What Is Neck Pain?
Neck pain explained by San Antonio, Austin, Houston, Dallas Texas top pain doctors
Neck pain is a common condition that generally affects women more often than men. In particular, it has been estimated that about 15% of men and 25% of women between the ages of 20 and 56 experience pain in the neck as well as the shoulder at some point in their lives. In addition, persistent neck pain can frequently develop due to different reasons. Evidence suggests that approximately half of the people who suffer from neck pain report experiencing the painful symptoms even after six months. Moreover, once neck pain develops, it can become recurrent. In other words, the initial incident that caused the neck pain makes individuals more susceptible to neck pain in the future. It is often easier to pinpoint the cause of neck pain in people who can recall a previous incident that resulted in the pain in comparison to someone who never suffered from neck pain. Therefore, previously struggling with neck pain greatly increases the risk of developing neck pain at a later time.
Neck pain often results in dramatic impairments in normal function and movement. Consequently, neck pain is associated with significant disabilities that detrimentally affect an individual’s ability to function properly at work and at home. More specifically, about 10% of patients who have chronic neck pain usually cannot continue to go to work. Similarly, neck pain has been shown to contribute to factors that negatively impact the economy. In other words, neck pain is often held responsible for decreased work performance and dramatic increases in health care services (e. g., treatment or therapy). Moreover, research shows that approximately 25% to 50% of people who suffer from neck pain seek professional treatment in order to help address their painful symptoms and discomfort. Therefore, the occurrence of neck pain is starting to warrant extensive empirical and theoretical research. During the last few decades, clinicians and researchers have conducted various studies to determine if there are prognostic factors that may indicate the presence of neck pain. In addition, numerous randomized controlled trials have been performed to test whether alternative forms of treatment are effective at relieving and reducing symptoms.
The part of the spinal column that is closest to the base of the head is called the cervical spine. This region is believed to be the cause of most neck pain. Ligament, muscle, and tissue damage in the neck are contributing factors as well. Cerebrospinal fluid (CSF) surrounds the spinal cord and this fluid acts as a protective barrier for the nerves along the spinal cord. Both the CSF and spinal cord are encased within a tough membrane called the spinal canal. The nerves along the spine function primarily to transfer information throughout the body and brain. Cervical facet joints, which are small connective bones, are located close to the neck and have slightly different shapes from facet joints in other parts of the body because the neck has a larger range of motion. If any of these joints become damaged or injured, soreness, inflammation, pain, and stiffness can develop in the neck as well as the shoulders or upper back.
The examination for neck pain typically includes a detailed medical history questionnaire and a physical assessment. The purpose of the examination is to help the clinician accurately diagnose the cause of the pain. Unfortunately, the exact cause may not always be identified. In such cases, a clinician will try to rule out other possibilities. For example, the clinician will conduct an assessment that can exclude possible problems with nerve roots or the spinal cord. The clinician will also evaluate the patient’s degree of mobility problems that may significantly limit daily activities. This part of the exam reveals the presence of possible yellow flags, which allow the clinician to develop the best treatment plan as well as a follow-up method. If a patient displays signs of nerve damage or spinal pathology it does not mean that this is the actual cause of the neck pain, but suggests that this increases the patient’s risk of experiencing this form of discomfort. Patients with possible underlying problems are generally recommended for additional testing. The main concern for the clinician involves determining whether the neck pain is limiting the patient’s activity or other body movements, or if the symptoms do not consistently indicate a problem that can be associated with neck pain.
Causes Of Neck Pain
Neck pain may arise due to a number of reasons given the structural anatomy of the neck and cervical spine. Gradual degeneration of muscle, ligament, or even bone is one of the main causes of neck pain. Furthermore, serious injury to the joints, ligaments, or muscles in the neck can also cause both chronic and acute pain. Despite these factors, there have been cases where the issue that is causing the neck pain could not be identified.
The cervical spine is positioned at the top of the spine, near the base of the head. This appears to be where the majority of neck pain originates. There are seven vertebrae (spinal bones) in the cervical spine that are connected by facet joints in the neck. These joints are highly susceptible to becoming damaged, inflamed, or irritated. The dislocation of spinal vertebrae and minor fractures can also result in neck pain, especially if left untreated.
Another condition that may cause neck pain is called stenosis. This condition causes the compression of the spine, which results in the abnormal narrowing of the space between the spinal vertebrae and the tissue that surrounds them. Stenosis develops for a number of reasons, but the formation of scar tissue along the spinal cord is the main cause. Bulging disc syndrome often causes neck pain as well. This syndrome causes the outward protrusion of spinal discs located between the vertebrae, which subsequently irritates and compresses spinal nerves and causes pain.
Whiplash commonly causes neck pain as well and may be caused by blunt force trauma such as a car accident that causes the head and neck to quickly jolt back and forth. Rollercoasters have also been known to cause whiplash. Whiplash is not fatal, but can lead to chronic pain. This is because it causes damage to muscles in the neck as well as the ligaments and spinal bones due to the abnormal whipping motion of the neck.
Numerous factors increase a person’s risks of developing chronic neck problems. These include age, specifically people who are 40 years of age or older, gender, as women are at higher risk of experiencing neck pain, a history of neck pain, loss of function in the hand or wrist, cycling regularly, a poor quality of life, and a history of frequent anxiety or stress.
Treatments For Neck Pain
Due to the variety of possible underlying problems that may cause neck pain, speaking with a clinician about any types of experienced symptoms is recommended so that the optimal form of treatment can be established. The increased incidence of neck pain has caused this condition to receive much more attention in terms of research and consequently, a number of interventions that are commonly utilized for the management of pain in the neck have been thoroughly studied through empirical investigations.
In actuality, the pain and disabling symptoms that can develop due to neck problems do not emerge exclusively as a result of illnesses or injuries. It is now better understood that several different factors play a role in a patient’s pain severity and level of disability. For example, the way patients feel about their pain as well as their attitudes regarding what defines a disability have been shown to influence the severity of a patient’s pain and their level of functional impairment. Moreover, the emotional response to this type of pain and psychological stress has also been shown to affect the level of pain that is felt. Accordingly, individuals who are concerned about how neck pain will affect them in the future in terms of whether they will experience recurrent pain throughout adulthood should discuss their apprehensions with a clinician.
After conducting an examination, the clinician will be able to answer questions regarding the prognosis of the condition as well as different treatments. In addition, the clinician can give the patient educational packets and information about neck pain. If the neck pain has not become severe or caused any type of impairment, a patient will probably be encouraged to gradually begin to do light activities that were normally performed before the pain began.
Previous clinical work regarding neck pain has demonstrated that the majority of cervical spinal pain cases can be effectively managed through conservative forms of treatment such as physical therapy. This type of intervention focuses on teaching patients how to do specific strengthening exercises and stretching techniques that help them regain their range of motion and mobility.
However, some treatment methods specifically focus on decreasing a patient’s level of functional impairment and disabling symptoms in addition to offering significant pain relief. For example, the main goal for most patients who had to apply for a significant amount of sick leave due to not being able to work because of neck pain is to be able to return to their jobs. This means helping the patient avoid reaching the disability level, which would further prevent the individual from returning to a normal routine. More specifically, if a person who is suffering from neck pain that is persistent and intense does not take steps to remain mobile, the person’s health will continue to deteriorate and the painful symptoms may become ongoing.
An additional method to improving a patient’s symptoms includes targeting the emotional response to the neck pain. Stress and tension have consistently proven to negatively affect the body and make handling daily obstacles more difficult. Take for instance, muscle tension, which is commonly reported along with neck pain and shoulder pain. Individuals who sit at a computer or desk for long periods of time have a dramatically higher risk of developing this form of tension.
An intervention that has demonstrated the ability to help some patients overcome emotional aspects such as these is known as biofeedback training. Research has actually shown that this approach effectively improves pain and muscle tension, but does not alleviate it completely. Biofeedback training is not an invasive technique and medication is not necessary during this procedure in order for patients to benefit from its effects. It entails helping patients learn how to identify symptoms that are triggered by their emotions in order to allow them to decrease or completely prevent the occurrence of such symptoms. Patients learn how to perform this task by being shown physiological readings in real time as they are coached about how their psychological responses are affecting the readings.
The biofeedback training device detects the slightest changes in physiology and displays it on a computer screen that is viewed by the patient. One particular part of this training procedure involves teaching the patients strategies that decrease stress because this allows them to actively alter their physiological state and in doing so, control their stress levels. Regulating internal states in this manner also helps patients decrease the degree to which stress can influence their pain intensity.
Physiological systems that are generally recorded during biofeedback training include:
- Electrocardiogram (ECG): A measurement of the heart rate
- Electroencephalography (EEG): A measurement of activity in the brain
- Electromyogram (EMG): A measurement of tension in the muscles
- Thermal feedback: A measurement of skin temperature
- Galvanic skin response (GSR): A measurement of moisture that develops on the skin’s surface
As the procedure is being performed, patients consistently practice changing their physiological states by looking at their readings and using the strategies they were taught by their biofeedback trainer. The imaging devices that are most frequently used for sessions regarding neck pain are the ECG, EMG, and a respiratory device to monitor breathing. Additionally, the patients are coached about how to use coping and relaxation techniques that will help them decrease their neck pain.
Additional types of conventional and non-invasive treatments are typically recommended for patients whose neck pain is not causing a significant impairment or disability. Chiropractic treatment, for example, helps many patients experience dramatic pain relief from discomfort due to cervical spine problems. It has also been reported to provide extensive improvements in overall wellbeing. This treatment approach involves the manipulation of the spine through controlled pressure thrusts that aim at releasing joints that have a restricted range of motion. Moreover, the use of chiropractic care to treat problems in the cervical spine involves applying pressure to facet joints in the neck as a means of reducing pain.
There are several side effects and risks associated with chiropractic procedures, which include fatigue, headaches, localized discomfort, cervical and lumbar spine manipulation complications, and irritation in parts of the body that were targeted during the treatment. Fortunately, most reports state that these types of complications often emerge on the same day as the treatment, but often resolve on their own after one or two days.
Cervical spine discomfort may also be treated through pharmacotherapy. For example, naproxen and ibuprofen are two common non-steroidal anti-inflammatory drugs (NSAIDs) that can be taken to relieve pain as well as inflammation. These types of NSAIDs are usually over-the-counter medications, but can cause certain few side effects including gastrointestinal discomfort, bleeding, and ulcers if they are taken for long periods. As a result, persistent cases of neck pain should not be treated with NSAIDs as patients can only avoid these side effects if they take them temporarily.
In addition, empirical research has shown that antidepressants are a specific approach that can help treat chronic pain. Tricyclics such as clomipramine, amitriptyline, and doxepin are a particular class of antidepressants that have been studied the most extensively. The mechanism behind how antidepressants produce analgesic effects is not completely understood, but it has been proposed that they block the activity of neurotransmitters such as serotonin and norepinephrine in the brain and in doing so provide pain relief.
Currently, there are two additional classes of antidepressants that may be prescribed to treat neck pain known as serotonin-and-norepinephrine reuptake inhibitors (SNRIs), which include desvenlafaxine, duloxetine, and venlafaxine as well as selective-serotonin reuptake inhibitors (SSRIs), which include fluoxetine, citalopram, and fluvoxamine. Sometimes clinicians prefer the newer forms because they cause fewer side effects than the tricyclics, but their mechanism is not properly understood either. SNRIs and SSRIS have demonstrated the ability to specifically reduce chronic cervical pain in numerous patients. However, whether or not the antidepressants actually elicit an analgesic affect is not clear. It appears to be more likely that some individuals who have struggled with neck pain for a significant amount of time have simultaneously developed symptoms of depression such as withdrawal or hopelessness; issues that are often relieved when SNRIs or SNRIs are taken consistently.
Muscle relaxants are an alternative treatment approach that may be suggested for neck pain. There are two categories in which this type of medication is divided into: antispastic and antispasmodic. Antispastic muscle relaxants such as baclofen and dantrolene reduce spasticity, which refers to excessive stiffness. Antispasmodic muscle relaxants such as non-benzodiazepines and benzodiazepines reduce spasms, a symptom that is often reported in conjunction with neck pain. Empirical research indicates that patients who take muscle relaxants experience relief from neck pain temporarily.
Additionally, an anticonvulsant (i.e., gabapentin) is sometimes prescribed for the alleviation of neck pain. This medication is especially helpful for neuropathic pain. The mechanism behind anticonvulsants’ ability to treat pain is not clear, but it is hypothesized that the ratio of gamma-aminobutyric acid (GABA)/glutamate increases in response to this medication. Moreover, anticonvulsants have a regulatory role on ion channels and boost GABA production; both of these processes may contribute to the efficacy of this medication.
According to self-reports, skin patches made up of capsaicin appear to afford some patients with relief from their pain. The patches work especially well for pain caused by nerve damage, similar to anticonvulsants. Capsaicin, which is the main component of chili peppers, binds to specific receptors in the skin and this process results in the activation of neurons. The activation causes a temporary period of increased sensitivity that causes feelings of prickling, burning, and itching, which is followed by a decrease in sensory sensitivity. Repeatedly applying the skin patches desensitizes the affected region of the neck for longer periods. Clinical evidence supports the use of capsaicin for pain relief by showing that they are more effective than placebos.
Patients with debilitating, severe, or resistant neck pain that is unresponsive to traditional treatments such as physical therapy and over-the-counter medications should consider discussing the possibility of taking opioids on a trial basis with their doctor. Commonly prescribed opioids include oxycodone, morphine, codeine, or tramadol. Opioid treatment is usually only suggested when neck pain has become resistant to other treatments. The ability of opioids to reduce pain is attributed to the manner in which they bind to their respective receptors that are located in the brain. An ample amount of evidence about the short-term treatment of pain in the neck region with opioids has been provided through the literature. However, long-term treatment with opioids can lead to side effects such as sweating, constipation, sexual impotence, and dizziness although these side effects usually resolve on their own. A more serious problem that may arise due to the use of opioids is potential abuse or misuse. As a result, opioids are not typically prescribed for long periods.
For neck pain that was not the result of blunt trauma as well as inflammation that has not been detected at the affected area, a special form of soft tissue massage called the active release technique may prove to be useful at providing relief. This technique involves the use of the fingers and thumbs to apply deep pressure to the soft tissue in the painful area. The patient is asked to perform specific movements repeatedly while the deep pressure is being applied so that the muscles can contract and expand repeatedly as this causes the restoration of the soft tissue’s normal structure. Furthermore, this technique reduces inflammation, pain, and stiffness. The incidence of tissue tearing, scarring, or the abnormal fusion of tissue also decreases due to this form of massage.
Several additional treatment options are available for treating neck pain. Acupuncture is an alternative approach that involves thin needle placement between one and ten centimeter depths into specific points in the body. The irritated areas dictate where the needles will be placed and other areas that are believed to be responsible for the discomfort are also targeted. This method is a common Chinese medicinal practice that is described as having low risks and being effective. In terms of side effects, some report experiencing minor bleeding, bruising, and soreness at the site of the needle placement. Additionally, electroacupuncture may be performed and this often causes patients to feel some skin irritation, although minor, in the needle insertion areas as well. There is some evidence which suggests that traditional acupuncture and electroacupuncture have the ability to increase blood flow and fluid circulation to the irritated tissue, thereby providing those treated with dramatic decreases in pain, shorter recovery times, and heightened muscle strength. This treatment method has even been deemed effective for other conditions by several health organizations, including the World Health Organization.
Sometimes patients unfortunately experience neck pain as a result of undergoing back surgery. The back and spine are made up an intricate combination of tissue, muscles, and bones that extend from the base of the head all the way to the pelvic region. The spine, for instance, is a narrow bony structure that helps support the body’s weight and it also provides protection for nerves that are embedded in the spine. The spine contains numerous individual bones that sit one on top of the other and are connected by facet joints and spinal discs, all of which promote support and flexibility. The spinal bones actually encase the spinal cord that the nerves are embedded within.
Failed back surgery may result in nerves that extend to the neck becoming injured or the formation of scar tissue which can affect spinal nerves after the surgical procedure and this can lead to persistent pain. When this happens, a technique called lysis of adhesions may be suggested as a means of alleviating pain. This entails injecting a chemical substance (e.g., hyaluronidase) through a needle and catheter at regions where scar tissue has formed. The chemical destroys the scar tissue and helps the body remove it. A recent study showed that this procedure helps reverse the negative effects of failed back surgery.
In reference to cervical spine pain that develops due to a bulging or damaged spinal disc, treatment known as a percutaneous discectomy is typically required for symptom improvement. This is a minimally invasive approach that aims at removing the damaged material and tissue surrounding the damaged disc as this is believed to be the reason that pain and inflammation occur. In order to be able to properly visualize the affected tissue, a clinician will use a fluoroscope, which is a form of X-ray that is used during the placement of the removal apparatus into the damaged spinal tissue. Once the apparatus is in the correct location, radio waves or heat waves are administered to dissolve and destroy the targeted tissue. Patients typically recover within one or two days of having this procedure done. The removal of tissue surrounding the disc relieves spinal nerve compression and effectively relieves pain in most cases.
Stenosis, which refers to inflamed nerves, can be treated with epidural steroid injections as well. The injections are delivered through the skin into a targeted location, which is usually the space between spinal bones, in order to decrease pain. A fluoroscope is used during this technique to inject medication that contains a pain reliever and a steroid. The steroids target inflammation at the site of targeted nerve roots that are located along the spine. Cervical spine injections with steroids are an additional treatment option that is effective. Both types of injections are non-surgical, outpatient procedures that can quickly be performed. Patients who receive steroid injections can expect to experience immediate relief or the complete alleviation of pain shortly after treatment. A study that specifically examined the administration of multiple steroid injections showed that receiving several injections throughout one year improved the outcome in patients who had symptoms that only decreased minimally after the first injection.
Complications that may arise due to steroid injections include arthritis, weight gain, gastric ulcers, and mood swings. Nerve blocks are a more permanent form of treatment that also involves injecting medication into targeted nerves. The effects last longer because the medication completely disrupts nerve signals and blocks the transmission of the pain response. Complications such as numbness where the medication was injected, chest pain, and nausea may develop. More serious complications such as the puncturing of a blood vessel may occur, but this is rare.
Injections with Botox are becoming more popular as well in terms of treating various types of pain. Botox refers to a purified form of a botulinum neurotoxin. This toxic enzyme is produced by bacteria called Clostridium botulinum and it temporarily paralyzes muscle tissue in small quantities. This treatment has been reported to alleviate neck and shoulder pain by inhibiting nerves that have been overstimulated due to injury. Furthermore, Botox stops the release of specific neurotransmitters that govern pain signal transmission. The effects of these injections tend to last between three to eight weeks. Research shows that patients respond much better to Botox than those who were given a placebo.
For individuals suffering from neck pain due to a fractured vertebra, repair of the fracture is very important. Vertebroplasty is a particularly useful method that treats this condition. The technique involves the injection of cement at the area where the fractured vertebra is located. This approach seems invasive, but it is not and can be performed as an outpatient procedure. As the cement begins to dry, the length of the vertebra becomes restored. This relieves compression and helps the spine regain its support. This approach, although still in its early stages, has proven to be useful at affording patients with significant pain relief. It does pose several risks, however, such as headaches, bleeding, infections, and even paralysis if nerve damage accidentally occurs. If the cement leaks inadvertently, seriously painful inflammation may also develop.
A similarly, minimally invasive technique is known as radiofrequency ablation and this entails inserting electro-thermal probes into areas that are close to spinal nerves. A high energy pulse is delivered through the probes in order to disrupt signal transmission and subsequently interfere with their ability to send painful sensory information to the brain. Risks that are associated with this method are bleeding, infections, and the possible injury of motor nerves.
In rare instances, spinal nerves that are responsible for neck pain do not respond to injections or other minimally invasive treatments. When this occurs, alternative approaches typically become necessary. Spinal cord stimulation, for instance, shows promise for resistant pain and unsuccessful back surgeries. This process entails inserting electronic devices close to the spinal cord that block the transmission of pain signals. A hand-held controller is usually available that can regulate the amount of impulse that is transmitted. A similar method is known as an intrathecal pump implant, which is also suggested for severe cases of chronic neck pain. These types of implants release pain relievers into the affected spinal nerves instead of electrical impulses. Cervical spine pain has shown to be especially responsive to intrathecal pumps. Both of these methods, however, may cause infections or bleeding and pose the risk of possible punctures. Furthermore, the implants can shift out of place and lose their ability to control pain, although this is rare.
Before the interventions that were discussed received clinical support and approval, extensive research was conducted. Given the complex nature and diversity of conditions that may cause neck pain, it is imperative to speak with a clinician early on who can determine the best treatment plan.
Neck pain is becoming a disabling condition that is quite common among adults and can affect various regions of the neck and even the shoulders. Significant mobility impairments as well as loss of function may develop as a result of persistent pain. Consequently, neck pain is associated with significant disabilities that detrimentally affect an individual’s ability to function properly at work and home. Evidence also suggests that approximately half of the people who suffer from neck pain report experiencing the painful symptoms even after six months. Moreover, once neck pain develops, it generally becomes recurrent. Gradual degeneration of muscle, ligament, or even bone is one of the main causes of neck pain, though serious injury to the joints, ligaments, or muscles in the neck can also cause both chronic and acute pain. Despite these factors, there have been cases where the issue that is causing the neck pain could not be identified.
Previous clinical work regarding neck pain has demonstrated that the majority of cervical spinal pain cases can be effectively managed through conservative forms of treatment such as physical therapy, over-the-counter pain relievers, acupuncture, and pain relieving injections. These types of interventions help reduce pain as well as improve a patient’s range of motion and mobility. However, the association between emotions (psychological aspects) and pain response should also be studied further in order to better determine appropriate treatment methods.
There are various alternative and unconventional treatment options available for persistent and resistant pain. For example, biofeedback training, implants that stimulate the spinal cord, and steroid injections have all been shown to be helpful. Certain minimally invasive procedures such as vertebroplasty can also be performed to remove scar tissue that may be contributing to the pain. Several of the newer treatments have proven to be very beneficial at treating neck pain. Speaking with a doctor is the best way to ensure that the optimal method will be utilized for your pain.
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