The old cliché “a pain in the neck” sounds funny, however, for people suffering neck pain, it is anything but funny.
Neck pain can originate from a number of different sources and sometimes is due to a combination of issues. The cervical discs are the shock absorber pads between the bones in the neck. The discs can bulge when the outer wall is weakened but still intact. The discs can rupture or herniate when the outer wall tears and the jelly center is extruded. As we age the jelly center of the discs (the nucleus) dries out, the discs become thinner and can develop bone spurs, this is called degenerative disc disease. The joints in the neck where movement occurs are called the facet joints. These joints can develop arthritis and can be injured in falls or other trauma. The muscles in the neck have the big job of holding up our head. People can develop muscle tension, knots, spasms, and pain called myofascial pain. Nerves in the neck can become pinched by bone spurs or disc protrusions, this is called cervical radiculopathy. The spinal cord in the center of the spine can become compressed. Determining the exact cause of neck pain can be difficult, even with MRI scans.
When people live with a level of neck pain for years, and then develop numbness in an arm, the first thought is that they have developed a pinched nerve in the neck. This often prompts an MRI scan of the neck that shows bulging discs and bone spurs. The problem is that all of us have these degenerative changes after the age of forty, degenerative changes can be pain-free, and determining if those changes are the cause of the problem is very important.
It is also important to consider other contributing factors such as a shoulder joint injury, which can radiate pain to the neck. Ruling out a pinched nerve at the wrist or the elbow contributing to the symptoms is also critical.
Electromyography (EMG) testing is imperative for an accurate diagnosis of nerve issues, especially before any invasive treatment options such as a cervical epidural injection or surgery are performed. An accurate diagnosis gives the best option for effective treatment.
Treatment for neck pain falls into four main categories.
Therapy and Hands on Work
Hands-on work such as physical therapy, adjustments, and massage. This also includes treatment such as heat, ice, ultrasound, electric stimulation, and traction (decompression). Traction can help reduce pressure on a pinched nerve or an inflamed facet joint. It does not make disc protrusions smaller or rehydrate a degenerative disc.
The most basic are trigger point injections done in conjunction with massage to address myofascial pain (painful muscle spasms). A trigger point injection involves injecting a local anesthetic into several locations of painful muscle spasms to temporarily knock out the spasm, followed immediately by massage. This is done once a week for up to six weeks. The goal is to block the pain-causing spasm - causing pain cycle even temporarily, with the hope that the muscles tension will relax. If two sessions fail, these are discontinued.
Botox injections can be performed for muscle spasms or headaches, these last 2 to 4 months, and often need to be repeated on an ongoing basis.
Cervical epidural injections are steroid (cortisone) injections into the spinal canal under x-ray, to calm the inflammation from a disc injury or a pinched nerve. These injections have a remote risk of spinal cord injury.
There are a number of injection options for facet joint pain. Steroid injections into the joints can be performed under x-ray. The nerves to the facet joints can be burned to block facet joint pain, this is called a rhizotomy. Prior to rhizotomy, test injections called “medial branch blocks” are performed to determine if the pain is originating from the facet joints. Rhizotomy typically lasts for six months, the nerves then regenerate, often requiring this procedure to be repeated.
Sadly there is no perfect pill, and all medications have potential side effects. It is best to discuss these options in more detail with your physician.
Reserved for severe pathologies such as spinal cord or nerve compression.
All the treatment options discussed above have their limitations, and there are plenty of people who try everything and have ongoing trouble with chronic neck pain. With neck pain you must avoid sleeping on your stomach. It is very important to protect and care for our neck. Poor desk setups that have the neck always turned to one side need to be corrected. It is not a good idea to fall asleep on the couch with your neck on the side armrest. Staying in one position for an extended period can flair neck pain.
As in all medical conditions, proper treatment first depends on an accurate diagnosis. Any type of nerve symptoms including pain radiating from the neck into the arm, numbness, or weakness needs evaluation. A pain in the neck is not always something that must be lived with.
AUTHOR: KATHARINE LEPPARD, MD
Medical Rehabilitation Specialists
3470 Centennial Blvd., Suite 110
Colorado Springs, CO 80907