Neck Pain

Neck pain or cervicalgia is a common problem, neck muscles can be strained from poor posture, whether it's leaning into your computer at work or hunching over your workbench at home. Wear-and-tear arthritis also is a common cause of neck pain.

Neck pain can come from a number of disorders and diseases and can involve any of the tissues in the neck.
Examples of common conditions causing neck pain are degenerative disc disease, neck strain, neck injury such as in whiplash, a herniated disc, or a pinched nerve.

Neck pain can also come from common infections, such as virus infection of the throat, leading to lymph node swelling and neck pain. Neck pain can also come from rare infections, such as tuberculosis of the neck, infection of the spine bones in the neck, and meningitis often accompanied by neck stiffness. Neck pain can also come from conditions directly affecting the muscles of the neck, such as fibromyalgia and polymyalgia rheumatica. Neck pain is also referred to as cervical pain.

Causes

• Abnormalities in the bone or joints
• Trauma
• Poor posture
• Degenerative diseases
• Tumors
• Muscle strain
• Accidents or falls can cause severe neck injuries such as vertebral fractures, whiplash, blood vessel injury, and even paralysis

Other causes include:

• Medical conditions, such as fibromyalgia
• Cervical arthritis or spondylosis
• Ruptured disk
• Small fractures to the spine from osteoporosis
• Spinal stenosis (narrowing of the spinal canal)
• Sprains
• Infection of the spine (osteomyelitis, diskitis, abscess)
• Cancer that involves the spine

Symptoms

Neck pain may:

• Spread to the upper back, shoulders, or arms.
• Be worse with movement.
• Make your neck stiff or tender.
• Cause headaches. These are common and may last for months. 

Nerve-related symptoms caused by pressure on the spinal nerve roots or spinal cord include:

• Numbness, tingling, or weakness in your arm or hand.
• A burning feeling when you are touched on the skin of the arm or hand.
• A pain that feels like a shock and extends into your arm or hand.
• Leg numbness or weakness, and loss of the ability to control urination (bladder control) or bowel movements. This can occur when there is pressure on or injury to the spinal cord.

Diagnosis

During the physical exam, your doctor will check for tenderness, numbness and muscle weakness. He or she will also ask you to move your head as far as it can go forward, backward and side to side.

Imaging tests

In some cases, your doctor may order imaging tests to get a better picture of what might be causing your neck pain. Examples include:

• X-rays. X-rays can reveal areas in your neck where your nerves or spinal cord may be pinched by bone spurs or a bulging disk.
• Computerized tomography (CT) scan. CT scans combine X-ray images taken from many different directions to produce detailed cross-sectional views of the internal structures of your neck.
• Magnetic resonance imaging (MRI). MRIs utilize radio waves and a strong magnetic field to create especially detailed images of bones and soft tissues, including the spinal cord and the nerves coming from the spinal cord.

However, many people have X-ray or MRI evidence of structural problems in their neck without experiencing any symptoms. So it can be difficult to determine if your symptoms are actually being caused by what shows up on imaging studies.

Nerve tests

If your doctor suspects that your neck pain may be related to a pinched nerve, he or she may suggest electromyography (EMG). This test involves inserting very fine needles through your skin into a muscle to determine whether specific nerves are functioning properly.

Lab tests

• Blood tests. Blood tests can sometimes provide evidence of inflammatory or infectious conditions that may be causing your neck pain.
• Spinal tap (lumbar puncture). During a spinal tap, a needle is carefully inserted into your spine to obtain a sample of the fluid that surrounds your brain and spinal cord. This test can reveal evidence of meningitis.

Treatment

Treatment of neck pain depends on the cause. For the vast majority of people, neck pain can be treated conservatively. Recommendations which help alleviate symptoms include applying heat or cold. Other common treatments could include medication, body mechanics training, ergonomic reform, and physical therapy.

Conservative treatment

Exercise plus joint mobilization and/or joint manipulation (spinal adjustment) has been found to be beneficial in both acute and chronic mechanical neck disorders. Both cervical manipulation and cervical mobilisation produce similar immediate-, and short-term changes; no long-term data are available. Thoracic manipulation may also improve pain and function. Low level laser therapy has been shown to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.

Medication

Analgesics such as acetaminophen or NSAIDs are recommended for pain. Muscle relaxants are often prescribed and are known to be effective. However, one study showed that one muscle relaxant called cyclobenzaprine was not effective for treatment of acute cervical strain (as opposed to neck pain from other etiologies or chronic neck pain). Over the counter topical creams and patches may be effective for some patients.

Surgery

Surgery is usually not indicated for mechanical causes of neck pain. If neck pain is the result of instability, cancer, or other disease process surgery may be necessary. Surgery is usually not indicated for "pinched nerves" or herniated discs unless there is spinal cord compression or pain and disability have been protracted for many months and refractory to conservative treatment such as physical therapy.

Home Treatment

Heat or ice:

• Use a heating pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours.
• Take a warm shower in place of one session with the heating pad.
• You can buy single-use heat wraps that last up to 8 hours.
• Try an ice pack for 10 to 15 minutes every 2 to 3 hours.

Practice good health habits:

• Try to reduce stress and tension at work and home.
• Practice relaxation exercises.
• Consider getting a massage.
• Stop smoking. Smoking slows healing because it decreases blood supply and delays tissue repair.
• Exercise regularly, including aerobic exercise such as walking

Pain relievers:

• Acetaminophen (such as Tylenol) can help relieve pain.
• Nonsteroidal anti-inflammatory drugs, ibuprofen (such as Advil) and naproxen (such as Aleve), can help relieve pain and reduce inflammation.

Get moving, but carefully

• Ease back into your normal daily activities as soon as you can. Movement helps your muscles stay strong.
• Avoid activities such as lifting and sports that make pain and stiffness worse.
• Do stretching and strengthening exercises to keep your neck flexible and strong and prevent stiffness.
• Avoid or change any activities that may be causing your neck pain, such as sitting for a long time at the computer or doing too much overhead work at a time.
• Gently massage or rub the area to relieve pain and encourage blood flow. Don't massage the injured area if it causes pain. Nonprescription creams or gels, such as Bengay, may provide pain relief.