Neck Pain

Neck Pain Treated in Alaska
Neck pain is one of the most prevalent reasons individuals consult with their physician. Neck pain occurs slightly more often in women, however many people experience some level of neck pain in the course of their lifetimes.

Most neck pain isn’t serious and may occur as a result of stress, improper body mechanics, like poor posture, or muscle strain in the neck from unusual or awkward positions.

Some serious symptoms that constitute a medical emergency that require immediate care include:

  • Loss of, or altered, consciousness
  • Changes in vision, such as blindness
  • Changes in bowel or urination
  • Nausea or vomiting
  • Fever
  • Weight Changes

The root cause or causes of neck pain have variable sources. Sudden pain lasting less than three months is classified as “acute.” Acute neck pain is commonly caused by facet syndrome (joint degeneration), muscle strain, or injuries, like whiplash. Pain lasting for more than three months, is classified as “chronic” neck pain. Neck pain can originate from multiple locations, but is often from facet joints irritation, discs, ligaments, and muscles.

Anatomy

The cervical spine (neck) is complex and has many important functions, which include providing support and mobility to the head and neck, as well as protection of the spinal cord emerging from the brain. Understanding the anatomy of the spine is crucial for a correct diagnosis and creating an effective treatment plan to alleviate neck pain.

Bone structures

The cervical spine has seven small vertebrae (bones). The cervical spine starts at the base of the head/skull. The small vertebrae provide a support structure and protect the spinal cord. The vertebrae support the head/skull and allow for movement.

Vertebral Discs

In between each of the vertebrae are jelly-like discs that cushion and minimize impact to the cervical spinal column. The soft design of the discs creates a tendency to become herniated “collapse backwards” or bulge through or onto adjacent ligaments, nerves or the spinal column itself. It’s this irritation or inflammation that leads to neck pain.

Spinal Ligaments and Muscles

Ligaments and muscles are integral part of the spinal system. They attach to each vertebra, providing support, mobility and movement for the cervical spine. Spinal nerves are attached to the cervical spinal cord.

Ligaments and muscles innervate the skin, surrounding structures of the neck and upper extremities (arms and hands). Damage to these structures is one of the major sources of neck pain.

Atlas and Axis

The Atlas (first vertebrae) and Axis are the first two cervical vertebrae, starting at the base of the head. These two vertebrae form pivot-type joints to support the head, control head movement, and connect to the spine. They are also part of the body’s coordination and balance system. The cervical spine is the most flexible portion of the spinal cord, thus is the most vulnerable to injury or trauma.

The first through the third cervical nerves, exiting from the cervical vertebrae provide sensory information for the head and face.

If these nerves are compromised, compressed or inflamed, they cause neck pain and sensory issues in some head and face areas.

Greater and Lesser Occipital Nerves

If these nerves are comprised, this can cause radiating pain to the face and head. The other nerves lower in the cervical spine combine to form a large nerve group, which provides motor and sensory support to the upper extremities (arms). Symptoms may include:  weakness, pain, loss of feeling, or other issues in the arms.

Procedure

Cervical epidural steroid injections (CESIs)

This procedure involves injecting a steroid into the epidural space (where the pain is located) in the cervical spinal canal. Two medications are used, a long-lasting steroid and a local anesthetic (lidocaine, bupivacaine).

The steroid reduces inflammation and irritation, while the anesthetic interrupts the pain cycle

Benefits

May provide immediate and longer-lasting pain relief

Cervical steroid injections are considered simple and relatively painless.

Risks

Mainly considered a low-risk procedure; but with any procedure, there is the risk of infection

Pathology

The most common causes of neck pain include:

  • Muscle strains
  • Trauma or injury
  • Herniated or bulging cervical disc
  • Stress

Muscle overuse and awkward positions for extended periods of time (such as sleep) often produces neck pain.  When the muscles in the back of the neck tighten and become strained, chronic pain may develop. A well-known cause of neck pain, “Whiplash”, occurs in motor vehicle accidents, most often in rear-end collisions.

This sort of neck pain often occurs from the stretching in the soft neck tissues, causing localized inflammation, muscle tension, and ligament strain. When ligaments and tendons become inflamed or damaged, it can cause additional pain that worsens with certain movements. In addition, the neck facet joints are also commonly involved in neck pain.

Conditions

Myofascial (muscle related) and ligament injury are the most common cause of neck pain. Ligaments have are susceptible to strain and irritation from strenuous lifting and prolonged overuse.

Degenerative disc disease (DDD)

DDD is a frequent cause of neck pain. Over time, the discs begin to fall apart or shrink. It’s one of the more common scenarios leading to spinal surgery. Disc disease can be acute, resulting from injury or trauma. However, more often it’s chronic and the pain is caused by a slow degeneration and occurs as part of the aging process. DDD is progressive and results from disc thinning and dehydration. This may lead to compression of the vertebrae or other adjacent structures that cause neck pain.

Cervical Spondylosis (neck arthritis)

Cervical Spondylosis is caused by degenerative cervical vertebrae changes and nearby facet joints. Symptoms typically start around the age of 40, but may start earlier with trauma or a genetic predisposition. Arthritis is a progressive disease; pain is often worse when the head is extended backwards. Degenerative disc changes occur through the aging process. The disc may decay, herniate, or bulge, causing local nerve root irritation or spinal cord compression.

Spinal Stenosis

Spinal Stenosis is another common cause of neck pain. It occurs, from a narrowing of the central spinal canal. This may cause spinal cord compression or pressure on surrounding nerves roots.  Some symptoms may include, cramping or shooting pain, or numbness in the legs, back, neck, shoulders or arms. The symptoms typically depend on the area of the spine that is compromised.  In cervical spinal stenosis, the upper extremities (arms) and shoulders are most commonly affected.

Mental health

Mental health issues, like depression, anxiety and stress, all have a tendency to exacerbate neck pain and other chronic pain syndromes.

Emotional issues often cause neck pain to grow worse. Dr. Rubin of the Mayo Clinic recently published a statement saying, “Low back and neck pain is a common problem and one of enormous social, psychological, and economic burden. It is estimated that 15% to 20% of adults have back pain during a single year and 50% to 80% experience at least one episode of back/neck pain during a lifetime. Low back pain afflicts all ages, from adolescents to the elderly, and is a major cause of disability in the adult working population.”

There are several identified risk factors in the development of spine pain. They are multidimensional; physical, socioeconomic status, general medical health and psychological state, and occupational environmental factors all contribute to the risk for experiencing pain” (Rubin 2007).

Central Sensitization

Central Sensitization or hypersensitivity is a common complication with chronic pain syndromes. It’s a development that involves both the peripheral nervous system (PNS) and the central nervous system (CNS). A local tissue injury and inflammation activate the PNS, which sends pain signals through the spinal cord to the brain. Central sensitization occurs when there is an increase in the excitability of neurons within the CNS at the level of the spinal cord and higher.

The once normal PNS signals begin to produce abnormal responses. Low-threshold sensory fibers activated by very light touch of the skin activate neurons in the spinal cord that should only respond to pain. Sensations that normally produce a harmless reaction now produce significant pain.

Other Conditions

Less common causes of neck pain include vertebral compression fractures, spinal cord disorders, tumors, and infection. Metastatic tumors (cancer spread from another organ system) are the most common type of malignant lesions of the spine. Some 5 to 10% of patients with a primary cancer suffer spinal metastases. Breast, lung, prostate, and renal cell carcinomas are the most common tumors that metastasize (attach) to the spine, whereas myeloma, lymphoma, and gastrointestinal carcinoma can also invade the vertebral column (James 2003).

Oropharyngeal cancers of the oral cavities and neck may also cause neck pain. All of these causes require immediate medical attention, seeing a physician should not be delayed.

Diagnosis

Diagnosis of neck pain is most often done by a medical physician. The physician performs a medical history and physical examine over certain areas of the spine; as well as performing various muscle tests to find any limitations in movement in the upper extremities.

The physician most likely will order one or more visual tests; such as X-ray, Computerized Magnetic resonance imaging (MRI) or Bone scan. MRI’s are considered the standard of care to detect the cause or causes acute or chronic neck pain.

Treatments

Before beginning any treatment, please consult a physician.

It’s vital to not only treat the physical symptoms, but the emotional stressors as well. Massage, acupuncture, biofeedback, and behavioral therapy can all be extremely beneficial in patients suffering from chronic neck pain.

Alternative or Complimentary Options

Benefits

Improved mobility and pain relief

Risks

Offering low to no risk

Acupuncture – the acupuncturist inserts small needles just under the skin. It’s thought that the needles trigger the release of hormones called “endorphins“, which are the body’s natural pain reliever. Acupuncture may aid in relaxation and decrease stress and tension.

Physical therapy is often helpful in reducing or alleviating neck pain.

Pain Relievers

Over-the-counter Pain relievers such as ibuprofen (like Motrin), or acetaminophen (like Tylenol) may provide neck pain relief.

Benefits

May offer pain relief for mild to moderate neck pain caused by muscle or ligament strain

Risks

Prolonged and frequent use of over-the-counter medications may lead to gastrointestinal conditions, such as ulcers; or liver damage in the case of acetaminophen.

For more information about neck pain, or the pain relief options described, please see your pain physician.

Resources

  • Neck Pain – PainDoctor.com
  • Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors. Skeletal Radiol. 2007 May;36(5):431-6. Epub 2007 Mar 6 Kwon JW, Lee JW, Kim SH, Choi JY, Yeom JS, Kim HJ, Kwack KS, Moon SG, Jun WS, Kang HS. PMID: 17340166
  • Epidemiology and risk factors for spine pain Neurol Clin. 2007 May;25(2):353-71 Rubin DI. PMID: 17445733
  • Botulinum toxin type A therapy for cervical dystonia Cochrane Database Syst Rev. 2005 Jan 25;(1):CD003633. Costa J, Espírito-Santo C, Borges A, Ferreira JJ, Coelho M, Moore P, Sampaio C. PMID: 1567491
  • Use of botulinum toxin-A for musculoskeletal pain in patients with whiplash associated disorders BMC Musculoskelet Disord. 2004 Feb 13;5:5. Juan FJ PMID: 15018625 Therapeutic cervical medial branch blocks in managing chronic neck pain: a preliminary report of a randomized, double-blind, controlled trial: clinical trial NCT0033272. Pain Physician. 2006 Oct;9(4):333-46 Manchikanti L, Damron K, Cash K, Manchukonda R, Pampati V. PMID: 17066118
  • Neuromodulation of the cervical spinal cord in the treatment of chronic intractable neck and upper extremity pain: a case series and review of the literature. Pain Physician. 2007 Mar;10(2):305-11 Vallejo R, Kramer J, Benyamin R. PMID: 17387353
  • Acupuncture for neck disorders. Spine. 2007 Jan 15;32(2):236-43. Trinh K, Graham N, Gross A, Goldsmith C, Wang E, Cameron I, Kay T. PMID: 17224820
  • Cervical Spinal Metastasis: Anterior Reconstruction and Stabilization Techniques After Tumor Resection James K. Liu, M.D.; Ronald I. Apfelbaum, M.D.; Bennie W. Chiles Iii, M.D.; Meic H. Schmidt, M.D. Neurosurg Focus 15(5), 2003. © 2003 American Association of Neurological Surgeons Posted 12/17/2003