It is one of the very common complaints. There are many structures in the neck which can be the source of the pain. These are cervical vertebrae, the disc in between these vertebrae, muscles and ligaments.
What causes neck pain ?
Our normal anatomical upright posture itself put lot of pressure on neck on which head lies (weighing around 7 kg). A further stress on the neck is caused by poor posture, poorly designed workstation, sleeping on stomach, large pillow or tilting the neck while talking on the phone. Other common causes are trauma from exercise, vehicular accident or heavy weight lifting or arthritic changes in neck joints.
Neck stain or stress causes tightening of the neck muscles and which in turn worsens the pain. Most of the time individuals do not remember how it happened. Rarely can it be due to fracture, ligamentous injury, cancer or infection.
One of the common cause of neck pain is levator scapulae syndrome. This is nothing but inflammation or tightening of levaotor scapulae muscle. Pain produce can mimic disc disease.
How is neck pain evaluated ?
- Physical examination
- X-rays and MRI ( if any serious problem, no response to conservative treatment)
How is common neck pain treated ?
Conservative treatment is the first line of therapy in the absence of serious problems and will result in improvement in most cases. In case of strain applying ice in the first 24 hours can help reduce swelling. After 24 hours, ice alternating with heat is best.
- Use of pain killers (paracetamol, non-steroidal anti-inflammatory medicines, opioids)
- Ultrasonic short wave physiotherapy, TENS
- Physical therapy, exercises and stretches for the neck muscles, such as chin tucks and range of motion activities (once the patient is able to perform them)
- Using an ergonomically designed workstation
- Sleep ergonomics, such as using appropriate pillow support and avoiding sleeping on the stomach
Usually by the end of six weeks pain is relieved and if not then further evaluation is required.
Treatments for Chronic Neck Pain
A choice of therapy depends on various factor including the nature and location of the pain, whether there is radiating pain or numbness in the arms or hands, any history of trauma and presence of bony changes in the cervical vertebrae.
Interventional treatments may include:
Trigger Point Injections
It is injections in the neck muscles which in turns help to relax the neck muscle and finally reduces pain with increased neck mobility. This is usually combined with physiotheraphy and neck exercises.
Cervical Epidural Steroid Injections
It is injection in the epidural space to reduce the inflammation and swelling on the nerve due to disc prolapsed.
Cervical Medial Branch Blocks
This is basically injecting medications around the medial branch which supply the facet joints. This medication blocks the transmission of signal to brain. This is the only way to confirm weather your facet joint are source of pain. Radio frequency ablation of these nerves are done after diagnostic injection confirm the source of pain.
It will be the last resort in selected cases where everything has failed.