Neck pain is very common. There are many complex and important structures in the neck, including the top seven bones in the spine (vertebrae), the disks between the vertebrae, blood vessels, spinal nerves, muscles and ligaments. Problems with any one of these can result in neck pain. If neck pain is chronic, and doesn't improve with neck exercises or ergonomics, your options might include injections or radiofrequency treatments.
Overview and Symptoms
What Causes Neck Pain?
Humans put a lot of demand on the neck every day simply by walking upright, as the structures in the neck are called upon to carry the head, which weighs about 15 pounds. Yet most of us do things that put even further strain on the neck, causing tightness and pain.
A great deal of neck pain is the result of daily strain on the neck from things like poor posture, cell phone use or a poorly designed workstation. Other common causes are arthritic changes in the neck, sleeping positions that strain the neck, or injuries from heavy lifting, exercise or car accidents.
Many times, people have pain in the neck due to neck strain, but cannot pinpoint how it happened. Stress, which can cause tightening of the muscles in the neck, can make neck pain worse. In rare cases, neck pain is the result of more serious problems such as fracture (a broken bone), ligamentous injury, infection, or cancer.
How is Neck Pain Evaluated?
Your doctor will first do a careful history and physical exam. These simple measures give important clues as to whether there is likely to be a serious problem. If serious problems are unlikely, further testing (such as X-rays or MRIs) is usually not needed for new onset neck pain. Rather, the doctor will recommend conservative measures (see below) to see if things improve. If conservative measures do not help, an X-ray or MRI may be done.
Treatment at BIDMC
How is Common Neck Pain Treated?
If there are no signs of serious problems, conservative measures are usually recommended and result in improvement in most cases. If there is new strain to the neck (from a known or unknown cause), applying ice in the first 24 hours can help reduce swelling. After 24 hours, ice alternating with heat is best.
Your doctor may also recommend:
- 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
- Use of non-steroidal anti-inflammatory medicines, such as ibuprofen
These measures usually cause improvement or relief of the pain within six weeks. If the pain persists beyond six weeks, further work-up and other treatments may be needed.
Treatments for Chronic Neck Pain
A number of different treatments are available for chronic neck pain. The type of treatment that is best for each patient depends on many factors, including the nature and location of the pain, whether there is also pain or numbness in the arms or hands, and existence of structural problems in the neck. Interventional treatments may include:
Trigger Point Injections
These are injections into the muscles of the neck, which can help them to relax, decreasing pain and increasing neck mobility. These are frequently used in conjunction with physical therapy.
Cervical Epidural Steroid Injections
These are injections of anti-inflammatory medication inside the spinal column and above the spinal cord, reducing swelling and pain.
Cervical Medial Branch Blocks
These are injections of numbing medicine into the small nerves that supply particular joints — facet joints — in the neck.
Sometimes radiofrequency treatment is used in patients who have had relief from medial branch blocks; it uses heat to provide longer-term numbing of these nerves.
In select cases, surgery may be recommended; surgery may remove the disc between the vertebrae, and/or parts of the vertebral bone; some surgeries involve fusing vertebrae together.