Systemic causes of neck pain Cancer
vessels and arteries. In addition to neck pain, otalgia, tinnitus, and dysphagia may be present (Priyamvada et al., 2021). Infection Infection conditions that can cause neck symptoms include ver- tebral osteomyelitis, meningitis, Lyme disease, retropharyngeal abscess, and epidural abscess (poststeroid injection). Autoimmune diseases: ● Rheumatoid arthritis . Rheumatoid arthritis is a chronic inflam- matory disease that typically affects the bones, joints, and ligaments, although it can affect almost every body system. A common early symptom is peripheral joint swelling, with chronic inflammation of the cervical spine being the second most common feature. In fact, neck pain is often one of the earliest symptoms to indicate cervical spine involvement in a patient with rheumatoid arthritis (Kazeminasab et al., 2022). ● Psoriatic arthritis . Psoriatic arthritis develops in some people with arthritis. It is a group of chronic inflammatory joint diseas- es. One subtype of psoriatic arthritis is psoriatic spondylitis, which affects the spine and can cause pain and stiffness in the neck (Kazeminasab et al., 2022). ● Polymyalgia rheumatica. Polymyalgia rheumatica is a rela- tively common chronic inflammatory disorder that causes widespread pain and stiffness, including neck pain. The aver- age age of onset is 70 years, and it is rarely found in anyone under age 50. It is often associated with giant cell arteritis (Ka- zeminasab et al., 2022). ● Ankylosing spondylitis. Ankylosing spondylitis is a debilitat- ing, progressive type of arthritis that mainly results in inflam- mation of the joints of the spine. Neck pain is common with this diagnosis, due to inflammation of the cervical spine (Ka- zeminasab et al., 2022). ● Systemic lupus erythematosus . Systemic lupus erythemato - sus is a fairly severe systemic autoimmune disease that can affect almost any part of the body, including the neck, where inflamed muscles can cause neck pain (Kazeminasab et al., 2022). Other possible systemic sources of neck pain Fibromyalgia and psychiatric disorders (depression, anxiety, post- traumatic stress disorder) have been associated with neck pain, as have viral myalgia, cervical lymphadenitis, and thyroid disease. Self-Assessment Quiz Question #24 Which of the following signs is considered a red flag for the pos- sible presence of cancer?
A history of tumor or neoplasm should always lead a clinician to consider whether cancer might explain the etiology of the pa- tient’s presenting problem. Malignancy is typically accompanied by unexplained weight loss, sudden loss of appetite, dysphagia, and/or headache. The failure of neck pain to respond to treat- ment in an expected manner might also be a warning sign. Both leukemia and Hodgkin’s disease have the potential for metastatic lesions to the neck (Cavallaro Goodman et al., 2018). Primary tu- mors of cervical bone and the cervical spinal cord should be ruled out, although primary spinal tumors are 10 times less common than primary cranial tumors (Samartzis et al., 2015). Several other types of cancer can present as neck pain. Lung can- cer, including Pancoast’s tumor (a type of non-small cell lung can- cer that develops in the apex of the lung), can refer symptoms to the neck. A case study by Akhavan et al. (2017) describes a 61-year-old male with a medical history of chronic neck pain with a one-month worsening of symptoms. Images of the cervical spine showed evidence of disc degeneration. When pain medications failed to decrease his pain symptoms, magnetic resonance im- aging (MRI) showed stage IV adenocarcinoma of the lung with widespread metastases. Healthcare consideration: Since neck pain (along with upper back and shoulder pain) can be a symptom of lung cancer, the assessing clinician should be familiar with symptoms that are often present with this type of cancer. According to Johns Hop- kins Medicine, these symptoms are chronic cough, shortness of breath, voice hoarseness, and chronic infections such as bron- chitis (Lannon, 2021). Esophageal and thyroid cancer have also been shown to have the potential to cause neck pain (Cavallaro Goodman et al., 2018). Cardiovascular The following cardiovascular conditions may refer pain to the neck: Angina, myocardial infarction, aortic aneurysm, occipital mi- graine, cervical artery ischemia or dissection, and arteritis. Pulmonary Pain from respiratory disease can present anywhere from the neck and shoulder regions to the mid-thorax. When the diaphragm is involved, pain may be referred to the shoulder and neck (Boisson- nault & Bass, 1990). Pulmonary conditions that can refer symp - toms to the neck include lung cancer (including Pancoast’s tumor), tracheobronchial irritation, chronic bronchitis, pneumothorax, and pleuritis involving the diaphragm. Gastrointestinal Gastroesophageal reflux disease involves movement of the gas- tric contents into the esophagus so that the contents irritate the mucosal surfaces of the upper digestive tract (Ahuja et al., 1999). An estimated 20%–60% of patients with gastroesophageal reflux disease (GERD) have head and neck symptoms without any appre- ciable heartburn (Ahuja et al., 1999). GERD can be distinguished from other sources of neck pain because GERD symptoms include pain after eating and with a supine position. Other gastrointestinal conditions that can cause neck pain include esophagitis and esophageal cancer. Osseous abnormalities Crowned dens syndrome , also known as pseudogout of the cervi- cal spine, is defined by calcifications in a crownlike configuration around the odontoid process. It is accompanied by acute pain in the cervico-occipital region along with neck stiffness, fever, and raised inflammatory markers (Younis, 2017). Chiari malformation is a condition where the skull is misshapen or smaller than typical, so the brain tissue extends into the spinal canal (Chiari Malformation - Symptoms and Causes, 2021) Although many people with Chiari malformation have no signs or symptoms, neck pain is a poten- tial issue when this condition is symptomatic. Eagle syndrome is an abnormality of ossification/morphology of the styloid process. This can be painful when it causes direct pressure on the nearby
a. Unexpected weight gain. b. Unexpected weight loss. c. Pain right after eating. d. Pain with exercise and/or exertion.
Viscerogenic sources of neck pain Several visceral sources of neck pain have been identified. Gas- trointestinal, biliary, renal, hepatic, heart, and pulmonary disor- ders evoke referred pain to the upper quadrant, including the neck (Oliva-Pascual-Vaca et al., 2019). Visceral referred neck pain is linked to the involvement of the vagus and/or phrenic nerves. Nociceptive input from the organs innervated by the vagus nerve sensitizes the trigeminocervical nerve complex that descends to C3 or C4 level with the potential to trigger a headache or neck pain. The phrenic nerve is formed by C3 and C4 roots and either directly or indirectly supplies the diaphragm, pleura, right atrium pericardium, esophagus, peritoneum, stomach, falciform and cor- onary ligaments of the liver, hepatic vein, inferior vena cava, liver, gallbladder, pancreas, small intestine, and suprarenal glands (Oli- va-Pascual-Vaca et al., 2019). As such, these structures can evoke pain referred along the C3–C4 dermatomes via autonomic con- nections; diaphragmatic pressure; or peritoneal irritation, a phe- nomenon known as phrenic pain (Oliva-Pascual-Vaca et al., 2019).
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