Rethinking neck-related arm pain: hypothetical clinical scenarios to differentiate the underlying IASP-defined pain mechanisms

ABSTRACT

Neck-related arm pain is frequently encountered in clinical settings, yet its underlying pain mechanisms remain elusive. While such pain radiating from the neck to the arm is often attributed to injuries or diseases of the nervous system (neuropathic pain), it can also arise from nociceptive (referred) or nociplastic sources. Regrettably, patients exhibiting this specific pain distribution are frequently diagnosed with varying terms, including ‘cervicobrachialgia', ‘cervicobrachial neuralgia', ‘cervicobrachial pain syndrome', and ‘cervical radiculopathy'. The ambiguity surrounding these diagnostic labels complicates the clinical reasoning process. It is imperative for clinicians to discern and comprehend the dominant pain mechanism. Three distinct hypothetical clinical scenarios depict patients with almost identical pain distribution but divergent dominant pain mechanisms. Within these scenarios, both subjective and objective examinations are employed to elucidate the dominant pain mechanism associated with neck-related arm pain: nociceptive, neuropathic, and nociplastic. Furthermore, clinicians must remain aware that the dominant pain mechanism can evolve over time.

KEYWORDS:

• Pain predominance
• clinical reasoning
• pain management

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The work was supported by the Erasmus+ [SCALENEo - 22PCS0007].

Notes on contributors

Renaud Hage

Renaud Hage is doctor in motor sciences. He is part-time lecturer at Haute Ecole Libre de Bruxelles, UCLouvain and clinical practionner focusing on neck pain. He is researcher in the field of clinical reasoning and the study of cervical kinematics. He is a project engineer at the CeREF Technique Research and Training Center in HELHa (Belgium) and (co)author in 25 peer-rewied publications. He is member of the board of the Belgian manual therapy association (MATHERA.be) and member of the Ministry of Health’s manual therapy accreditation commission.

Nathalie Roussel

Nathalie Roussel is full-time Professor and heads the department of Rehabilitation Sciences and Physiotherapy at the Faculty of Medicine and Health Sciences, University of Antwerp, Belgium. She published more than 115 peer-reviewed publications as (co)-author, lectures in different universities in the field of joint pain and is regularly invited to present her results at international conferences. She was awarded with several national and international grants to study musculoskeletal pain in patients and performing artists.

Frédéric Dierick

Frédéric Dierick, PT, OMT, PhD, leads the RehaLAB at Luxembourg’s Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter. His primary focus lies in analyzing human pathological human movement disorders. His pioneering research has resulted in the development of innovative clinical analysis tools, significantly advancing rehabilitation techniques. An accomplished author, he has contributed over 50 scientific papers to the field. He is a committed member of the academic community, serving as a guest editor and reviewer for various scientific journals. His management skills are evident in his oversight of major European projects, most notably the Interreg NOMADe project (2019-2022), which focused on an interdisciplinary approach to understanding and managing neuro-musculoskeletal disorders. His work in this project highlights his dedication to enhancing the knowledge and treatment of these complex conditions.

Joël Da Natividade

Joël Da Natividade is a part-time physiotherapist at the Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter at Luxembourg. He completed his master’s degree in physiotherapy at the UCLouvain where he is regularly invited to give continuing education courses in the field of OMT. He obtained his Certificate in Orthopedic Manual Therapy (IFOMPT) at the University of Liège. He is part-time clinical researcher at the RehaLAB of Rehazenter where he carries out European projects in the field of physiotherapy.

Mark Jones

Mark Jones PT, BS (Psych), Grad Dip Advan Manip Ther, MAppSc (Manip Physio), MAPA, MACP, is an Adjunct Senior Lecturer, Allied Health & Human Performance Academic Unit, University of South Australia, with 35 years’ experience teaching undergraduate and postgraduate physiotherapy. He has conducted and supervised research in the areas of clinical reasoning and musculoskeletal physiotherapy with over 90 publications including three editions of the text “Clinical Reasoning in the Health Professions” and two editions of the text “Clinical Reasoning for Musculoskeletal Practice”. Mark has presented 30 Keynote Conference presentations and has taught professional development courses in clinical reasoning and musculoskeletal physiotherapy across 27 countries.

Antoine Fourré

Antoine Fourré, PT, OMT, PhD, is a physiotherapist, teacher and researcher. His main field of interest is clinical reasoning and beliefs of healthcare practitioners managing low back pain. His current research is evaluating direct-access to physiotherapy in Belgium. He teaches at UCLouvain in the manual therapy program (IFOMPT) in different thematics such as clinical communication and patient-centered management. He works in a private practice and at the University Hospital Saint-Luc in Brussels to treat patients with neuromusculoskeletal disorders.