Who Is Affected By Neck Pain?
Neck pain refers to pain in the cervical (neck) region that may radiate into the upper extremities. Every year, approximately 10% of the population will have an episode of neck pain. Neck pain can affect individuals of all ages, affecting women slightly more often then men.
What Are The Risk Factors And Causes Of Neck Pain?
Most cases of neck pain are the result of wear and tear of the structures in the neck. This wear and tear can occur with aging or from overuse of the neck and arms. Approximately 10% of neck pain cases are associated with systemic illnesses, such as polymyalgia rheumatic.
Common musculoskeletal conditions that cause neck pain include:
- Muscle strain: Can occur after prolonged activity (i.e. sitting at a computer too long), or after sleeping in an awkward position.
- Intervertebral disc herniation: Compression of a nerve in the cervical region caused by a disc herniation can cause severe arm pain, neck pain, and may also lead to a loss of function of the affected nerve, resulting in muscle weakness, diminished reflex, and decreased sensation.
- Osteoarthritis: Bone spurs that often develop with this condition can cause localized pain in the neck as well as radiating arm pain if a nerve is compressed.
- Spinal stenosis: Narrowing of the spinal canal can cause compression of the spinal cord in the cervical region. The narrowing can be caused by various conditions including disc bulges, bone spurs, and ligament thickening.
- Whiplash: This injury is most commonly caused by rear-impact motor vehicle accidents. The neck pain associated with this type of injury typically develops 24-48 hours after the accident.
- Systemic disorders: Ankylosing spondylitis, polymyalgia rheumatic, tumors, infection, and rheumatoid arthritis can all lead to neck pain.
Various factors have been identified that increase an individual’s risk of suffering from chronic neck pain, including:
- Female sex
- History of neck injury or pain
- Loss of function of the hands or wrists
- Frequent cycling
- Poor quality of life
- Frequent anxiety attacks or stress
- Age over 40
Diagnosing Neck Pain
The diagnosis of neck pain begins with an accurate history and thorough physical exam. Many cases of neck pain can be diagnosed by using the information gained from these assessment methods.
Special imaging tests such as X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) may be ordered for patients who are unresponsive to treatment or when underlying pathology is suspected. Soft tissue injuries, disc herniation, spinal stenosis, nerve injuries, and tumors can all be ruled out with imaging techniques. Additionally if neck pain is believed to be caused by an irritated nerve, diagnostic nerve blocks may be used to confirm this suspicion.
Lifestyle Changes To Manage Neck Pain
Prevention is key when it comes to living with neck pain. Patients should avoid sitting at a computer for extended periods of time throughout the day and take regular breaks to stretch their neck and back. Patients should maintain an active lifestyle and exercise regularly to decrease stress. Patients who are overweight should try to lose weight by exercising and eating healthy. Patients who are smokers should quit, as smoking is a predisposing factor for neck pain. Additionally, smoking slows down the natural healing process in the body.
Treatments For Neck Pain
Once the cause of an individual’s neck pain has been established, recommendations can be made that are tailored to the underlying cause of their pain.
From a pharmacologic perspective, non-steroidal anti-inflammatory drugs (NSAIDS), including naproxen and ibuprofen are often recommended to patients experiencing neck pain. NSAIDS should only be taken on a temporary basis, as there is a risk of gastrointestinal issues, bleeding, and ulcers with long-term use.
Patients suffering from chronic neck pain may be prescribed antidepressants such as amitriptyline, doxepin, and clomipramine, which are tricyclics. The way in which these type of antidepressants work remains unknown; however, it is believed that this type of drug blocks neurotransmitter activity in the brain, which helps to relieve pain symptoms.
Muscle relaxants, including antispasmodic medications and antispastic medications, may be prescribed to patients suffering with neck pain. These medications have been shown to help temporarily relieve neck pain symptoms. Anticonvulsants may be prescribed, especially in patients where the pain is believed to be caused by nerve damage.
Patients with severe or debilitating neck pain may be prescribed a trial of opioid therapy with drugs such as codeine, tramadol, morphine, or oxycodone. These drugs are believed to help relieve neck pain by binding to appropriate receptors in the brain. When opioids are used, they should only be used for a short period of time due to their serious side effects and potential for abuse and misuse.
Different types of injections, such as epidural steroid injections and Botox injections, may be recommended for some patients with neck pain.
Physical therapy has been shown to be an effective treatment option for the majority of patients suffering from neck pain. Physical therapy involves manual therapy as well as specific stretching and strengthening exercises for the cervical spine.
Chiropractic care has also been shown to reduce neck pain in some patients. This type of treatment has also been associated with an enhanced sense of well being. Chiropractic care involves spinal manipulation, which uses controlled thrusts to the affected area of the spine in an attempt to restore normal joint movement. Chiropractors may also make exercise recommendations to help improve neck range of motion and strength.
Massage therapy, in particular active release technique, may also be beneficial for some patients experiencing neck pain. Additionally, acupuncture has shown some potential for reducing neck pain symptoms.
An alternative treatment method that has been shown to help reduce neck pain in some individuals is biofeedback training. During this method patients are taught how to alter their body’s physiological responses by being shown visual cues of their physiological responses in real time. During this therapy, patients are taught exercises that will help them to cope with their neck pain. To reduce neck pain symptoms, the recommended biofeedback tools are EMG to monitor muscle tension, ECG to measure heart rate, and a respiratory machine to measure breathing patterns.
Back surgery may be required for some patients who suffer from neck pain; however, surgery should only be considered once all conservative methods have been exhausted.
If you suffer from neck pain consider reviewing the links to the literature below to learn more about this condition. Furthermore, consulting with your physician will help to answer any other questions or concerns that you may have regarding your neck pain, including potential treatment options that may be beneficial for your condition.