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Neck Pain

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Acute Neck Pain.

The most common and best understood type of pain is acute pain. Acute pain will result when tissue is injured by trauma, surgery, illness, or infection. This type of pain is generally understood and expected. It is typically sharp, shooting, aching, or burning, and it decreases as the tissue heals and the body recovers. This is pain that is “talking to you” and telling you that something is wrong.

The sudden onset of pain in the neck can occur after an injury or may appear without a known problem. If the pain is only in the tissues around the spine and does not radiate into the shoulders, arms, or hand, it is less likely to involve pressure on the nerve roots. If the pain is radiating into the limb, then this is more likely to involve pressure on the nerve. The etiology could be strain or tearing of the supporting tissues with intense muscle spasm, a herniation of the disc between the vertebrae, or a fracture of the bony structure of the spine. Initial care will include rest, pain medications, muscle relaxants, and possible epidural steroid injections, with trigger point injections for muscle spasm. The early use of physical therapy is important in many cases.

Chronic Neck Pain.

When a particular pain outlasts the normal healing process, it is categorized as chronic pain. Chronic pain symptoms can be caused by a variety of abnormalities in the nervous system. It can be complex, and it is often disabling. Chronic pain can greatly affect a person’s work, personal relationships and self-esteem. The determination of a specific and accurate diagnosis is mandatory for proper treatment.

Chronic neck pain is pain experienced longer than 3 to 6 months and might result from the same sources as noted in acute neck pain. However, many times the pain may originate from injury to the nerve tissues from chronic degeneration of the spine, or may continue after surgery. Appropriate evaluation might reveal the pain source, and allow specific treatment. The anatomical reasons for pain need to be differentiated from the pain caused by nerve injury which is also known as neuropathic pain.

Cervical Radiculopathy



Cervical radiculopathy causes neck pain when a cervical nerve root is irritated and radiates pain into the shoulder or arm. Two nerve roots, one on the right and one on the left, exit in between each bone in the spine (vertebrae) and supplies sensation, motor ability, and position sense to a specific area in the body. The nerve roots can become irritated if pressed upon such as when there is a bulging disc pushing against a nerve, narrowing in the spinal cord, or narrowing in the space where the nerve roots exit through the vertebrae. Symptoms typically include neck pain that radiates into the arm(s). Pain is described as pins and needles, burning, or aching pain. Patients may also complain of numbness or weakness in the arms. Treatment options include physical therapy, non-steroidal anti-inflammatories (NSAIDs), ice, traction, and epidural steroid injections.

Cervical Spondylosis


Cervical spondylosis is a degenerative condition that occurs with aging and affects the vertebrae and discs. It is a type of arthritis in the neck that causes inflammation in the small joints on the side of the vertebrae (facet joints). When the joints become inflamed or bone spurs develop, narrowing can occur where the nerve roots exit and pinch the nerves. Symptoms can include neck pain that may radiate into the shoulder or arm, headaches in the back of the head, “cracking” sounds, arm weakness or numbness. Treatment options include traction, physical therapy, traction, massage, epidural steroid injections, facet joint injections, medial branch blocks, radiofrequency denervation, and surgery.

Degenerative Disc Disease

Degeneration of the intervertebral disc is a condition that results from age-related changes to the discs that serve as cushioning between the vertebrae in the spine. As we get older, the discs become drier, worn down, and thinner which make them provide less support in between the vertebrae. The discs have a tough outer later and a soft inside, similar to a jelly donut, and with age the outer layer can tear (annular tear). The soft material can leak out and irritate the nerve roots. The facet joints can become inflamed and even become loose (subluxation) and bone spurs can develop, causing narrowing in the spinal cord (spinal stenosis). Symptoms can include pain in the neck with possible radiation into the arm or shoulder, neck stiffness, and muscle spasms. Treatment options include exercise, physical therapy, non-steroidal anti-inflammatories (NSAIDs), muscle relaxants, pain medication, heat and ice, epidural steroid injections, and surgery.

Facet Joint Syndrome



Facet joints are a pair of joints on the back of the spine and are prone to arthritis. This is one of the most common causes of back pain. Just as arthritis in a person’s hand can cause enlargement of the joints, the same occurs in the back. When the facet joints enlarge, they can narrow the opening where the nerve roots leave the spinal cord and go out to the body. Symptoms can include neck pain without associated arm pain. The pain is typically described as an ache and centrally located. Treatment options include physical therapy, chiropractic adjustments, medial branch blocks, facet joint injections, and radiofrequency denervation.

Occipital Neuralgia


Occipital neuralgia is a chronic pain disorder caused by irritation or injury to the occipital nerve located in the back of the head. People with this disorder experience pain originating at the back of the neck. The pain is often described as throbbing and migraine-like and spreads up and around the forehead and scalp. This can result from physical stress, trauma, or repeated contraction of the muscles of the neck. Treatment options include massage, rest, pain medications, anti-depressants, nerve blocks, and epidural steroid injections.

Post Laminectomy Syndrome



Post laminectomy syndrome is continued back and/or leg pain even after surgery. The cause for the continued pain is varied and could be due to injury to the nerve root during surgery, scar formation after the surgery, changes above or below fusion, and delayed surgery causing significant damage to the nerve root prior to surgery. Symptoms include back pain with or without associated leg pain. Treatment options include physical therapy, pain medication, tricyclic anti-depressants, anti-seizure medications, epidural steroid injections, and spinal cord stimulation.

Cervical Spinal Stenosis



Spinal stenosis is narrowing in the spine that can be in the central canal, where the spinal cord is located, or where the nerve roots exit from the spinal cord, the neuroforamen. This is most commonly due to degenerative changes such as disc bulges or enlargement of the facet joints from arthritis, bone spurs, thickened ligamentum flavum (ligament that runs in between the vertebrae and spinal cord providing strength to the spine). Symptoms can include pain and/or numbness in the neck with possible radiation into the arms, weakness, numbness, and if severe enough, can cause bladder and bowel difficulty. The pain is worse with activity such as working with the upper extremities, driving, or working over a desk or computer. Treatment options include oral steroids, anti-inflammatory medications like Ibuprofen or Naproxen, anti-seizure medications, pain medications, physical therapy, and epidural steroid injections. In some patients, surgery to open the space is necessary or indicated.