Neck pain occurs frequently in western societies. In the majority of cases, no specific cause can be identified. In order to gain insight into the clinical course and prognostic factors of non-specific neck pain, a systematic review was conducted. A computerized literature search was carried out to identify observational studies on non-specific neck pain and randomized clinical trials (RCTs) on conservative treatment of non-specific neck pain. Two reviewers scored independently, the methodological quality of all identified publications, using a standardized set of 13 criteria which were divided into five categories according to: study population, study design, follow-up, outcome measures and analysis/data presentation. To determine prognosis per study, an overall percentage of recovery for the most important outcome measures (pain, general improvement, functional status, health care utilization and lost days of work) was calculated. In total 23 eligible publications were identified (six observational studies and 17 RCTs). Only seven of 23 studies scored 50% or more of the 13 items, indicating a generally poor quality of methods. The most prevalent methodological shortcomings appeared to be selection of the study population, the sample size and analysis techniques. Most information regarding the clinical course is available for the group of patients with complaints for more than 6 months, who are treated in a secondary care or an occupational setting. In this group of patients, 46% (median) had less pain, with a range of 22-79% and a general improvement that ranged between 37 and 95% (47% median). The reduction in the use of analgesics ranged between 32 and 80% (37% median). Six studies reported on prognostic factors. Bearing in mind the limited number of studies and the low methodological quality, there are some indications that the localization (radiation to the arms/neurologic signs) and radiologic findings (degenerative changes in the discs and joints) are not associated with a worse prognosis. A higher severity of pain and a history of previous attacks however, seems to be associated with a worse prognosis.

The prevalence of neck pain in the general population ranges from 10 to 15%. The complaints can result in substantial medical consumption, absenteeism from work and disability. In this study we investigated the costs of neck pain in the Netherlands in 1996 to assess the financial burden to society. The study was based on prevalence data. Data sources included national registries, reports of research institutes and health care authorities. Direct health care costs were estimated for hospital care, general practice care and paramedical care. These costs were calculated using fees. Calculation of indirect costs (absenteeism and disability) was based on the Human Capital Method (HCM). As an alternative approach the Friction Cost Method (FCM) was used. The total cost of neck pain in The Netherlands in 1996 was estimated to be US $686 million. The share of these costs was about 1% of total health care expenditures and 0.1 % of the Gross Domestic Product (GDP) in 1996. Direct costs were $160 million (23%). Paramedical care accounted for largest proportion of direct costs (84%). When applying the HCM for calculating indirect costs, these costs amounted to $527 million (77%). The total number of sick days related to neck pain were estimated to be 1.4 million with a total cost of $185.4 million in 1996. Disability for neck pain accounted for the largest proportion (50%) of the total costs related to neck pain in 1996 ($341). When applying the FCM for calculating the indirect costs, these costs were reduced to $96 million. The costs related to neck pain in 1996 in The Netherlands were substantial. Some caution should be taken in interpretation, as a number of assumptions had to be made in order to estimate the total costs. The cost structure shown in this study, with high indirect costs, has also been found in other studies. From an economical point of view it seems to be important to prevent patients from having to take sick leave and disability. One way in achieving this goal is to develop and investigate more effective treatments for acute neck pain, in order to prevent patients developing chronic pain and disability. Another option is to protect chronic patients from sick leave and disability by careful management. Thus, also in the area of direct medical costs, there may be room for cost savings by stimulating and improving cost-efficiency and cost-effectiveness of the (para)medical care. In order to deal with the lack of specific disease information, more detailed information of medical consumption, sick leave and disability is required for future cost analysis.

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BackgroundWhile in general practice chronic non-specific abdominal complaints are common, there is insufficient data on the clinical course and the management of these complaints. Aim of this study was to present a primary care based profile of these chronic complaints including health care involvement, health status and clinical course.MethodsThirty general practitioners (GPs) and patients from their practices participated in a prospective follow-up study. All patients and GPs were asked to complete questionnaires at baseline and at 6, 12 and 18 months of follow-up. The GPs provided information on diagnostic and therapeutic management and on referral concerning 619 patients with chronic non-specific abdominal complaints, while 291 patients provided information about health status and clinical course of the complaints.ResultsWhen asked after 18 months of follow-up, 51,7% of the patients reported an equal or worsened severity of complaints. General health perception was impaired and patients had high scores on SCL-anxiety and SCL-depression scales. Diagnostic tests other than physical examination and laboratory tests were not frequently used. Medication was the most frequent type of treatment. The persistence of chronic non-specific abdominal complaints was quite stable.ConclusionOnce non-specific chronic abdominal complaints have become labelled as chronic by the attending physician, little improvement can be expected. The impact on patients' physiological and psychological well-being is large. GPs use a variety of diagnostic and therapeutic strategies. Research into the evidence base of currently applied management strategies is recommended.