Arteritis Arteritis is inflammation of the arteries and occurs in many diseas- es, including rheumatoid arthritis and systemic lupus erythema- tosus (Boissonnault et al., 1990). This arteritis can be a potential Screening for pulmonary causes of neck pain When screening for a possible pulmonary cause of neck pain, medical history of cancer; recurrent upper respiratory infection or pneumonia; or recent scuba diving, accident, trauma, or overex- ertion (pneumothorax) is relevant. Risk factors include smoking; prolonged immobility; chronic immunosuppression; malnutrition; dehydration; chronic diseases such as diabetes, chronic lung dis- ease, or cancer; and upper respiratory infection or pneumonia (Carvallaro Goodman et al., 2018). According to Boissonnault et al. (1990), pulmonary disease rarely manifests itself a pain syn - drome without associated symptoms of disease being present. These symptoms include sore throat, fever, hoarseness, cough, dyspnea, stridor, and wheezing. Case Study: Larry Lane Mr. Lane is a 56-year-old male who presents to physical therapy via referral from his primary care provider. He has had neck pain for “a couple of months.” He is unable to describe a specific pat - tern to his neck pain in terms of what makes it worse and bet- ter. When questioned about accompanying symptoms, the client hesitantly reports that he has had a persistent cough for the last few months. Question What red flags are present in this case? Based on the presentation and history, what are questions/processes that might assist with a differential diagnosis? What examination findings might further increase your suspicion that the client’s symptoms do not origi- nate from pulmonary structures? Discussion One red flag for this client is the presence of a cough. This is a hallmark of pulmonary disease. Another red flag is the fact that there is no specific pattern to his neck pain; the client cannot iden - tify what makes it better or worse. Central sensitization and chronic neck pain A study by Lam et al. (2018) found that patients with chronic neck pain demonstrate high levels of central sensitization. In fact, 62% of patients with chronic neck pain presented with signs of central sensitization. There were statistically significant associations be- tween pain catastrophizing, fear of movement, and high percep- tion of disability due to neck pain. When central sensitization and cooccurring biopsychosocial influences are present, these factors should be considered in the management of patients with neck Psychological factors and neck pain Neck pain is multifactorial, and the literature shows a clear link between psychological variables and neck pain (Kazeminasab et al., 2022). According to Kazeminasab et al. (2022), the following psychological factors are relevant to the onset of neck pain: ● Stress . Perceived stress is an identified risk factor for neck pain. Investigators have found that adolescents with neck pain had significantly higher stress levels than adolescents without neck pain. Also, permanent or regular feelings of stress were correlated with significantly increased reports of report neck pain. Stress may contribute to altered central pain process- ing at the spinal, brainstem, or cortical levels, resulting in en- hanced pain sensitivity (Kazeminasab et al., 2022). ● Anxiety . Neck pain has been found to be comorbid with anxi- ety. Adolescents with neck pain were found to have higher lev- els of anxiety than adolescents without neck pain. In addition, anxiety disorders were found to be the second most common comorbid disease associated with neck pain (Kazeminasab et al., 2022).
source of neck pain. Polymyalgia rheumatica is a vasculitic disease that causes aching and stiffness in numerous regions of the body, including the neck.
One question that might be helpful with differential diagnosis is whether the client has a history of pulmonary disease (including cancer). Another important question is whether the client is or was a smoker, and whether he is experiencing any shortness of breath. Again, these symptoms are consistent with pulmonary disease. Examination findings that might point toward the presence of a pulmonary origin of neck pain include full neck range of motion, lack of muscle involvement, and lack of tenderness over the facet joints or spinous processes, as these findings are consistent with musculoskeletal cervical spine issues (Cavallaro Goodman et al., 2018). Pulmonary symptoms Autosplinting, where the client prefers to lie on the involved side, is considered a valuable red flag of possible pulmonary involve- ment. This is effective because lying on the involved side puts pressure on the lungs, reducing respiratory movement and pain. Other important signs for differential diagnosis include dyspnea, persistent cough, cyanosis, hemoptysis, and general malaise. Vi- tal sign assessment and assessment for the effect of respiratory movement such as coughing or deep breathing for reproducing the painful symptoms can be revelatory. In addition, no pain with performance of neck range of motion may help determine that neck symptoms are not originating from cervical structures (Car- vallaro Goodman et al., 2018). Self-Assessment Quiz Question #26 People with pulmonary pain often prefer to lie on the involved side because this puts pressure on the lungs and reduces respi- ratory movement and pain. The name for this is:
a. Stridor. b. Angina.
c. Autosplinting. d. Phrenic pain.
pain. As mentioned above, biopsychosocial factors that lead to central sensitization can exacerbate the pain experience and con- found treatment. Cognitive–emotional factors have been shown to modulate the activity of descending brain pathways (Lam et al., 2018), so effective intervention in these instances might include pain neuroscience education aimed at decreasing the influence of cognitive–emotional drivers of pain. ● Depression . The relationship between depression and neck pain is bidirectional. In other words, people diagnosed with depression are more likely to develop neck pain, and people diagnosed with neck pain are more likely to develop depres- sion. Literature suggests that the strongest psychosocial risk factors among individuals with chronic neck and back pain is depressed mood (Kazeminasab et al., 2022). ● Cognitive variables. Pain cognitions, such as catastrophizing, self-perceived poor health, fear-avoidance beliefs, and pas- sive coping are related to increased pain such as neck pain. Low self-efficacy and low resilience have been shown to cor- relate with increased disability related to neck pain (Kazemi- nasab et al., 2022). ● Sleep problems . The relationship between sleep quality and neck pain is bidirectional, as each can lead to the other. Litera- ture suggests that insufficient quality and quantity of sleep are
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