened response to such signals which can cause them to experience severe pain when others would only sense light pressure or nothing of note. The signals sent to the spinal cord may make the journey up to the brain for interpretation but some take part in a feedback loop in the spinal cord itself. With chronic pain having developed into a major problem (more than 75million Americans report pain lasting more than 24hrs) the science of pain is a rich area of study.
A Bigger Problems than Cancer, Heart Disease, and Diabetes
Pain affects more people than cancer, diabetes, and heart disease combined and is more common in women and low-income adults. The disparity in the experience of pain is reflected in the treatment of pain and there are concerns that women are more likely to have their pain dismissed as subjective than men whose suffering is seen as less histrionic and more worthy of therapy and intervention. A third of those who report experiencing pain say that it is disabling and adversely affects their quality of life. The economic impact of chronic pain is substantial as health care expenses combine with reduced productivity and income deficits to total an estimated $100 billion ($85.9 billion of which is attributed to low back pain alone). Arthritis costs are estimated at $128 billion and are the leading cause of disability in the US.
Arthritis and Neck Pain
Arthritis and neck pain may also be contributing to lost work days and healthcare costs under the guise of migraines, fatigue, and depression or other mental health issues as those with chronic pain experience emotional problems and mood disorders at higher levels than those free of such pain. Those with lower back pain were found to be four times as likely to suffer serious psychological distress compared to those without low back pain and such findings may be able to be extrapolated to those suffering other kinds of pain that can have an impact on energy levels, social activities, ability to work, family life, and sexual well-being.
By 2030 an estimated 67 million people will have been diagnosed with arthritis, many of these with cervical spondylitis or spondylosis and some with conditions such as cervical spinal stenosis leading to pain in the upper limbs, the neck, and the face. Cervical arthritis can also lead to neurogenic claudication that can affect the health of the thyroid gland, vocal cords, and even respiration as innervation of these areas may be compromised.
Treating Neck Pain
Jaw pain, migraine, and lower facial pain, all of which can be factors in temporomandibular joint disorder (TMJ/TMD) are thought to affect more than 25 million people in the US, many of whom self-medicate, often inappropriately. Using over-the-counter remedies for pain may be fine for short periods but the long-term use of NSAIDs and other anti-inflammatories and analgesics can have profound effects on other aspects of health. There are also those who find little comfort in prescribed pain medication, or who become addicted to narcotic medications and the possibility of drug abuse connected to chronic pain reveals yet another problem affecting individuals, families, and society at large.
Accessing Treatment for Chronic Pain
The disparity in healthcare between people of different ethnicities is also a factor here as African-Americans and Hispanics are likely to be under-treated by some physicians and may find themselves turning to alternative sources of comfort, experiencing poorer employment prospects, and having things such as education and social mobility adversely affected by chronic pain. One study found that over 80% of African Americans and 80% of Hispanics waited until their pain levels reached 10/10 on a pain severity scale before accessing medical care. This reluctance to seek help for pain may be partly cultural but there is likely an element of learned reluctance following poor treatment in the past. Such findings may need to be taken into consideration when trying to tackle a number of social issues that are often attributed to race, social class, gender, and disability. Without addressing underlying chronic pain, including neck pain, as a factor in unemployment, psychological distress, and even drug addiction and alcoholism these problems may simply be considered intractable.
Spinal Health Month
The American Pain Foundation is campaigning to raise awareness of this huge health problem affecting millions directly each year and millions more indirectly. Chronic neck pain can cause significant psychological distress, frustrate parent’s wishing to play an active role in their childrens’ lives, cost employers huge amounts of money in lost productivity and extended health care costs, and cost the tax-payer more in the long-run through palliative care rather than preventative measures and education. Neck pain and associated symptoms such as migraine are not inconsequential but could be easily avoided in some cases; with these new figures on pain perhaps it is time for Spinal Health Month to be taken more seriously.
Portenoy, R, Ugarte C, Fuller I, Haas G. ”Population-based Survey of Pain in the United States: Differences Among White, African American, and Hispanic Subjects” Journal of Pain, Vol 5, Issue 6, 2004; pp 317-318
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National Center for Health Statistics. Health, United States, 2006 With Chartbook on Trends in the Health of Americans. Hyattsville, MD: 68-71.
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