Differential diagnosis and treatment of neck pain

Abstract

Neck pain is widespread in the population and reaches 60%. Women in the age group under 60 are more likely to be affected than men. Acute pain is typical for young people, chronic – for patients of the older age group. Neck pain can be nonspecific, neural or mixed, depending on the involvement of various anatomical structures in the pathological process.Nonspecific (nociceptive, musculoskeletal) pain accounts for about 80–90% of all cases. The clinical picture may also include limited range of motion in the cervical spine (CS), changes in muscle tone in the region. With damage to the cervical spinal roots, neural symptoms join, which is observed in 11.9–43% of cases.The key to making the correct diagnosis is a deep study of complaints, anamnesis, and a thorough physical examination. Paraclinical research methods play a secondary role in the diagnosis, they are prescribed only if their results can affect the formulation of the diagnosis and further treatment. The need for differential diagnosis between nonspecific and neuropathic pain arises in the presence of complaints and clinical manifestations characteristic of both options. Standard schemes of drug therapy for nonspecific and neuropathic pain have certain differences, while they do not depend on the localization of the process and the involvement of certain structures in the process. In both cases, the main therapeutic tasks are to provide effective pain relief and influence on the inflammatory process. With these tasks, NSAIDs are most fully coping. The original diclofenac has a pronounced analgesic and anti-inflammatory effect with a high safety profile, which, together with a variety of dosage forms, makes it attractive for the treatment of various types of neck pain. An additional local effect on pathologically altered structures by the topical diclofenac forms significantly increases the effectiveness of the treatment. In the above clinical cases, two variants of neck pain are considered, which have similar symptoms, while being different forms of pathology.

Keywords

• cervicobrachialgia
• myofascial pain syndrome
• herniated disc
• radiculopathy
• connective tissue dysplasia
• nonsteroidal anti-inflammatory drugs
• diclofenac
• topical form of diclofenac