When it comes to spinal pain, low back pain gets most of the press — and rightly so. It is extremely common and one of the most expensive health care problems.

But neck pain is no slouch. About two-thirds of the population will have at least one episode of it during their lives. For some, the problem becomes chronic, even disabling. According to the Global Burden of Disease study, nearly 5 percent of the population has neck pain at any given time, and it’s the fourth leading cause of chronic disability worldwide.

The neck has many sources of stress. It holds up the head, which weighs about 10 pounds, but still has to allow for a large range of motion. The upper back, which is functionally linked to the neck, also has to support the arms and shoulders. These muscles are among the first to react to mental and emotional stress, which has a tendency to store in the form of “knots” that can contribute to pain.

People who work at a desk all day are at a higher risk because they tend to have more of a forward head posture, which stresses the structures of the neck and upper back. For this reason I recommend postural exercises, such as the corner stretch and the “wall angel.”

Patients have no problem understanding that muscle tension can cause neck and upper back pain, but for most their problems go beyond that. The joints of the neck and upper back are common “behind the scenes” causes of pain as well. These joints can become stiff and misaligned, causing inflammation and pain, along with tension in the muscles, to protect the dysfunctional area. Many patients who have had years of muscle treatments find that much of the spasm responds to joint manipulation. This means the spasm was a reaction to an underlying joint problem.

As with health problem, neck pain can have a range of causes. If the pain is only because of joint and muscle dysfunction, then joint manipulation and some form of muscle therapy will be enough. However, plenty of patients do not get complete relief until we look outside the spine.

For example, with some patients we need to address an inflamed stomach. This can cause reflex pain and reactivity in the neck and upper back, sometimes without any obvious symptoms in the stomach itself. For a few of my patients, stomach inflammation was caused by taking daily “baby aspirin” to thin the blood. Another common cause are the very drugs used to ease chronic pain. The gallbladder is well-known for causing right shoulder and upper back pain, even without any pain in the gallbladder itself.

Wellness care dictates we address as many parts of the patient’s problem as we can and as naturally as we can, after we make sure there is no serious underlying disease. Once the joint and muscle problems are addressed, lifestyle changes are the next logical step — better workstations, neck and shoulder exercises, stress control, even sleeping positions (sleeping on your stomach tends to be the worst for the neck). Patients who have an inflamed stomach and gallbladder may need to change their diet, especially avoiding fried foods, wheat or dairy products. Natural medicines can help support the stomach and gallbladder function.

For most patients, this approach is helpful enough that they don’t have to use prescription medications or more aggressive therapies.

Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.