Neck Pain

Neck pain (or cervicalgia) is a common problem, with two-thirds of the population having neck pain at some point in their lives.

Neck pain, although felt in the neck, can be caused by numerous other spinal issues. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the nerves emanating from the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back.

The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The top three joints in the neck allow for most movement of your neck and head. The lower joints in the neck and those of the upper back create a supportive structure for your head to sit on. If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.

Neck pain may also arise from many other physical and emotional health issues.

Differential diagnosis

Neck pain may come from any of the structures in the neck including: vascular, nerve, airway, digestive, and musculature / skeletal or be referred from other areas of the body.

Major and severe causes of neck pain include:

• Carotid artery dissection
• Referred pain from acute coronary syndrome
• Infections: retropharyngeal abscess, epiglottitis, etc.
• Spondylosis – degenerative arthritis and osteophytes
• Spinal stenosis – a narrowing of the spinal canal
• Spinal disc herniation – protruding or bulging discs, or if severe prolapse.

The more common and lesser neck pain causes include:

• Stress – physical and emotional stresses
• Prolonged postures – many people fall asleep on sofas and chairs and wake with sore necks
• Minor injuries and falls – car accidents, sporting events and day to day minor injuries
• Referred pain – mostly from upper back problems
• Over-use – muscular strain is one of the most common causes
• Whiplash

Although the causes are numerous, most are easily rectified by either professional help or using self help advice and techniques.

More causes include poor sleeping posture, torticollis, head injury, rheumatoid arthritis, Carotidynia, congenital cervical rib, mononucleosis, rubella, certain cancers, ankylosing spondylitis, cervical spine fracture, esophageal trauma, subarachnoid hemorrhage, lymphadenitis, thyroid trauma, and tracheal trauma.

Treatment

Treatment of neck pain depends on the cause. Many acute problems in the spine/neck generally resolve themselves in as little as a few days to a few months. Persistent problems involving the cervical spine should be evaluated by a health care practitioner. Common treatments could include medication, body mechanics training, ergonomic reform, or physical therapy.

Conservative treatment

Exercise plus joint mobilization and/or joint manipulation has been found to be beneficial in both acute and chronic mechanical neck disorders. Neither mobilization or manipulation without exercise however has been found to be helpful. Mobilization is equivalent to manipulation.

The use of heat or cold may provide short term pain relief. Ultrasound has been shown not to be efficacious.

Medication

Analgesics such as acetaminophen or NSAIDs are recommended for pain. Muscle relaxants such as cyclobenzaprine have not been found to be useful and are therefore not recommended. Over the counter topical creams and patches containing counterirritants have little evidence to support efficacy.

Surgery

Surgery is usually not indicated for most 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.

Prognosis

About one-half of episodes resolve within one year. About 10% of cases become chronic.