Neck Pain

It is defined as pain, muscle tension or stiffness in your neck.  It is a common condition that usually involves the muscles of your neck as well (myofascial pain syndrome).  Typically, it can occur acutely after a specific event/trauma from poor posture to after a motor vehicle accident.  Chronically, it can stem from arthritis in your neck that increases through time.  (see facet syndrome)

Rarely, neck pain is a symptom of a more serious problem.  If the pain travels down the shoulders/arms and/or causes any numbness or tingling, this may be a sign that the pain may be coming from a nerve that is being irritated in your neck (radiculopathy).  It is important to rule out other potential causes of neck pain that may not be coming from your spine such as infection.

The most common cause of mechanical neck pain comes from irritation and/or arthritis of the joints in your neck (cervical facet syndrome).  This is followed by disc related issues (degenerative disc disease).  Other potential causes of low back pain include:  muscle spasms (myofascial pain) and spinal stenosis.

Like with any pain condition, the earlier you address the condition with the appropriate treatment, the likelihood of this not becoming a chronic problem improves dramatically.  One of the worst things you can do is do nothing.  Therefore the goal of the treatment is to decrease/eliminate your pain as quickly as possible to allow you to return back to your normal daily activities without delay.  In addition lifestyle and behavioral changes can help to prevent any recurrence of your neck pain which can involve dietary changes as well as strengthening the muscles around your spine.

Acutely, neck pain can improve with oral medications typically anti-inflammatories and possibly muscle relaxants if you have a significant component of muscle spasms as well.  If you have shoulder/arm pain associated with your neck pain (cervical radiculopathy), then an anti-seizure medication or antidepressant may be added to help control your pain.  The majority of “pain” medications have the side effect of sleepiness so they can also help you rest.  Opioids ie “narcotics” are not recommended for first line treatment of acute neck pain.

If your pain continues after several weeks or becomes too debilitating despite oral medications, being evaluated by a spine specialist should be your next step.  Physical therapy may be recommended but can be difficult if your pain is still not under control.  As we now realize that a significant amount of cases of acute neck pain is not treated by surgery initially, a referral to see a spine surgeon is likely unnecessary and at times, may delay appropriate treatment as it may take several weeks to months to be seen and evaluated.  In the meantime, you may be given medications to help control your pain that are not indicated and/or may give you intolerable side effects.  These may mask your pain and can have addictive properties that may make you dependent on them.  If you decide to wait to see a spine surgeon, you will likely be referred to see another spine specialist for further treatment.  Even if your neck pain is causing significant arm pain as well to the point that it may be numb, tingle or even weak, surgery is still unlikely to be an initial option.

If you have factors such as a history of trauma, cancer or osteoporosis an x-ray may be warranted to rule out any type of fracture.  If not, x-rays are typically not needed.  In addition, if you have arm pain associated with your neck pain, an MRI is likely not needed prior to treating your condition.  However, if treatment based upon your clinical picture (see cervical epidural steroid injection) does not improve your symptoms, further studies including an MRI of your lower back may be the next step in your care.  Only after conservative therapies fail, and appropriate treatment and diagnostic studies have been performed, should you need to see a spine surgeon.  Your pain relief should not be delayed waiting to see specialist nor should you be treated with medications that only mask your pain that do not target the specific cause of your pain as you wait to be seen.

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