BY Samuel Mathis, MD
Recently, I read an article in Lancet Rheumatology that documented the growing prevalence of neck pain worldwide. Over the past 30 years, from 1990-2020, neck pain has increased slightly, around 0.2%. However, the trend that has occurred recently projects that the prevalence of chronic neck pain will increase by 32.5% over the next 30 years (1). This could cause significant issues in the future with this increased burden of disease. In the US, musculoskeletal pain is one of the top contributors to missed workdays and lost productive time at work (2). This lost time equated to over $61 million of lost revenue per year based on one study in 2003 (2). Neck pain is a common cause of headaches, shoulder pain, and even some back pain.
Phone use is one of the primary causes of this issue. The term “Text Neck” refers to the pain associated with poor posture when using phones. It is caused by continually looking down instead of looking at something at eye level. As we look down, we extend the cervical paraspinal muscles, round out the shoulders, and move our neck forward, causing worsening posture and degeneration of the cervical spine. Symptoms of Text Neck include neck pain, headache, stiffness, pain between the shoulder blades, and eventually arthritic joints of the neck and shoulders. While we don’t know the long-term effects of Text Neck, it is concerning since the syndrome is being seen among younger patients.
When these patients present for evaluation and treatment, it is important that management not only works on pain control and muscle training but should also address the lifestyle choices that are causing the pain. Lifestyle choices include instructing patients to hold their phones in front of their faces instead of in their laps. Simple exercises can be helpful to open the chest and relax the shoulders down and back instead of hunched forward. Cell phone use should be limited, and chronic game use should be discouraged until the pain improves. Structured stretching like yoga or tai chi as well as Physical Therapy can be helpful in these populations if basic stretching doesn’t help.
Other integrative therapies for neck pain include acupuncture, massage therapy, and manual therapies like osteopathic manipulation, which have good evidence in providing relief but are not curative for structural issues like cervical disc disease. Some supplements like turmeric and other anti-inflammatories may provide help, but research is limited. For patients with arthritis, a 2021 study out of BMJ showed that turmeric was better than placebo for patients with knee osteoarthritis (3). While studies have not directly looked at neck arthritis, some have indicated turmeric may also be helpful for muscular pain. A typical recommended regimen is 300mg of turmeric 2-3 times daily. Another supplement that has shown some promise is magnesium. Magnesium plays a vital role in muscular contraction and may decrease inflammation and pain from chronic contracture of the muscles. Continuous contraction of neck muscles from looking down at a phone may cause muscle fatigue and subsequent pain. The recommended dose of magnesium is 400mg a day. Caution should be taken with higher doses as loose stool is a common side effect of too high a dose.
While the above list is not comprehensive, these simple recommendations can have a profound impact on patients with neck pain. Many times, patients desire simple solutions instead of jumping directly to prescription medications or procedural-based care. If unsuccessful, then topical or oral NSAIDS, Tylenol, and trigger point injections may be a good next step. Appropriate imaging can be performed after 6-8 weeks and referral to an orthopedic or neurosurgeon for management of any significant findings may be necessary. Finally, education is vital for all patients. Neck pain may soon become the next chronic low back pain without adjustment in how we interact with our technology. We must teach our patients about the potential risks of chronic phone use and how to counteract that with appropriate stretching and phone breaks.
- GBD 2021 Neck Pain Collaborators. Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2024 Mar;6(3):e142-e155. doi: 10.1016/S2665-9913(23)00321-1. PMID: 38383088; PMCID: PMC10897950.
- Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost Productive Time and Cost Due to Common Pain Conditions in the US Workforce. 2003;290(18):2443–2454. doi:10.1001/jama.290.18.2443
- Paultre K, Cade W, Hernandez D, Reynolds J, Greif D, Best TM. Therapeutic effects of turmeric or curcumin extract on pain and function for individuals with knee osteoarthritis: a systematic review. BMJ Open Sport Exerc Med. 2021 Jan 13;7(1):e000935. doi: 10.1136/bmjsem-2020-000935. PMID: 33500785; PMCID: PMC7812094.