NECK PAIN 

Neck pain can be caused by a number of factors, including muscle or ligament strains, arthritis, or a “pinched” nerve (when a nerve is irritated by something pressing on it). Approximately 10 percent of adults have neck pain at any one time. Most of the time, regardless of the cause, pain improves with conservative therapy. Neck pain is often categorized as “acute” (lasting less than six weeks), “subacute” (lasting 6 to 12 weeks), or “chronic” (lasting more than 12 weeks). While most episodes of acute pain resolve quickly, some people do go on to have longer-term pain.

CAUSES

Cervical strain — Cervical muscle strain can occur when there is an injury to the muscles of the neck, causing spasm (sudden tightening) of the cervical and upper back muscles. Cervical strain may result from the physical stresses of everyday life, including poor posture, muscle tension from psychological stress, or poor sleeping habits. Sports-related injuries can also result in cervical strain. 

Cervical spondylosis — Cervical spondylosis is a condition caused by abnormal wear and tear (called degenerative changes) of the cervical spine. This leads to gradual narrowing of the disc space, a loss of the normal square-shaped bone, and bone spurs (growths at the edges of the bones). These spurs can increase pressure on the surrounding tissues and lead to pinched nerves. Some degree of wear and tear is expected with normal aging, although severe degenerative changes are not typical.

Cervical discogenic pain — Cervical discogenic pain may be the most common cause of neck pain. It is caused by degenerative changes in the structure of one or more of the discs in between the cervical vertebrae. Common symptoms of discogenic pain include pain in the neck when turning or tilting the head. Discogenic pain can also cause referred pain or odd sensations into the arm or shoulder.

Cervical facet syndrome — The facet joints are located on sides of the vertebrae, and arthritis in this area can cause pain in the middle or side of the neck; some people also notice pain in the shoulders, around the shoulder blades, at the base of the head, into the ear and jaw, or in one arm. A common cause of cervical facet syndrome includes a job that requires a person to repeatedly extend the neck (tilt the head backwards).

Whiplash injury — “Whiplash” is a term used to describe injury caused by a traumatic event that causes an abrupt forward/backward movement of the neck. The most common cause of whiplash is a motor vehicle accident. A similar type of injury can occur in sports, when there is a significant blow to the body and the neck has to control the motion of the head. Whiplash can affect many of the structures in the neck, including the muscles, ligaments, and joints. 

Cervical myofascial pain — Myofascial pain is a disorder that causes tight and tender areas of muscle that are sensitive to pressure. Myofascial pain in the neck can develop after trauma or with other conditions, such as psychologic stress, depression, or insomnia.

Diffuse skeletal hyperostosis — Diffuse skeletal hyperostosis (DISH) is a syndrome in which there are abnormal calcifications (bone deposition) in the ligaments and tendons along the cervical spine, causing these tissues to become hardened. Many people with DISH have no symptoms while others develop stiffness, loss of mobility, and pain. This condition can also involve the thoracic (middle) and lumbar (lower) spine.

Cervical spondylotic myelopathy — Cervical spondylotic myelopathy occurs when there are degenerative changes that narrow the central spinal canal. This narrowing can injure the cervical spinal cord or cause it to function improperly. In addition to pain and loss of motion, signs of cervical spondylotic myelopathy may include a variety of neurologic complaints. Weakness, difficulty walking or coordinating movement, inability to empty or control the bowels or bladder, and sexual dysfunction (erectile dysfunction) may occur as a result of irritation of the spinal cord.

Cervical radiculopathy — Cervical radiculopathy occurs when a nerve root is irritated by something pressing on it (a protruding disc, arthritis of the spine, or a mass or cyst). Symptoms of radiculopathy can include pain, weakness, or changes in sensation (such as numbness or tingling) in the arms. The most common causes of cervical radiculopathy include:

Degenerative changes related to aging or injury

Herniation of a cervical disc

CONSERVATIVE TREATMENTS 

In most cases, neck pain can be treated conservatively with over-the-counter pain medications, ice, heat, massage, and strengthening and/or stretching exercises at home. If you still have pain or restrictions in movement restrictions after a few weeks of conservative treatment, see your health care provider for further evaluation.

Pain relief — Acetaminophen (sample brand name: Tylenol) or a nonsteroidal antiinflammatory medication (NSAID) such as ibuprofen (sample brand names: Advil, Motrin) or naproxen (sample brand names: Aleve, Naprosyn) may help relieve mild to moderate neck pain. (See “Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)”.)

Ice — For some people, ice applied to the sore area can help relieve neck pain. In general, for acute injuries, ice is recommended as the initial treatment, especially if swelling is present. You can also relieve muscle tightness by placing a bag of ice, bag of frozen peas, or a frozen towel to the painful area. The cold source should be wrapped in a thin dry cloth layer before it is placed on the neck to protect the skin. The ice or cold pack should be left in place for 15 to 20 minutes to deeply penetrate the tissues; this can be repeated every two to four hours until symptoms improve. Skin damage can result from excessive use of ice, especially in people with poor skin sensation; it’s a good idea to inspect your skin each time you apply ice. Look for changes in pigmentation (for example, lighter- or darker-colored areas) and let your health care provider know if you notice any problems.

Heat — Heat can also help to reduce neck pain. Apply moist heat for 10 to 15 minutes with a shower, hot bath, or moist towel warmed in a microwave. If you use a heated towel, be careful not to overheat, as this can cause injury.

Stretching exercises — You can help restore and preserve your range of motion with exercises that stretch and strengthen the neck muscles. Range of motion exercises and stretching may help decrease pain from muscle injury. It is best to perform stretching exercises when the muscles are warm, such as after the application of heat, or after a few minutes of cardiovascular warm-up exercises. Exercises can be done in the morning to relieve stiffness and again at night before going to bed. Expect mild, achy muscle pain if you are new to exercise. If you have sharp or “electric” type pain in your shoulder or arm, tell your provider right away.

OTHER TREATMENTS

Many other treatments have been studied for neck pain. Some have limited evidence for benefit, while others are appropriate in certain situations (such as people with severe or chronic pain or certain types of neck injury). If conservative treatments are not effective, your health care provider might suggest trying one or more of the following.

Prescription pain medications — As discussed above, treatment with an over-the-counter pain reliever such as a nonsteroidal antiinflammatory drug (NSAID) or acetaminophen may be enough to reduce your neck pain. 

Massage — Massage can be helpful for relieving muscle spasm. There are different types of massage, and people have different preferences about the technique and amount of pressure used. If you want to try massage, it’s best to seek out a licensed massage therapist with experience in treating people with neck pain.

Acupuncture — Acupuncture involves inserting very fine needles into specific points, as determined by traditional Chinese maps of the body’s flow of energy. Many acupuncturists have experience in treating people with neck pain; if you would like to try this, your health care provider may be able to recommend someone.

Movement-based therapy — Depending on your situation, your health care provider might recommend working with a physical therapist to develop an individualized exercise program. This typically involves a combination of stretching, strengthening, and stabilizing exercises. A physical therapist can teach you exercises that you can continue to do at home between treatments.

Spinal manipulation and other manual therapy — “Spinal manipulation” is a technique sometimes used by chiropractors, physical therapists, doctors, massage therapists, and others to relieve neck or back pain; it can be effective when used in conjunction with exercise. Manual therapy and joint mobilization are gentle types of manipulation that can help improve joint and soft tissue movement and flexibility.

Trigger point injections — This involves injecting a local anesthetic medication (such as lidocaine) into the muscles at specific areas of tenderness. Trigger point injections may be recommended if conservative treatments do not significantly improve pain. However, there is no good evidence that trigger point injections help to reduce pain or speed healing in the long term. Trigger point injections with steroids into the neck muscles are not recommended due to the risk of injury to the muscles and lack of additional benefit.

Psychological and mind-body therapies — People with chronic neck pain may benefit from something called cognitive behavioral therapy (CBT). CBT involves learning about your condition (including addressing any misconceptions and fears that you may have about your pain), learning how to develop a more positive way of thinking, and setting activity goals and working toward those goals. CBT techniques may be performed by a psychologist, physical therapist, or other trained professional.

Resources:

https://www.uptodate.com/contents/neck-pain-beyond-the-basics

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