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Neck Pain
While not as common as pain in other areas of the body, neck pain can be quite debilitating, especially for older adults or those suffering from an injury. Learn more about some common causes of neck pain and explore your treatment options here.
Neck Pain: Conditions, Causes and Treatment Options
Neck pain is a common condition that affects many people at some point in their lives. It is typically characterized by pain or discomfort in the neck and upper shoulders, and may be accompanied by stiffness, limited mobility, and headaches.
Some common causes of neck pain include:
- Poor posture or ergonomics, such as hunching over a computer or holding the head in a forward position for extended periods of time.
- Muscle strain or injury, such as from whiplash, sports injuries, or falls.
- Degenerative changes in the spine, such as arthritis, disc degeneration, or spinal stenosis.
- Nerve compression or irritation, such as from a herniated disc or a pinched nerve.
- Inflammatory conditions, such as rheumatoid arthritis or fibromyalgia.
Treatment for neck pain depends on the underlying cause and severity of the symptoms. In many cases, rest, ice or heat therapy, stretching, and over-the-counter pain medications can provide relief. Physical therapy, chiropractic care, or massage therapy may also be helpful in relieving symptoms and improving mobility.
For more severe or persistent neck pain, prescription medications or injections of corticosteroids or other medications may be necessary. In rare cases, surgery may be required to correct the underlying problem causing the neck pain.
Prevention of neck pain can be achieved by maintaining good posture, taking frequent breaks when sitting for extended periods, using ergonomic workstations, and practicing good neck and shoulder stretching and strengthening exercises.
Most common diagnosis of neck pain?
Neck pain can have many different causes, and the specific diagnosis will depend on the underlying condition causing the pain. Some common diagnoses associated with neck pain include:
Cervical Strain / Sprain
This is a common injury that occurs when the neck is suddenly forced to move beyond its normal range of motion, causing damage to the soft tissues in the neck. It can be caused by car accidents, falls, sports injuries, or poor posture.
Cervical Degenerative Disc Disease
Cervical degenerative disc disease is a condition that occurs when one or more discs between the vertebrae of the cervical spinal column deteriorates. The gel-like material wears out, in most cases due to aging, losing its cushioning ability. The body reacts by laying down bone to stabilize the spine, known as bone spurs, which can cause pain for the patient in the neck and upper back. Nonsurgical treatment options such as medication, rest, exercise, and physical therapy may be recommended for those with no evidence of nerve root compression or muscle weakness. Additional conservative options may include steroidal injections, and if these treatments fail to provide relief, surgery is considered, in which a discectomy is performed to remove the affected disc(s).
Cervical Degenerative Joint Disease
Degenerative joint disease is the most common form of arthritis, marked by the breakdown of cartilage in joints, and can occur in almost any joint in the body. As degeneration progresses in the cervical spine, those soft areas in the cartilage crack and wear down, exposing bone and causing irritation in the neck. Other symptoms of degenerative joint disease include pain, stiffness, limited range of motion, loss of flexibility, and muscle spasms. In most cases, treatment for degenerative joint disease is non-surgical and can include physical therapy, pain medication, injections, and other modalities. Severe cases may warrant spine surgery.Cervical Facet Syndrome
Cervical facet syndrome is a form of arthritis that affects the facet joints in the top part of the spine. Facet joints are located on the back of the spine and are responsible for connecting the vertebrae and providing stability. Loss of cartilage and fluid in these joints causes friction between the bones, resulting in bone spurs on the facet joints, which can cause symptoms like neck pain, pain and tenderness at the level of the affected joint, muscle spasms, changes in posture, and loss of motion. For mild symptoms, nonsurgical treatment includes activity modification to reduce flare-ups, physical therapy, or joint injections. Severe cases may warrant spine surgery.Cervical Herniated Disc
Between each vertebrae in the spine is a structure called the intervertebral disc. An intervertebral disc is made up of 2 parts: the outer, fibrous ring and a gel-like center. When the outer ring is torn, the center can push out and put pressure on other structures in the area, like spinal nerves. Symptoms may include neck or back pain, stiffness or reduced range of motion, sensory changes such as tingling or numbness in the nerve that has been affected, loss of motion, and difficulty sitting or bending. However, if the damaged disc is not pressing on a sensitive structure, the patient may also remain symptom-free. Most pain from a herniated disc will resolve over a few weeks to a couple months with nonsurgical treatment and pain management. If the pain lasts longer or if the pain or damage is severe, spine surgery may be an option, which can include a laminectomy or discectomy in which part of all of the damaged disc is removed.Cervical Radiculopathy
Radiculopathy is commonly referred to as a pinched nerve, when the nerve roots that exit the spine are damaged or irritated. At each level in the spine, a nerve exits and travels in a specific path to skin and muscles. Because nerves are responsible for pain, sensation, and strength, compression of a nerve in the cervical spine may result in pain, sensation changes, or weakness at different locations of your body. Cervical radiculopathy may lead to weakness or numbness in the shoulder, arm, hand, or fingers.
Cervical Stenosis
With age, your spinal canal can start to narrow, which can put pressure on the nerves that travel through the spine. The narrowing is usually caused by arthritis of the spinal column and discs between the vertebrae. When the cervical spine begins to narrow, symptoms may occur in the neck, shoulders, and arms. While some can be born with a narrower spinal canal, most cases are the result of aging and wear and tear on the spine. Other causes of spinal stenosis can include herniated discs, overgrowth of bone or bone spurs, and spinal injuries. For mild cases of stenosis, conservative treatment such as pain medication or physical therapy is recommended. Steroid injections can help reduce inflammation and relieve some of the pain. For more progressive cases, surgical options such as a laminectomy may be recommended to relieve the pressure on the spinal cord or affected nerve roots.Whiplash
Whiplash occurs when your neck jerks back and forth quickly and violently. Your spine bends past its normal range of motion, which can injure the vertebrae of your cervical spine and damage the supporting ligaments and muscles in your neck. Whiplash can cause pain and stiffness in your neck at the time of injury, or it may not begin until days later. This is a common injury in motor vehicle accidents.
Other less common diagnoses associated with neck pain include infections, tumors, fractures, and inflammatory conditions such as rheumatoid arthritis. If you are experiencing neck pain, it is important to seek medical attention to determine the underlying cause and receive appropriate treatment.
Conservative Care Options
Rest
Taking a break from activities that aggravate the pain, such as typing or lifting heavy objects, can help reduce inflammation and allow the body to heal.
Ice or Heat Therapy
Applying ice or heat to the neck can help reduce pain and inflammation. Ice is typically recommended for the first 24-48 hours after the onset of pain, followed by heat therapy to increase blood flow and promote healing.
Over-the-counter pain Medications:
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help reduce pain and inflammation.
Physical therapy: A physical therapist can help design an exercise program to improve range of motion, strengthen the muscles in the neck and upper back, and reduce pain.
Chiropractic Care
A chiropractor can perform manual manipulations to the spine and neck to help reduce pain and improve mobility.
Massage Therapy
Massage can help relieve muscle tension and reduce pain in the neck and upper back.
Acupuncture
This traditional Chinese medicine practice involves the insertion of fine needles into specific points on the body to help reduce pain and promote healing.
In addition to these conservative treatments, lifestyle modifications such as maintaining good posture, using ergonomic workstations, and avoiding activities that exacerbate the pain can also help reduce neck pain. It is important to consult with a healthcare provider to determine the most appropriate treatment plan for your individual needs.
Pain Management Treatments for Neck Pain
Cervical Trigger Point Injections
Cervical trigger point injections are a type of treatment that can be used to relieve pain and muscle spasms in the neck and upper back. Trigger points are small knots of muscle that can form in response to injury, overuse, or stress, and can cause pain, stiffness, and limited mobility.
During a cervical trigger point injection, a small needle is inserted into the trigger point, and a local anesthetic and/or a corticosteroid medication is injected directly into the muscle. This can help relieve pain, reduce inflammation, and improve mobility by relaxing the affected muscles.
Cervical trigger point injections are typically performed in an outpatient setting and take only a few minutes to complete. The procedure is generally safe, but there is a small risk of infection or bleeding at the injection site. Some patients may experience mild soreness or bruising at the injection site, but this typically resolves within a few days.
Cervical trigger point injections can be used as a standalone treatment or as part of a comprehensive treatment plan that may include physical therapy, medications, or other therapies. It is important to discuss the potential risks and benefits of this procedure with a healthcare provider to determine if it is the right option for your individual needs.
Cervical Epidural Injection
A cervical epidural injection is a type of minimally invasive procedure that can be used to treat neck pain, arm pain, and other symptoms caused by pressure or inflammation of the nerves in the cervical spine. The procedure involves injecting medication directly into the epidural space, which is the area around the spinal cord and the nerves that exit the spine.
During a cervical epidural injection, the patient lies face down or up depend type of approach on a table, and the healthcare provider cleans and numbs the injection site. A small needle is then inserted through the skin and muscle and directed into the epidural space using imaging guidance such as fluoroscopy. Once the needle is in place, a combination of local anesthetic and corticosteroid medication is injected into the epidural space to help reduce inflammation and relieve pain.
Cervical epidural injections are typically performed on an outpatient basis and take only a few minutes to complete. The patient may feel a brief sensation of pressure or discomfort during the injection, but the procedure is generally well-tolerated. After the injection, the patient may be monitored for a short time and then discharged home with instructions to rest and avoid strenuous activities for a few days.
Cervical epidural injections can be an effective treatment option for a range of cervical spine conditions, including herniated discs, spinal stenosis, and degenerative disc disease. The benefits of the injection may last for several weeks to months, and the procedure can be repeated as necessary to provide ongoing relief of symptoms. However, as with any medical procedure, there are potential risks and complications associated with cervical epidural injections, including infection, bleeding, and nerve damage. It is important to discuss the potential risks and benefits of this procedure with a healthcare provider to determine if it is the right option for your individual needs.
Cervical Facet Medial Branch Bloc
A cervical medial branch block is a type of diagnostic and therapeutic procedure that can be used to diagnose and treat neck pain caused by facet joint syndrome. Facet joints are small joints located between the vertebrae of the spine, and they can become inflamed or irritated, causing pain, stiffness, and limited mobility.
During a cervical medial branch block, a healthcare provider injects a local anesthetic medication into the medial branch nerve, which is a small nerve that supplies sensation to the facet joint. This can help to temporarily block the transmission of pain signals and help identify whether the facet joint is the source of the patient’s pain.
The procedure is typically performed on an outpatient basis and takes only a few minutes to complete. The patient lies face down on a table, and the healthcare provider cleans and numbs the injection site. Using fluoroscopy or other imaging guidance, a small needle is then inserted near the target medial branch nerve, and a small amount of anesthetic medication is injected. The patient may feel a brief sensation of pressure or discomfort during the injection, but the procedure is generally well-tolerated.
If the patient experiences significant pain relief after the injection, it may suggest that the facet joint is the source of the pain, and further treatment such as radiofrequency ablation may be recommended to provide longer-lasting relief.
Cervical medial branch blocks are generally safe, but as with any medical procedure, there are potential risks and complications, including infection, bleeding, and nerve damage. It is important to discuss the potential risks and benefits of this procedure with a healthcare provider to determine if it is the right option for your individual needs.
Cervical Medial Branch RFA
Cervical radiofrequency ablation (RFA), also known as cervical facet thermal ablation, is a minimally invasive procedure used to provide long-lasting relief from neck and upper back pain caused by facet joint syndrome. Facet joints are small joints located between the vertebrae of the spine, and they can become inflamed or irritated, causing pain, stiffness, and limited mobility.
During a cervical RFA procedure, a healthcare provider uses a specialized needle to deliver heat energy to the targeted nerves that supply sensation to the facet joint. The heat energy destroys the nerves’ ability to transmit pain signals, providing long-lasting relief from pain.
The procedure is typically performed on an outpatient basis and takes only a few minutes to complete. The patient lies face down on a table, and the healthcare provider cleans and numbs the injection site. Using fluoroscopy or other imaging guidance, the provider inserts a small needle near the target nerves, and a tiny electrode is then inserted through the needle. The electrode delivers heat energy to the nerves, which is carefully monitored to ensure that the correct nerves are targeted.
Cervical RFA is generally well-tolerated, and most patients experience only mild discomfort during the procedure. After the procedure, patients may experience some soreness or discomfort for a few days, but this typically resolves quickly. The benefits of the procedure can last for several months to years, and the procedure can be repeated as necessary to provide ongoing relief of symptoms.
Cervical Percutaneous Discectomy
Cervical percutaneous discectomy is a minimally invasive procedure used to treat cervical disc herniation, a common cause of neck and arm pain. This procedure is performed using a small needle and specialized instruments to remove the herniated portion of the disc, which can help relieve pressure on the nerves and reduce pain and other symptoms.
During the procedure, the patient is typically positioned lying face down on a table, and the healthcare provider uses fluoroscopy or other imaging guidance to locate the herniated disc. A small needle is then inserted through the skin and into the center of the disc, and specialized instruments are used to remove the herniated portion of the disc. This procedure can be performed using local anesthesia and sedation, and typically takes less than an hour to complete.
Cervical percutaneous discectomy is generally considered a safe and effective procedure, with a low risk of complications. However, as with any medical procedure, there are potential risks and complications, including infection, bleeding, nerve damage, and allergic reactions to medications or contrast dye. Patients should discuss the potential risks and benefits of this procedure with their healthcare provider to determine if it is the right option for their individual needs.
Surgical Treatments for Neck Pain
Cervical Disc Replacement
Cervical disc replacement is a surgical procedure that involves removing a damaged or degenerated cervical disc in the neck and replacing it with an artificial disc to maintain mobility and stability in the spine. This procedure is typically performed to alleviate pain, weakness, and numbness in the neck, shoulders, and arms caused by disc herniation or degenerative disc disease.
During the procedure, the patient is placed under general anesthesia and the surgeon makes a small incision in the front of the neck. The damaged cervical disc is then removed, and a metal or plastic implant is inserted in its place. The artificial disc is designed to mimic the natural function of the disc, allowing for normal movement and stability in the spine.
Cervical disc replacement is typically performed on an outpatient basis, and most patients can return to normal activities within a few weeks. The procedure is generally considered safe and effective, with a low risk of complications, such as infection, bleeding, nerve damage, or implant failure.
Cervical disc replacement may not be appropriate for all patients, and the decision to undergo this procedure should be made in consultation with a healthcare provider. Patients with severe spinal deformities or instability, previous neck surgeries, or other medical conditions may not be suitable candidates for cervical disc replacement.
ACDF for Anterior Neck Fusion
Anterior cervical discectomy and fusion (ACDF) is a surgical procedure performed to alleviate neck and arm pain caused by a damaged or herniated cervical disc in the neck. The procedure involves removing the damaged disc and fusing the adjacent vertebrae together to stabilize the spine.
During the procedure, the patient is placed under general anesthesia, and a small incision is made in the front of the neck. The damaged disc is then removed, and the vertebrae above and below the disc are fused together using bone grafts or metal implants. The fusion helps to stabilize the spine and prevent further damage or herniation of the disc.
ACDF is typically performed on an outpatient basis, and patients can usually return to normal activities within a few weeks to several months, depending on the extent of the surgery and individual recovery time. The procedure is generally considered safe and effective, with a low risk of complications, such as infection, bleeding, nerve damage, or implant failure.
ACDF may not be appropriate for all patients, and the decision to undergo this procedure should be made in consultation with a healthcare provider. Patients with severe spinal deformities or instability, previous neck surgeries, or other medical conditions may not be suitable candidates for ACDF.
Cervical Microscopic Discectomy
Cervical microdiscectomy is a minimally invasive surgical procedure used to treat herniated or damaged cervical discs in the neck. This procedure involves removing a portion of the damaged disc through a small incision in the neck to relieve pressure on the spinal cord or nerves, which can cause neck pain, arm pain, weakness, and numbness.
During the procedure, the patient is placed under general anesthesia, and a small incision is made in the front of the neck. The surgeon then uses specialized instruments and a microscope to remove the portion of the damaged disc that is compressing the nerves or spinal cord. The remaining disc material is left in place to maintain the stability of the spine.
Cervical microdiscectomy is typically performed on an outpatient basis, and most patients can return to normal activities within a few weeks. The procedure is generally considered safe and effective, with a low risk of complications, such as infection, bleeding, nerve damage, or anesthesia complications.
Cervical microdiscectomy may not be appropriate for all patients, and the decision to undergo this procedure should be made in consultation with a healthcare provider. Patients with severe spinal deformities or instability, previous neck surgeries, or other medical conditions may not be suitable candidates for cervical microdiscectomy.