SESSION J3. What a Pain in the Neck! Clinical Pearls for Neck Pain Christopher J. Standaert, MD
37th Annual Advanced Practice in Primary and Acute Care Conference: October 9-11, 2014
2:45
SESSION J3 What a Pain in the Neck! Clinical Pearls for ...
37th Annual Advanced Practice in Primary and Acute Care Conference: October 9-11, 2014
2:45
SESSION J3 What a Pain in the Neck! Clinical Pearls for Neck Pain Christopher J. Standaert, MD
Session Description: Neck pain is a very common clinical complaint, and it can be challenging to effectively diagnose and treat patients with neck pain. This session will help clinicians to understand important etiologic factors in neck pain, various treatment modalities, and patient factors that are critical in optimizing outcomes for treatment. Specific approaches, language, and conceptual models will be discussed. Learning Objectives: Following my presentation, participants will be able to: 1. Discuss specific conditions or injuries that are commonly associated with neck pain. 2. Identify critical factors in the evaluation of patients with neck pain. 3. Articulate important concepts in treatment, particularly as related to clinical outcomes.
S E S S I O N J3
10/6/2014
Overview Making sense of Neck Pain: “What a Pain in the Neck!”
Christopher J. Standaert, MD Department of Rehabilitation Medicine UW Sports and Spine Physicians Harborview Medical Center
• It is not the structure that determines the pattern of pain stemming from it: rather, the pattern of pain is determined by the nerve supply of the structure.
– 49% of chronic neck pain after whiplash – 50% of headache (C2/3 joint) after whiplash
• Felt along scapula • Level varies by level of the disc
– Lord, et al, 1996
Understanding Pain Cervical
Lumbar
• Facet joint more common cause of axial pain than disc • Radiculopathy more commonly related to uncovertebral spur/ bone • 10% of epidural injections • Spinal cord, arteries, etc complicate surgical approaches to spine
• Disc is more common source of axial pain than joint • Radiculopathy more commonly caused by disc protrusion • 90% of epidural injections • Spinal canal relatively accessible to surgical approaches
Understanding Pain • Acute pain – Pain associated with tissue injury – Acute inflammatory response – Withdrawal from exacerbating activities helpful – Passive modalities can be helpful
• Chronic pain – Pain occurs without tissue injury – Acute inflammatory response often resolved – Withdrawal is maladaptive – Over-reliance on passive or interventional care is maladaptive
Understanding Pain • Pain is a sensory and emotional experience • Direct nociception • Cortical modulation • Psychological factors • Acute pain is distinct from chronic pain • Pain is distinct from suffering
Understanding Pain • Chronic pain – Physiological changes – Strong role of psychological factors – Outcomes for interventions are worse
3
10/6/2014
Chronic Pain Pain is a complex perception- an experience- not a thing that can be surgically excised or pharmacologically “killed.” – Sinclair 2003
Assessment • Rule out bad things • Establish diagnosis • Understand scope of the problem – Pain – Disability – Psychosocial barriers