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Neck Pain

Overview

Neck pain is a leading cause of pain in the aging population, as well as subsequent to auto accident-whiplash type injury, in which the neck is violently snapped back, then forward, after the victim is usually hit from behind, by another vehicle.

Neck pain can arise from a multitude of causes. This is usually what produces the symptoms experienced by the patient. The etiology must be diagnosed, and treatment will be aimed at the appropriate source. Sometimes, there are several causes that occur simultaneously. This makes diagnosis and treatment more complex. Surgery is usually a last resort for pain in and of itself, however if neurological symptoms become evident, it may be the necessary avenue to pursue.

Poor posture certainly contributes to neck pain. But the design of your neck also makes it vulnerable. All the interconnected structures that give your neck its incredible range of motion are subject to the wear-and-tear damage of arthritis and the "overstretching" injuries of whiplash.

Neck pain accompanied by a headache and fever could be a symptom of meningitis, an infection of the membranes that surround your brain. If your neck is so stiff that you can't touch your chin to your chest, you should seek immediate medical attention.

Causes

  • Muscle strains. Overuse, such as too many hours hunched over a steering wheel, often triggers muscle strains. Neck muscles, particularly those in the back of your neck, become fatigued and eventually strained. When you overuse your neck muscles repeatedly, chronic pain can develop. Even such minor things as reading in bed or gritting your teeth can strain neck muscles.
  • Arthritis. Just like all the other joints in your body, your neck joints tend to deteriorate with age. Facet joints, which are the two areas (one on each side) in the back of the neck, which represent where one vertebra contacts the vertebra underneath, can become enlarged from arthritis, and inflamed, producing pain.
  • Disk disorders. As you age, the cushioning disks between your vertebrae become dry, narrowing the spaces in your spinal column where the nerves come out. The disks in your neck also can herniate. This means the inner gelatinous material of a disk protrudes through the disk's tough covering. Nearby nerves can be irritated. Other tissues and bony growths also can press on your nerves as they exit your spinal cord, causing pain.
  • Injury. Rear-end collisions often result in whiplash injuries, which occur when the head is jerked forward and back, stretching the soft tissues of the neck beyond their limits.

Signs and Symptoms

Your neck contains bones, joints, tendons, ligaments, muscles and nerves, any of which can hurt. Neck pain also may come from regions near your neck, such as your jaw, head and shoulders. Conversely, problems in your neck can make other parts of your body hurt, such as your upper back, shoulders or arms.

If your nerves are involved in your neck pain, you may also feel numbness, tingling or weakness in your arms or legs.

Neck pain can be posterior (along the back aspect of the neck), anterior (along the front of the neck) and can often radiate to the upper or lower extremities, or even to the skull, and produce headaches.

Seeking Medical Advice

Muscle irritations are usually easy to self-diagnose. They typically come on after excessive activity, a period of overuse or prolonged postures that put excessive strain on your neck muscles. But they usually get better on their own within a few days to a couple of weeks. If the pain doesn't let up within a week or two, see your doctor.

Also see your doctor if the following signs and symptoms occur in conjunction with neck pain:
  • Severe pain from an injury. After head or neck trauma, such as whiplash or a blow to your head, see your doctor immediately. Severe pain over a bone might indicate a fracture or an injury to a ligament.
  • Shooting pain. Pain radiating to your shoulder, through your shoulder blades or down your arm, or numbness or tingling in your fingers, may indicate nerve irritation. Neck pain from nerve irritation can last from three to six months or longer. Because serious problems may occur after continued nerve irritation, see your doctor.
  • Loss of strength. Weakness in an arm or a leg, walking with a stiff leg, or shuffling your feet indicates the need for immediate evaluation.
  • Change in bladder or bowel habits. Any significant change, especially a sudden onset of incontinence, could indicate a neurological problem.

Screening and Diagnosis

Your doctor often will be able to diagnose the cause of your neck pain and recommend treatment just by asking questions about the type, location and onset of your pain.

In less clear-cut cases, your doctor may use imaging techniques such as X-rays, magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These tests may show compression of nerve roots, narrowing of nerve root outlets, spinal cord problems and disk problems.

Electromyography (EMG), a test that evaluates the electrical activity in nerve and muscle, may help determine if there's nerve damage. And myelography, or X-ray imaging of the spinal cord after injection of a dye beneath its tough outer membrane, may be helpful in determining if a disk, bone or other growth is crowding the nerves or spinal cord.

Treatment

Most neck pain responds well to home care. Neck injuries or strains often result in painful inflammation. You may want to try over-the-counter pain relievers that also combat inflammation, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). Acetaminophen relieves pain but not inflammation.

Ice is another good way to reduce inflammation. Heat can help relax sore muscles, but it sometimes aggravates inflammation, so use it with caution. Apply heat or ice for 15 to 20 minutes, with a 40-minute rest between applications.

For pain that doesn't get better with simple home-care measures, your doctor may recommend:
  • Physical therapy. Heat, ice or similar treatments combined with an appropriate stretching and muscle strengthening program may enhance the structures that support your cervical spine. Such treatments are often all you need for neck pain.
  • Pain medications. Your doctor may prescribe stronger pain medicine than what you can get over-the-counter. Opioid analgesics are sometimes used briefly to treat acute neck pain. Muscle relaxants or tricyclic antidepressant medications also may be prescribed.
  • Traction. This therapy, under supervision of a medical professional and physical therapist, may provide relatively fast relief of some neck pain, especially pain related to nerve root irritation. Relief may last for hours or even days.
  • Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on your skin near the painful areas deliver tiny electrical impulses that may relieve pain.
  • Corticosteroid medication. Although there is some evidence that corticosteroids are useful, research is inconclusive. These drugs may be administered orally or via injection into the space around the nerve roots.
  • Short-term immobilization. A soft cervical collar that supports your neck without taxing your muscles may help.
  • Nerve blocks such as transforaminal injections, facet blocks, medial branch blocks are all extremely useful at first in diagnosing the exact location of the “pain generator” and then in providing more therapeutic benefit in pain relief.
  • Radiofrequency Procedures are performed after a patient has received substantial (greater than 50%) pain relief after the above mentioned nerve blocks, which have isolated the particular pain generator(s). The advent of “pulsed” radiofrequency has made radiofrequency a viable treatment option to treating sciatica type pain, in which surgery used to be the main alternative, if conservative treatment failed.
  • Surgery. Surgery is rarely needed for neck pain. It is used to relieve nerve root or spinal cord compression.

Prevention

Most neck pain is associated with poor posture. The goal is to keep your head centered over your spine, so gravity works with your neck instead of against it. Some simple changes in your daily routine may help.
  • Take frequent breaks if you drive long distances or work long hours at your computer. Keep your head back, over your spine, to reduce neck strain. Try to avoid gritting your teeth.
  • Adjust your desk, chair and computer so the monitor is at eye level. Knees should be slightly lower than hips. Use your chair's armrests.
  • Avoid tucking the phone between your ear and shoulder when you talk. If you use the phone a lot, get a headset.
  • Stretch frequently if you work at a desk. Shrug your shoulders up and down. Pull your shoulder blades together and then relax. Pull your shoulders down while leaning your head to each side to stretch your neck muscles.
  • Balance your base. Stretching the front chest wall muscles and strengthening the muscles around the shoulder blade and back of the shoulder can promote a balanced base of support for the neck.
  • Avoid sleeping on your stomach. This position puts stress on your neck. Choose a pillow that supports the natural curve of your neck. 

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