NECK PAIN

Neck pain and neck injuries are common. The neck region is a highly mobile part of the body, with intricate components and hence is susceptible to injury.

Problems with the neck can affect all aspects of life from getting dressed to driving a car and even working productively.

The neck (cervical spine)—is a complex network of bones (vertebrae), joints, muscles, ligaments and nerves, designed for movement, strength, stability, and nerve communication. The cervical vertebrae extend from the base of the skull to the upper torso. The cervical discs act like shock absorbers between the vertebrae. The neck supports the head and allows for motion.

Any abnormalities in the neck like inflammation, or injury can cause neck pain or neck stiffness.

Neck pain is common among adults, but it can occur at any age. It is said that in one year up to 15% of adults can have an episode of neck pain.

Many people experience some type of neck pain or neck stiffness. These causes are usually minor like poor posture or overuse. In these instances the neck pain is mild and is relieved within a few days.

Sometimes, neck pain is caused by more serious injuries like following a fall, contact sports, or a whiplash injury and in some instances the neck pain can indicate serious injury or illness and requires a doctor or specialist medical care.

Neck pain can also be related to problems elsewhere in the body like the thoracic (chest) spine or even the shoulder.    

Most of the time more than one cause for the pain may occur at the same time, which can then make assessing and managing neck pain more complex.

NECK PAIN SYMPTOMS

Neck pain can occur suddenly or it can occur slowly. It may occur immediately after an injury or the onset of symptoms can be delayed.

Symptoms may include a sharp pain or a stiff neck, pain radiating down into the shoulder and arm, or pain radiating up into the head and face. There might be tingling, numbness, pins and needles and weakness or even headaches and symptoms of migraine. Sometimes people can be very unwell if there is a more serious cause like an infection or fracture of the spine.

• Neck joints

  • The joints in the neck are called cervical facet joints. The facet joints can become inflamed and swollen (arthropathy), which can cause stiffness and pain. Sometimes the pain can be debilitating and long-lasting.

• Neck muscle pain

  • Muscles around the neck are complex and can be a source of pain. These muscles can become weak or go into spasms.

• Myofascial pain

  • This is pain that occurs because of problems with the surrounding muscles, ligaments and tendons of the neck and the upper back. The muscles may develop discrete little tight knots (taut bands) that are called myo-fascial trigger points. Trigger points are hyperirritable spots in the covering (fascia) surrounding muscle and can be very painful and quite debilitating. When a trigger point is touched or examined, it can cause exquisite pain in and around the area.

• Whiplash syndrome

  • This occurs with a sudden and vigorous movement of the head, forwards and backwards or sideways. This problem tends to occur after a car accident or fall.

• Cervical spondylosis (cervical osteoarthritis) is neck arthritis, which is an age-related condition that affects the joints, discs and ligaments of the neck. This can also occur in the C1/2 joint.

• Spondylolisthesis

  • Pronounced spon-di-low-list-thee-sis.

  • Misalignment of spine bones occurs when one vertebra slips over the one below it. It can be caused by problems with the bone or discs (degeneration) or ligament issues. It usually occurs with spondylosis.

• Degenerative disc disease

  • When cervical discs degenerate and change, they can sometimes become painful.

• Referred pain

  • Referred pain is where pain in one part of the body can be felt in another part of the body that is nearby. This occurs when different parts of the body share the same nerves to send signals to the spine and brain. Neck problems like cervical (neck) facet joint arthritis or disc prolapses can both contribute to spinal nerves being compressed where they leave the spinal column (pinched nerves). This compression condition is called cervical foraminal stenosis and can cause radiating pain anywhere down into the shoulder, arm or hand.

• Neck nerve pain

  • Sometimes neurological problems can cause neck pain. Neurological causes might include shingles (zoster), post herpetic neuralgia, or even some brain conditions like meningitis.

  • When a compression occurs into the spinal column itself, this may be called cervical spinal stenosis and if the compression is serious it can compress the spinal cord itself, which is called myelopathy. Myelopathy is when the compression of the spinal cord starts causing symptoms, such as weakness or problems with coordination in the arms, hands, legs, or even feet. Neurological or myofascial problems can also cause pain between the shoulder blades.

• Sensitisation

  • Sometimes a problem in the nervous system called sensitisation can occur. This is when the pain, usually a nerve pain seems to be spreading up into the body and or down into the arm, or even into the other side of the body. People with sensitisation can even have sensitive skin and even light touch using a brush can be exquisitely painful.

• Post-surgical pain

  • After an operation or surgery pain can sometimes persist even after the tissue has had sufficient time to heal. This can occur in up to 25% of all surgeries and sometimes the persistent pain can be intolerable and debilitating. Post-surgical pain can be caused by almost any type of operation, and can be caused by many things, including nerve injury or scarring, ongoing inflammation or infection, muscle weakness and stiffness. This is a complex pain condition and should be assessed and managed by pain specialist physicians in conjunction with the operating surgeons.

Serious causes of neck pain may include heart conditions like angina or even a heart attack (myocardial infarction).

Chronic neck pain treatment occurs when pain has been present for longer than 3 months and most treatments that have been tried have not helped. Treatment for persistent neck pain depends on what is causing the pain and should be delivered by a pain specialist doctor and their team of experts.

Contact us to find out what's causing your pain.

WHO GETS NECK PAIN?

Anyone can get neck pain and it can occur at any age, although some people are more likely to develop neck pain.

Here are a few risk factors that might make the development of neck pain more likely:

• Older age

• Lack of exercise and low fitness level

• Being overweight

• Certain jobs or activities that require heavy lifting, pushing or pulling, particularly when it involves repetitive movements of the neck or arms.

WHAT NECK PAIN TREATMENT IS AVAILABLE? 

Treatment of the neck pain depends on if the problem is acute (meaning it only occurred recently i.e. days and weeks) or if the problem is chronic (meaning it has been present for more than 2-3 months).

ACUTE NECK PAIN TREATMENT

• Simple treatments like hot or cold packs, physical activity and exercise and physical therapy.

• Pain medications like anti-inflammatories and anti-spasm medications to provide you pain relief.

If pain is long lasting (chronic pain), debilitating and has not been responding to treatments an assessment should be made by a pain management specialist, who can assess and treat most types of chronic pain.

TYPES OF TREATMENT

• Medications to reduce the pain

  • These may be simple over the counter medications or can be pain medications prescribed by your pain specialist. Medications might include muscle relaxants or nerve pain medications (neuropathic pain medications). Sometimes analgesic compound creams are used to ease pain.

• Pain interventions

  • Injection therapies can be used to target, diagnose and manage chronic pain caused by muscle, joint and nerve pain.

  • It includes interventional therapies like nerve blocks (medial branch nerve, third occipital nerve, cervical nerve roots, greater and/or lesser occipital nerves), radiofrequency ablation (RFA), pulsed radiofrequency (PRF) and epidural and nerve root steroid injections.

  • Some of these therapies can be focused on various structures that might be causing or making the pain worse like the cervical facet joints, the C1/2 joint, the spinal nerve roots, the greater and/or lesser occipital nerves and other nerves around the head and neck. Platelet-rich plasma can also be used in some locations around this area.

• Nerve stimulation or neuromodulation techniques

  • Advanced pain reduction strategies may include spinal cord stimulation for severe chronic neck pain. Some forms of spinal cord stimulation are high frequency stimulation (HF10), tonic stimulation, multi-waveform stimulation, BurstDR stimulation and even Dorsal Root Ganglion (DRG) stimulation.

• Surgery

  • Generally recommended when tests show structural changes that need corrective surgery. When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. These are typically performed by a neurosurgeon or a spinal surgeon. Types of surgery might include disc decompression surgery (laminotomy, laminectomy, discectomy) and or stabilisation surgery (fusion)

• Rehabilitation

  • Most types of chronic pain treatment should be managed alongside some form of specialist rehabilitation. This is when the best results occur.

WARNING SIGNS OF MORE SERIOUS NECK PROBLEMS

In some instances, neck pain can indicate more serious problems. These problems might include cancer, fractures, infection, severe nerve compression (pinched nerve pain) and ankylosis spondylitis. 

• If there is cancer in the bones of the spine, this usually means metastases (the cancer has spread to the spine).

• Fractures of the spine can be caused by a direct hit, fall, accident but sometimes can occur without trauma, called spontaneous fractures. Spontaneous fractures, usually can occur in elderly people with osteoporosis or those who may be taking steroid medications that weaken the bone.

• Infections of the spine tend to occur if patients have a weakened immune system from any cause or medical condition. Sometimes infections of the spine can occur if there is an infection elsewhere in the body. People with spinal infections usually feel unwell and can have sweats and a fever.

• Nerve compression, called myelopathy, where there is a dangerous compression of the spinal cord in the neck. Myelopathy could cause symptoms that might include, weakness or problems with coordination in the arms, hands, legs, or even feet.

• Ankylosing spondylitis is progressive arthritis of the spine and can cause widespread inflammation, pain and stiffness throughout the spine.

Seek urgent and specialist medical advice if you have:

• Sudden, unrelenting, disabling and severe neck pain

• Recent weight loss

• Recent injury or fall

• Signs of infection are present like fever or feeling unwell, the area is red, hot or swollen.

• Numbness or tingling of the arm

• Weakness in arms and or legs

• Problems with bladder or bowel function

• Stiffness is worsening

• Pain does not settle by itself after a few days or weeks