Neck Pain

WHAT IS NECK PAIN?

Neck pain is a common complaint that most of us will experience at one point or another. The pain is usually a result of neck muscles being strained extensively. It can exist in many forms. When neck pain occurs abruptly and with intensity, it is considered as being ‘acute’. This can be a simple crick, or more seriously, facet syndrome or muscular rheumatism.

 

The degree of neck pain can range from mild discomfort to a severe burning sensation. Neck pain that lasts for three months or longer is considered “chronic”. This may be indicative of a serious medical condition that requires special medical care, especially if your pain radiates to your shoulder or causes a loss of strength in hands or arms.

WHAT ARE THE SYMPTOMS OF NECK PAIN?

The most common symptoms include regular headaches, decreased ability to move your head, lack of flexibility to move neck, muscle spasms or tightness, and pain that’s worsened by keeping your head in one place for long periods of time (while working on a computer, or when driving).

WHAT ARE THE CAUSES OF NECK PAIN?

More often than not, there is no specific or forthcoming underlying reason for neck pain. In some cases, people may experience pain due to trauma or injury (sudden whiplash or jolt), but a mechanical or muscle problem can also be the source. The trigger for discomfort can also be caused from sleeping in an awkward way or hunching over your workbench, causing stress on neck muscles.

 

Sitting in an improper posture for long periods can also produce neck problems, such as sitting and using computer keyboard for long periods. More serious causes for neck problems come from slipped disc, osteoporosis, and brittle bones. A curvature of the spine due to deformity (known as “Scoliosis”) may cause neck pain too. On some rare occasions, tumors and/or infections can also end up being the culprit.

HOW IS NECK PAIN TREATED?

Treatment varies based on the cause of your neck pain. If you are suffering from neck discomfort, it is a good idea to seek medical attention from your primary health care provider, who may suggest:

  • Transcutaneous electrical nerve stimulation (TENS) – A therapy that involves using electrodes placed on your skin to deliver tiny electrical impulses to relieve pain.
  • Short-Term Immobilization – A specially designed soft collar that will support your neck by taking pressure off the muscles, hence relieving pain.
  • Traction Exercises – These exercises typically use pulleys, weights, or an air bladder for gently stretching your neck.
  • Physical Therapy – Physical therapists will work with you and teach correct neck-strengthening, posture, and alignment exercises to prevent recurrence and pain.
  • Facet or Medial Branch Blocks – these treatments involve steroid and numbing medication being injected either into the painful facet joint or around it. These often provide immense relief for weeks to months at a time and can be repeated then as necessary.
  • Epidural Steroid Injections – when a patient has pain from a pinched nerve in the neck, it may lead to considerable pain around the neck, shoulder and arm. The epidural injection may help considerably.
  • Radiofrequency Ablation – this treatment has been shown to relieve neck pain for 6 to 18 months at a time. The results have been revolutionary for the nonoperative treatment of neck pain.
TOP TEN NONOPERATIVE NECK PAIN TREATMENTS

Neck pain involves the cervical spine, which is made up of vertebrae that extend from the upper torso to the skull. Bones and muscles support the head and allow for motion. Many times, these structures become injured, inflamed, or diseased, resulting in stiffness, loss of function, and pain. Here are the top 10 nonoperative neck pain therapies.

Physical Therapy

Physical therapy involves a treatment program aimed at alleviating aching and stiffness around the neck region. Exercises are used to strengthen and stretch the neck muscles. In addition, the therapist can use hands-on maneuvers to loosen up the cervical (neck) vertebrae, improve posture, and align the spine.

Transcutaneous Electrical Nerve Stimulation (TENS)

The TENS machine delivers mild, electrical impulses to the cervical neck region. These impulses reduce or block pain signals that go to the spinal cord and brain. TENS involves wearing external electrodes that connect to wires. The wires run to a small battery-operated generator that is worn on the outside of the body.

Facet Joint Injections

Along the cervical spine are tiny facet joints. These vertebral joints can degenerate, causing irritability and pain. Facet joint injections involve injecting a corticosteroid with or without an anesthetic into the joints. X-ray guidance is used to assure the needle is placed inside the joint near the targeted nerves. The full effects of the procedure are usually felt within one week following the injections.

Radiofrequency Ablation

Many patients with chronic neck pain benefit from destruction of the affected nerves. With radiofrequency ablation, the doctor inserts a small needle and probe near the targeted nerves using real-time x-ray. The nerves are ablated (destroyed) using radiofrequency heat energy. This procedure offers long-term pain relief, but nerves eventually regenerate.

Epidural Steroid Injection

The epidural space is the small area surrounding the nerves inside the spinal canal. With this procedure, the doctor uses real-time x-ray to guide the needle into the space. A corticosteroid agent is injected, with or without an anesthetic. Most patients report pain relief within 48-72 hours, but it could take up to 2 weeks for full effects.

Acupuncture

Acupuncture practitioners work on the premise that the body has an energy force called Qi (pronounced chee). When Qi is blocked, the patient develops physical illness. Acupuncture is used for chronic neck pain to restore energetic, healthy flow of Qi, and alleviate pain. The procedure involves insertion of tiny, fine needles into the skin and muscle along the painful body regions.

Chiropractic Treatment

The chiropractor uses a combination of manual therapy, spinal manipulation, and spinal adjustments to treat neck pain. Spinal techniques used include:

  • Flexion-distraction – Use of the hands to exert a pumping action on intervertebral discs rather than use direct force.
  • Specific spinal manipulation – Restores joint movement using gentle thrusting techniques.
  • Instrument-assisted manipulation – Use of a hand-held instrument to apply force without thrusting into the spinal column.
  • Soft tissue therapy – Use of instruments to treat muscle tension and spasms.
  • Therapeutic massage – Used to relax tense muscles.

Medications

Depending on the source of neck pain, medications can be prescribed. For nerve-related pain, antidepressants and anticonvulsants may help. For inflammatory pain, nonsteroidal anti-inflammatory drugs (NSAIDs) are used. Muscle relaxants, analgesics, and topical agents are often prescribe.

Prolotherapy

The doctor can inject a sclerosant (sugar water solution) is used to treat connective tissue injuries of the musculoskeletal system that cause neck pain. These injections promote a healing response to weakened tissue and small tears, which improves function and alleviates pain. Prolotherapy can treat whiplash, degenerative disc disease of the cervical spine, and other neck conditions.

Pain Pump Implant

Also called a spinal pump, the pain pump delivers pain medication into the intrathecal space around the spinal cord. The pump is implanted under the skin, and a catheter runs from the pump to the intrathecal space. Spinal pumps can be used to manage pain associated with failed neck surgery syndrome, as well as pain that does not respond to other therapies.

Resources

Manchikanti L, Abdi S, Atluri S, et al. (2013). An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician, 16(2), 49-83.

Rakesh G, Saurabh J, Seema M, & Sushma B (2012). Evidence Based Practice of Chronic Pain. Ind J Palliat Care, 18(3), 155-161.