Differential Diagnosis for Neck Pain in a Meth User

• Single most likely diagnosis:
  • Musculoskeletal strain: This is likely due to the physical activities or postures associated with methamphetamine use, or the drug's effects on muscle tone and movement.
• Other Likely diagnoses:
  • Methamphetamine-induced vasculitis or vascular spasms: Meth use can lead to vascular complications, including vasculitis or spasms, which might cause neck pain.
  • Dental problems: Meth users often have poor dental health, which can lead to referred pain in the neck.
  • Anxiety or stress-related tension: Methamphetamine use can cause significant anxiety and stress, leading to muscle tension and neck pain.
• Do Not Miss diagnoses:
  • Stroke or transient ischemic attack (TIA): Methamphetamine use increases the risk of stroke, and neck pain can be a symptom of a stroke or TIA, especially if accompanied by other neurological symptoms.
  • Infective endocarditis: Meth users are at higher risk for infective endocarditis, which can cause neck pain due to embolic phenomena or septic thrombophlebitis.
  • Spinal epidural abscess: This is a serious condition that requires prompt diagnosis and treatment. Meth users might be at higher risk due to increased incidence of skin infections and bacteremia.
• Rare diagnoses:
  • Temporomandibular joint (TMJ) disorder: While not exclusive to meth users, the habit of grinding teeth (bruxism) associated with methamphetamine use can exacerbate TMJ disorders, leading to neck pain.
  • Fibromyalgia: Though not directly caused by meth use, the chronic stress, sleep disturbances, and other factors associated with drug use might contribute to the development or exacerbation of fibromyalgia, which includes neck pain among its symptoms.