Conditions

Neck pain

What is neck pain?

Neck pain treatment is one of the most frequently requested therapies. Neck pain is slightly more common in women, but most people experience some form of neck pain at some point in their lives.

Neck pain also falls into two categories: acute or chronic. If the pain suddenly occurs and lasts less than three months then it is considered acute. Acute neck pain is commonly caused by facet syndrome, acute muscle strain, or traumatic injury like whiplash. If the pain persists more than three months, it is termed chronic neck pain. This pain can be from multiple sources, but is often due to facet joint irritation, discs, ligaments, and muscular sources.

What causes neck pain?

There are many causes of neck pain but the most common causes are due to:

  • Muscle strains
  • Trauma or injury (damage to the muscles, tendons, or ligaments)
  • Herniated cervical disk
  • Stress

Muscle strain / overuse
Overuse of the muscles and falling asleep in awkward positions for extended periods of time often produces muscle strains. The neck muscles located in the back of the neck become tense. When the neck muscles are continuously or frequently strained, a chronic pain syndrome can develop.

Trauma or injury
Whiplash occurs after motor vehicle accidents, specifically in rear-end collisions. This hyperextension of the neck often results in stretching of the soft tissues of the neck, producing local inflammation, muscle tension, and ligament strain. When ligaments and tendons become inflamed or damaged, they can cause persistent pain that intensifies with particular movements. In addition to neck muscle strains, the neck facet joints are also commonly involved in painful neck conditions.

Neck arthritis
Cervical spondylosis (neck arthritis) is caused by degenerative changes of the cervical vertebrae and adjacent facet joints. The symptoms typically present around the age of 40, but can present earlier with trauma. The arthritis continues to progress, and pain typically worsens with extending the head backwards. Degenerative disc changes occur as a person ages, and the disc can decay or herniate, producing local nerve root irritation or compression of the spinal cord.

Disc disease
Disc disease is one of the most common causes of neck pain and one of the most common reasons for surgery. Disc disease may be acute, resulting from trauma, or more commonly, chronic pain caused by degeneration. Degenerative disc disease is a process that is due to a thinning and dehydration of the discs over time that can lead to compression of other nearby structures.

Spinal stenosis
Another frequent cause of neck pain is spinal stenosis, which is a narrowing of the central spinal canal. This narrowing can compress the spinal cord and surrounding nerves roots. This compression can cause cramping pain, shooting pain, or numbness in the legs, back, neck, shoulders, or arms. The symptoms typically depend on the area of the spine that is affected. In cervical spinal stenosis, the upper extremities and shoulders are most commonly affected. Depression, anxiety, and stress tend to exacerbate chronic pain syndromes. Worsening neck pain is a common manifestation of these emotional stressors.

Typical diagnosis

The physician may perform a physical exam testing tenderness over certain areas of the spine, as well as assessing the various limitations in movement. The physician may also order radiological imaging such as X-ray, CT scan, MRI, or bone scan depending on her or his clinical suspicion and the history obtained.

Symptoms

Common complaints of people experiencing neck pain are:
Neck pain
Reduced range of motion in the neck
Headaches
Upper extremity pain, weakness, or sensory changes
Coordination and balance difficulty

Treatments

Injections

Cervical epidural steroid injections
Epidurals are frequently used for pain syndromes due to common conditions such as degenerative disc disease. The method involves injecting a steroid into the epidural space of the spinal cord where the irritated nerve roots are located. The medicine then spreads to other levels and portions of the spine, reducing inflammation and irritation.

Cervical medial branch blocks/denervation
This is a widely-used treatment for neck pain by pain specialists. Medial branch blocks (MBBs) are a minimally-invasive non-surgical treatment that is used for arthritis-related neck and back pain. The injections work by reducing the inflammation and irritation in the facet joints of the spine that is causing your pain.

Cervical lysis of adhesions
Cervical lysis of adhesions also known as the “Racz procedure,” this procedure has been proven effective in removing excessive scar tissue in the epidural space when conservative neck pain treatment has failed. This procedure is used in vertebral body compression fractures, post-laminectomy syndrome, radiculopathy, and disc disease.

Occipital nerve blocks
This method involves an injection of local anesthetic and corticosteroid over the occipital nerves (back of head). The blocks can dramatically improve pain and increase the quality of your life.

Trigger point injections
These can be an effective treatment for muscle spasms. The procedure involves injecting a local anesthetic and steroid into a “trigger point.”

Botox
Used in treating neck pain, this is an exciting new treatment that is widely accepted among modern medical practitioners. In 2005, “Botulinum toxin Type A (BtA) became the first line therapy for the treatment for cervical dystonia.” Although a single injection of BtA is effective, multiple injection cycles seem to work better for patients (Costa 2005).

Infusion techniques
This procedure involves inserting a small catheter through a needle into the epidural space or directly next to affected nerves. Local anesthetic and other medicines are often given through the catheter for extended time periods. When the nerves are blocked continuously with an infusion, pain relief can be dramatic and long-lasting.

Nerve stimulation

Cervical spinal cord stimulation (SCS)
This method involves tiny electrodes being placed within the epidural space close to the spinal cord. The electrodes release a small electrical current to the spinal cord that inhibits pain transmission. This inhibition of pain signals allows for pain relief. Cervical SCS is currently used for treating chronic pain syndromes such as complex regional pain syndrome, chronic neck pain, diabetic neuropathy, post herpetic neuralgia, peripheral ischemia, and other conditions that are resistant to more conservative treatments.

Treatments (cont.)

Occipital nerve stimulation
This method involves tiny electrodes being placed close to the occipital nerves (back of head). The electrodes release a small electrical current that inhibits pain transmission and causes pain relief.

Transcutaneous electrical nerve stimulation (TENS)
This is a technique that relieves pain by applying mild electric current to the skin at the site of the pain. The electric impulses interfere with normal pain sensations and alter perceptions that were previously painful.

Alternative therapies

Physical therapy
In order to decrease or prevent functional limitations, physical therapy and occupational therapy are recommended as well as medical treatments. Physical therapy for neck pain aims to increase range of motion and muscular strength.

Acupuncture
In this procedure, small needles are inserted into the skin. These needles cause your body to release hormones called endorphins that are your body’s natural pain relievers. Acupuncture can also help you relax, decreasing stress, tension, and muscular spasm.

Nutrition and exercise
Exercise improves neck pain by increasing flexibility and range of motion. Another benefit is the release of hormones called endorphins that are your body’s natural pain relievers. Nutrition and healthy eating may be powerful treatments to combat nutritional deficits.

Massage
Gentle focal rubbing of tender areas may help relieve muscle spasms or contractions and improve the discomfort associated with it. Massage can also help you relax, decreasing stress and tension.

Chiropractic manipulations
Targeted adjustments, especially combined with other modalities, may significantly reduce neck pain. Manipulations are undertaken in order to allow correct nerve transmission.

Prolotherapy
This treatment is also known as regenerative injection therapy. It is a technique of injecting irritating substances into painful ligaments and tendons. The procedure is used to initiate the body’s healing of a damaged ligament or tendon.

Treatments

Management of neck pain depends on the etiology of the pain. Minimally-invasive procedures are numerous and can be the most helpful to control pain and improve daily functioning. In the past few years there has been an abundance of research surrounding non-surgical procedures and their effectiveness in treating neck pain.

Procedures / Surgeries

Various procedures are available for the treatment of neck pain.

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