We often use the phrase, 'a pain in the neck' to refer to difficult people or situations, not realizing that this phrase aptly describes the challenges one experiences with neck pain. Suffering with an acute episode of neck pain can really put a 'kink' in almost all activities in your daily life, including sleep. Losing sleep due to neck pain typically makes the pain feel worse. Many people suffering with neck pain would welcome any suggestions to help them sleep better or prevent pain in the morning.
Your doctor or fellow neck pain sufferers may have suggested the use of a 'specialized' pillow. In the quest for a pillow that will help, you notice a large variety of specialized pillows in local stores. Many are available and perhaps you had not expected to be faced with so many choices. Which one should you select?
The manufacturers make several health claims about the features that make their pillows 'special'. Sometimes these pillows are labelled as 'orthopaedic' or 'specialized' pillows. The manufacturer claims suggest that specialized pillows are designed or ideal for those with neck pain. The claims suggest that the benefits of these pillows may be related to the type of material of the pillow (i.e. made from gel or foam or filled with water). Alternatively, the benefits are attributed to the shape of the specialized pillow (i.e. contoured, roll like, moldable, etc.). All of these special features are believed to provide better support to the neck or keep it in a good position while sleeping. Some of these specialized pillows are relatively expensive compared to regular pillows. But do these specialized pillows really help? Which, if any of these special features, are worth the extra cost? Choosing a specialized pillow for neck pain is a valid health concern given the potential to help, and the cost.
Why is neck pain a health issue?
Neck pain is very common in the general population (1;2). More surprising is that it is a leading cause of disability. From 291 health conditions assessed, neck pain ranked fourth highest with respect to overall disability (3). Women were shown to have higher rates of disability and burden associated with neck pain relative to men (3). From 50% to 75% of the general population continue to experience problems one to five years after reporting neck pain (4). Neck pain can be experienced as very painful bouts that become worse over time. During these painful episodes some are unable to work or do the things they really enjoy. Unfortunately, the number of people complaining of neck pain increases as we age. This is made worse with body postures (i.e. ergonomics) that stress the neck when working with electronics (e.g. laptop computers, tablets). Having pain in your neck can affect your ability to sleep and your overall quality of life.
What is the scientific evidence on specialized pillows?
There are many different options to treat your neck pain, and one of these is the use of specialized pillows. A Cochrane systematic review (5) evaluated the best available research on the use of pillows and neck pain. The five trials evaluated in the systematic review compared the specialized pillow to:
- regular (non-specialized) pillows (or patient's usual pillow),
- other specialized pillows (e.g., water pillow compared to roll pillow), or
- specialized pillows combined with other therapies (e.g., exercise, massage, etc.)
Unfortunately, only one of these five studies was conducted using good scientific methods. The review noted that there was little information about who funded the studies and what role the pillow manufacturer played in the research. This leaves us with uncertainty about the effects of using specialized pillows and who funded the research.
The specialized pillows evaluated in these five clinical trials had very different shapes and materials. These differences make it difficult to judge the benefits of the specialized pillows, somewhat like comparing apples and oranges. The specialized pillows were compared to participants 'usual pillow'. The usual pillows were not well described and this again makes it difficult to compare, somewhat like apples and 'mystery' fruit. To make matters worse, only two studies actually measured how sleep quality was affected. More research is needed before we can determine the benefits or harms from using these specialized pillows in people with neck pain.
In general, there are few studies evaluating pillows and sleep. One study evaluated specialized pillows in people without neck pain. This study (4) compared five different pillows in people without neck pain who prefer side-sleeping. This study showed that the type of pillow material and the shape of the pillow may affect some aspects of sleep quality. Unfortunately we have the same problem of comparisons we noted in studies in people with neck pain. The evidence in people without neck pain is equally limited.
What is the bottom line about specialized pillows?
We don't yet have credible scientific evidence helping us understand the effect of specialized pillows. We don't know if they will help, hurt, or make any difference to pain, function or sleep in both people with and without neck pain. We also don't yet know about any potential negative effects when using specialized pillows. Few studies measured adverse effects, but when they did, they reported mild effects (e.g., sleep worsened while adjusting to the new pillow or increased pain in the morning). More research is needed to assess any potential benefits and harms associated with using specialized pillows.
If your doctor or therapist suggests you use a specialized pillow, ask if there is the opportunity to try out some different types for several weeks. Note that you must encase the pillow in a plastic pillowcase, similar to those used in hospitals. As you try the different specialized pillows, monitor whether your morning pain decreases, or if your neck function improves or if the quality of your sleep improves. If these benefits occur, only then consider switching from your usual pillow. Until we have more research, we need to use some caution and common sense when considering the purchase of specialized pillows.