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

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.

Does the Addition of Manual Therapy Approach to a Cervical Exercise Program Improve Clinical Outcomes for Patients with Chronic Neck Pain in Short- and Mid-Term? A Randomized Controlled Trial

“…Another limitation is that the last follow-up was done after 6 months, so we cannot know the long-term evolution. Finally, even though patients were referred by doctors, the presence of neck pain with a visceral origin may have been underestimated, so our clinical trial may have taken into account visceral referred neck pain in the inclusion and exclusion criteria [70].…”

Immediate and Short-Term Effects of Upper Cervical High-Velocity, Low-Amplitude Manipulation on Standing Postural Control and Cervical Mobility in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

“…In addition, the possible visceral etiology of neck pain and motion restriction was not controlled, so part of the sample might have received neck treatment instead of the right treatment for the visceral disorder. This fact might result in an incorrect estimation of the treatment’s effect size [ 67 , 68 ]. Another limitation could be the lack of control over pain intensity during study follow-up, although the initial aim of the study was not really to assess the influence of this factor.…”

Effect of visceral manipulation on forward head posture in subjects with chronic non-specific neck pain – a pilot study

“…A prevalência de dor no pescoço varia de 4,8% a 79,5% e é mais comum em mulheres e em países de alta renda. Pacientes sem uma fonte bem identificada para sua dor cervical são rotulados como tendo dor cervical idiopática, mecânica ou não específica 5 .…”

“…A dor referida visceral (PRV) ocorre, como hiperalgesia secundária, em áreas somáticas embrionicamente conectadas aos órgãos afetados. A sobreposição de informações aferentes somáticas e viscerais em uma via neural compartilhada parece estar relacionada a uma interpretação errônea nos níveis periférico, espinhal ou supraespinhal 5 .…”