Neck Pain Causes and Treatment

Neck pain is almost as common a complaint as low back pain.

Most cases of neck pain are due to minor muscular or ligament stresses. But there could be many other causes including the serious ones.

Most of the neck pain cases are short-lasting and often can be managed at home. But a chronic pain in the neck or pain that worsens with time can point to some underlying cause and often requires a consultation with a physician.

The neck consists of the cervical spine and other tissues and any abnormality in any structure can cause neck pain.

The cervical spine is a mobile region of the spine that bears the weight of the head and is attached at the other end to an immobile thorax.

Causes of Neck Pain

Most of the neck pains in the adult are caused by musculoskeletal issues. For sake of completion, other causes are also included but these are not discussed further in the article. Only musculoskeletal causes and presentations are further discussed.

Here is a list of conditions that might cause neck pain due to direct or indirect involvement. The list involves both musculoskeletal and non-musculoskeletal causes.

Musculoskeletal Causes

Cervical spine injury
- Fractures of vertebrae
- Whiplash injury
- Neck sprain and strain
Lesions of vertebrae
- Infection [osteomylitis]
- Benign and malignant lesions including metastasis
Herniated intervertebral disc
Degenerative changes leading to cervical spondylosis
Meningeal infection or tumors
Diseases of the muscles
- Myofascial pain syndrome
- Viral myalgia
- Hematoma
- Calcific tendinitis of the musculus longus Colli
- Reflex spasm (meningitis, adenitis, acute pharyngitis)
- Torticollis acquired or congenital
Lesions of mandible – fracture, infection etc

Non-Musculoskeletal Causes

Pharynx lesions
- Pharyngitis
- Ludwig’s angina
- Pharyngeal cyst which is inflamed
Tonsillar lesions
Lesions of tongue – ulcers and malignancy
Esophagitis
SKin lesions furuncle
Lesions of salivary gland
Thyroid lesions
Lymph node swelling
Carotid body tumor
Subclavian artery aneurysm
Referred Pain as in bronchial tumor or pancoast’s tumor

Diagnosis

Neck pain is a symptom and not the disease in itself. Therefore, a patient presenting with pain in the neck region needs to be evaluated for all the probable causes.

Minor acute pains resolve with local therapy. However, chronic pain indicates an underlying problem that requires more detailed evaluation.

Musculoskeletal neck pain can present as acute or chronic pain in the affected region of the neck. The pain is often worsened by neck movements.

There are associated symptoms and findings which may suggest a probable cause. These are

Numbness or tingling sensation [paraesthesias] in front of the chest or back or upper limb
Dysphagia[difficulty swallowing]
Giddiness
lightheadedness
Swelling
Referred pain that leads to
- Headache
- Facial pain
- Shoulder pain
- Pain in the arm or forearm or hand

The patient should be enquired for the following history

Associated pain in the lower back or other joints [rheumatoid or other arthropathies]
Trauma
Sprain
Fever
Pain at night
Morning stiffness
Movements and postures that worsen the pain
Movements and postures that make it better
Professional history like the use of computers, reading, etc.
Sleeping habits and postures

The patient’s neck is examined for

Tenderness
Tautness of structures
Swelling
Redness
Muscle spasm
Range of movement

Neurological examination is done to know muscle reflexes, muscle power and sensation.

Neurologic examination is critical in evaluating the patient with neck pain, as radicular symptoms and neurologic deficits localize the areas of pathology. The pattern of radicular symptoms and the motor, sensory, and reflex deficits localize the nerve root involved.

Imaging

Anteroposterior and lateral views x-rays of the cervical spine are the basic x-ray film studies. All seven cervical vertebrae must be visualized.

A lateral flexion and extension view could be ordered for flexion-extension injuries e.g., whiplash or in chronic instability of the neck.

X-rays should be assessed not only for bone damage but for soft-tissue injury as well.

Most of the neck pain cases do not require x-rays. Very few patients require imaging beyond the x-rays of the neck.

CT and MRI provide better images and an in-depth study of the structures.

MRI is the preferred modality of the imaging and is indicated where neural symptoms are present and the patient ins not showing any improvement in spite of the treatment.

MRI is also able to show any space-occupying lesion like abscess, tumor. It is the imaging of choice to visualize disc herniation and nerve root compression.

CT is better at showing bony pathologies and is better at finding fractures of the vertebrae or ossification of posterior longitudinal ligament.

Bone scan is important in cases of malignancy.

Treatment of Neck Pain

Treatment of the neck pain involves providing comfort to the pain and at the same time addressing the cause of pain if discernable.

Most neck pains can be treated with nonoperative methods. Quite a lot are amenable to self care measures whereas for others consultation with a physician becomes necessary.

Nonoperative Treatment for Neck Pains

Nonoperative treatment includes both – selfcare measures and other treatments.

Minor neck pains can be dealt at home with selfcare. The measures include

Rest to the part
Ice or heat application
Gentle stretches
Over the counter pain relief drugs like Acetaminophen
Neck massage

There are certain measures that include lifestyle changes and long term benefits in neck pain and other kinds of musculoskeletal pain. These are

Active lifestyle
Quitting smoking
Posture improvement
Ergonomic measures

If a few days of self-care do not result in an improvement, a consultation with a doctor may be sought and the advice followed.

The following approaches are used for musculoskeletal neck pain.

Physical therapy

Cervical orthoses
Stretch exercises
Neck muscle strengthening exercises
Done under the supervision of physical therapist and physician
Later, the exercises can be continued at home

Drugs

Other NSAIDs like ibuprofen
Muscle relaxants like chlorzoxazone, thiocolchicoside
Gabapentin, pregabalin
Opioid drugs

Invasive Treatments and Surgery

Injections

Cervical epidural steroid injection
- For pains of cervical origin
- Instillation of steroid solution into the cervical epidural space,
Radiofrequency ablation
- For pains of facet joint origin
- Done under fluoroscopy
- Uses heat probe to destruct sensory nerves at the join

The injections provide only temporary relief.