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 life. There are many causes of neck pain and they can generally be separated into acute and chronic causes. If the pain is 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.
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
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.
A well-known cause of neck pain, referred to as 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.
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.
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.
Diagnosis of neck pain can be difficult, so the pain physicians at LA Pain Doctor have received extra training to examine and diagnose your painful condition. 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.
Neck Pain Treatment and Therapy Options
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.
Some of the current treatments are:
- Pharmacotherapy: NSAIDs, acetaminophen, muscle relaxants, and membrane-stabilizing medications are often effective in treating neck pain.
- 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. A specific nerve, the medial branch, innervates the facet joints and can be blocked with the injection of medication into a specific area of the body with a nerve-numbing substance or anesthetic. Facet joints are located on the back of the spine, where one vertebra slightly overlaps another. These joints guide and restrict the spine’s movement.
- 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 (Vallejo 2007). Patients reported significant (70-90%) reductions in neck and upper extremity pain when treated by cervical SCS. Several of the patients in this particular study also benefited from a decrease in associated headache and lower extremity pain.
- 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.
- 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.
- 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). Botox injections have also been found to be effective in patients with whiplash injuries. Along with reductions in pain, patients were found to have improved range of motion (Juan 2004).
- Biofeedback: This is a treatment for neck pain that teaches a patient to become aware of processes that are normally thought to be involuntary inside of the body (such as blood pressure, temperature, and heart rate control). This method enables you to gain some conscious control of these processes, which can influence and improve your level of pain. A better awareness of one’s body teaches one to effectively relax, and this can help to relieve pain.
- 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. Acupuncture has been shown to be very helpful in those with chronic pain, helping to relieve their symptoms (Trinh 2007).
- 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.
Treatment options are available for chronic pain, headaches, reduced range of motion, and more.