Visceral Origin: An Underestimated Source of Neck Pain. A Systematic Scoping Review

Ángel Oliva-Pascual-Vaca, Carlos González-González, Jesús Oliva-Pascual-Vaca, Fernando Piña-Pozo, Alejandro Ferragut-Garcías, Juan Carlos Fernández-Domínguez, Alberto Marcos Heredia-Rizo, Ángel Oliva-Pascual-Vaca, Carlos González-González, Jesús Oliva-Pascual-Vaca, Fernando Piña-Pozo, Alejandro Ferragut-Garcías, Juan Carlos Fernández-Domínguez, Alberto Marcos Heredia-Rizo

Abstract

The diagnosis of neck pain is challenging. Many visceral disorders are known to cause it, and clinical practice guidelines recommend to rule them out during neck pain diagnosis. However, the absence of suspicion of any cause impedes one from establishing that specific aetiology as the final diagnosis. To investigate the degree of consideration given to visceral aetiology, a systematic search of trials about neck pain was carried out to evaluate their selection criteria. The search yielded 309 eligible articles, which were screened by two independent reviewers. The PEDro scale score was used to assess the methodological quality of the studies. The following information was retrieved: number of authors affiliated to a clinical or non-clinical institution, number of citations in the Web of Science, study aims, characteristics of participants, and eligibility criteria. The top 15 most cited trials, and the 15 most recent studies about treatment efficacy in neck pain, published in first quartile journals of the Journal Citation Reports, were selected. Females represented 67.5% of participants. A single study was of poor methodological quality (4/10). Based on the eligibility criteria of the articles that were systematically reviewed, it would appear that visceral aetiology was not considered in eighty percent of the trials on neck pain, showing a low level of suspicion both in research and clinical settings.

Keywords: diagnosis; neck pain; phrenic nerve; referred pain; visceral pain.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Pattern of visceral referred pain along the C2–C3–C4 dermatomes. (A) Anterior view; (B) posterior view.
Figure 2
Figure 2
Flowchart diagram of the study selection process (Preferred Reporting Item for Systematic Reviews and Meta-Analyses, PRISMA, guidelines). Q1, first quartile; JCR, Journal Citation Reports.

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