Psychosomatic Connection Needs to Be Considered

Letters to the editor regarding the article Clinical Practice Guideline: Nonspecific Neck Pain by Ahmad El-Allawy, Nils Hecht, Kerstin Luedtke, Philipp Schleicher, Norbert Weidner, and Thomas Kötter in issue 20/2025

The presentation of the guideline on non-specific neck pain (1) is commendable, even only as far as the point prevalence of about 5% is concerned. In this, the references to numerous potential causes are important. Multiple experiences and systematic research have shown that pain in the neck and back mostly reflects myofascial, functional muscular, and/or fascial-origin disorders (2). They often have a psychosomatic connection, especially if signs and symptoms persist (3). Chronic pain in general places a strain on those affected, their relatives, the healthcare system, and society. It affects many areas.

The guideline report focuses almost exclusively on somatic aspects. But any pain is in essence a conscience phenomenon. In simple physiological forms, sensory experiences are present—in chronic pathological states as a symptom or independent pain disorder—but also emotions, suffering, and often impairments. In addition to the biological components, mental aspects, social participation, and careers need to be considered in the treatment (3).

Especially in a scenario of severe suffering and impairments, the focus on symptoms—which has been pushed in the past decades—and the absence of a focus on the pathogenesis—mechanical, inflammatory, poor posture, stress, lifestyle, etc) is inappropriate and should be supplemented in principle by assessment of the etiopathogenesis, recording situational circumstances, personality, and potential effects of an expanded concept of pain (4). Primary care physicians have the best insight into the complex reality of patients with chronic pain, and they therefore have a key function. Particularly difficult pain states, however, require special competencies—in specialist practices, pain outpatient clinics, or pain management centers.

DOI: 10.3238/arztebl.m2025.0230

PD Dr.med. Roland Wörz

Arzt für Neurologie und Psychiatrie, MA Medizinethik

Conflict of interest statement

The author declares that no conflict of interest exists

References

1. El-Allawy A, Hecht N, Luedtke K, Schleicher P, Weidner N, Kötter T: Clinical Practice Guideline: Nonspecific neck pain. Dtsch Arztebl Int. 2025; 122: 552–7

2. Junker U, Nolte T (eds.): Grundlagen der Speziellen Schmerztherapie. München: Urban & Vogel 2005.

3. Egle UT, Hoffmann SO, Lehmann KA, Nix WA (eds.): Handbuch Chronischer Schmerz. Grundlagen, Pathogenese, Klinik und Therapie aus bio-psycho-sozialer Sicht. Stuttgart, New York: Schattauer 2003.

4. Wörz R: Schmerz in erweiterter Konzeption. Schmerzmedizin 2023; 39: 1–32