The link between arthritis and neck pain. Is there one ?
Okinawa Sports and Spinal research review
People often blame arthritis for the neck pain but what is the relationship between the joints in the neck known as facet joints (Zygapophysial) joints and the amount of cartilage damage in the joint ?
A great paper has recently been published in the Journal of Pain medicine by the legendary Australian back pain research Nikolai Bogduk that looks at this question.
It turns out the relationship isn’t very strong at all. So you can can have a great looking x-ray and suffer from neck pain and you can have a terrible looking x-ray and be mostly pain free and everything in between.
So what is going on here ?
Studies show that about 36 to 60 percent of chronic neck pain comes from the facet joints in the neck ( 1) but what’s actually the cause of pain is far from understood. In order to understand the authors looked at many of the papers published on osteoarthritis and neck pain to see if was any evidence that degernative changes in the neck causes neck pain.
What the found when looking at a number of studies was that pain was although pain was more common in subjects with osteoarthritis (40%) than in those unaffected by osteoarthritis (26%), and although the prevalence of osteoarthritis in subjects with pain (25%) was greater than in subjects without pain (15%), in neither instance did the difference in prevalence reach statistical significance (1).
In other words if you have osteoarthritis its quite possible that you might not have have neck pain and if you have neck pain its quite possible you dont have arthritis. What the data is not showing is a clear link between progressive arthritis and progressive levels of pain.
Table from the study
The association between neck pain and severe osteoarthritis (OA) of the cervical zygapophysial joints (Z joints), based on the data of Heller et al.51
| OA | Neck pain
|
Prevalence pain
|
Prevalence OA
|
Odds ratio | |||
|---|---|---|---|---|---|---|---|
| Z joints | Yes | No | OA | No OA | Pain | No pain | (95% CI) |
| Severe | 56 | 40 | 58% | 65% | 9% | 11% | 0.8 |
| Other | 597 | 325 | (48-68) | (62-68) | (7-11) | (8-15) | (0.5-1.2) |
Figures in parentheses are the 95% CIs of the odds ratio or prevalence rates.
Ok so what does that mean for me ?
Firstly it means that yourself and your health practitioners should not be over concerned about your imaging findings and also that reaching for an image in cases of neck and pain may not be the right step forward.
The study made 2 firm conclusions
-
No study has produced any conclusive evidence that osteoarthritis is a cause of Z joint pain, either in the cervical spine or in the lumbar spine. Rather, the opposite applies.
-
Osteoarthritis of Z joints is so common in asymptomatic individuals that, even if it was a cause of pain, it could not be diagnosed with any confidence by any form of currently available medical imaging. The prevalence of osteoarthritis is essentially the same in subjects with pain as in subjects with no pain. Simply seeing osteoarthritis on images does not distinguish a painful joint from an asymptomatic one.
What this paper also shows is that your health care team needs to do a better job of understanding your pain and how it affects you and not place to much importance on your imaging findings. As an older mentor used to say ” treat the person, not the image ”
If you would like to have a chat with the practitioners at Okinawa Sports and Spinal about your neck pain and how to manage it you can make a booking here
References
- Bogduk, Macviar ” Osteoarthritis of zygapophysial joints as a cause of back pain and neck pain: a scoping review ” Pain Medicine, Volume 25, Issue 9, September 2024, Pages 541–554
- https://doi.org/10.1093/pm/pnae036
