Neck Pain Clinic

What causes neck pain?

One of the most common complaints to doctors, especially pain specialists, is neck pain. Neck pain can be experienced by anyone but is more common in women than men. Neck pain has a number of causes that can either be considered acute or chronic. When an injury has a sudden onset and lasts for less than three months, it is considered acute and is commonly caused by muscle strain, facet syndrome, or a traumatic injury. Chronic neck pain lasts longer than three months and is often a result of facet joint irritation, muscle sources, ligaments, and/or disc problems.

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The vertebrae of the spine are set one atop another with soft discs between that act as cushions to reduce the impact to the cervical spinal column. Because the discs are soft, it is not uncommon for them to herniate posterior, or collapse backward through the ligaments and irritate close by nerves and even the spinal cord. Another major complaint and cause for surgery is disc disease. Disc disease can be caused by an injury, making it acute, but more often it is chronic pain caused by disc deterioration. 

 Degenerative Disc Disease is a continual process — the discs gradually thin due to dehydration and can lead to the compression of nearby nerves, tendons, and ligaments. Ligaments are attached to each vertebra to provide strength and mobility to the cervical spine, which has the job of providing support and mobility to the head and neck. It also protects the spinal cord as it emerges from the brain. There are also several muscles attached that provide movement. Nerves exit the spine to innervate the surrounding structures (skin and muscles) of the neck and arms. Strenuous lifting or exercising can irritate some nerves and cause pain.

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The most flexible part of the spine is the cervical portion. This is the portion that makes it easy to strain. The Atlas and Axis are the top two cervical vertebrae and are responsible for the majority of rotational movement of the head. These vertebrae also form joints and connect the head to the spine. The first through third cervical nerves provide the head and face with sensation and cause headaches and facial pain when compressed. The greater and lesser occipital nerves also cause facial pain when compression or irritation occurs. The other cervical nerves combine to form a plexus of nerves that provide sensation to the arms. If affected, pain, weakness, loss of feeling, and other symptoms will be felt in the arms.

Some of the most common causes of neck pain are muscle strains, trauma or injury, stress, and herniated cervical disc. 

• Muscle strains-are often the result of overuse of muscle or falling asleep in an awkward position for several hours at a time. Constant or frequent strain of the neck can cause the development of chronic pain syndromes.
• Whiplash- is a condition that occurs in motor vehicle accidents, especially rear end collisions, and is characterized by hyper-extension of the neck and results in local inflammation, ligament strain, and muscle tension.

The facet joints in the neck are also a common cause of neck pain. When the facet joints of the cervical vertebrae deteriorate, it is called Spondylosis (arthritis of the neck). Symptoms of spondylosis usually surface at about the age of 40 but can appear earlier if trauma is involved. When the head is extended backward, spondylosis will continue and often worsen if no steps are taken to resolve the problem.

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Spinal Stenosis which is the narrowing of the central spinal canal is another major cause of neck pain. This happens because the narrowing can compress the spinal cord and surrounding nerve endings. Common complaints of spinal stenosis include shooting pain, cramping pain, and numbness in the back, neck, and arms, though symptoms are different depending on what part of the spine is affected.

Pain syndromes are usually worsened by depression, anxiety, and stress. Therefore, it is important to not only treat the physical pain, but also the psychological problems that often trouble chronic pain patients. A doctor will also likely look at a patient’s socioeconomic status and general medical health in considering treatment options.

Another common complication with neck pain is central sensitization, which is the development of both the central nervous system (CNS) and the peripheral nervous system (PNS). Injury and inflammation activate the PNS, which sends signals to the brain through the spinal cord. When central sensitization occurs, there is increased excitability of the CNS’s neurons, causing normal inputs from the primary nervous system to produce abnormal, often painful responses. Allodynia is characterized by minor stimuli (such as the wind blowing against the skin), causing pain symptoms. Hyperalgesia is characterized by a normally painful stimulus (bumping against something), causing much higher levels of pain than would normally be felt.

Some of the less common causes of neck pain include infection, tumors, spinal cord disorders, or vertebral compression fractures. Metastatic tumors (those which spread from another organ) are sometimes seen on the spine, also causing pain. These less common causes for neck pain require immediate response and a physician should be seen right away. When a patient experiences certain symptoms they should be taken to the emergency room to make sure a problem isn’t urgent. These symptoms include sudden blindness, paralysis, neck pain with altered level of consciousness, weakness, severe vomiting, changes in hearing/vision/and taste, bowel/bladder changes, recent weight changes, or fever.

Neck Pain Clinic Treatment

The diagnosis of neck pain is often difficult. A physician will likely perform a physical exam to assess movement and tenderness. He/she will also often order radiological imaging depending on a patient’s history and clinical suspicion. Once a diagnosis is made, a treatment plan will be created by the patient and doctor. This will often include several modalities in order to achieve maximum results. Some of the treatments offered for neck pain include:

• Pharmacotherapy- The most effective pharmaceuticals for treating low back pain include NSAIDs (ibuprofen), Acetaminophen (Tylenol), membrane stabilizing drugs, and muscle relaxants.
• As the name implies, ESI involves the injection of steroids into the epidural space near the spine, which spreads to other levels and portions of the spine. This reduces inflammation and irritation.
• Medial Branch Blocks/denervation- MBBs are minimally invasive treatments that reduce inflammation (if steroid is used) and irritation of the facet joint, ultimately relieving pain. MBBs are mainly diagnostic in nature and will most likely lead to destruction of the nerve for long lasting pain relief.
• Lysis of Adhesions- Also known as “Racz procedure,” has proven effective in the removal of scar tissue in the epidural space of the spine where more conservative options have failed.
• Chiropractic manipulations- A chiropractic adjustment may greatly reduce back pain by correcting nerve transmission. It is often even more effective when combined with other modalities.
• Massage- A massage can be beneficial in reducing stress and tension that might contribute to pain symptoms. A massage can also help relieve muscle spasm and contractions.
• Nutrition and Exercise- A proper diet, accompanied with exercise, often reduces the pain associated with sciatica by increasing flexibility and range of motion. This also releases endorphins, which are the body’s natural pain reliever.
• Acupuncture- When small needles are inserted into the skin during acupuncture, the body naturally releases endorphins. Acupuncture can also help people relax, which decreases tension, stress and muscle spasms.
• Physical Therapy- Physical therapy can be very helpful because it builds muscles around a degenerated area and reduces pain signals. Physical therapy works best when combined with other modalities.
• Biofeedback- Biofeedback is a treatment that teaches patients to be more in tune with their body and helps them regulate otherwise involuntary processes (such as heart rate or blood pressure). When a patient is more in tune with their body it is easier for them to relax, which can in turn alleviate pain.
• Transcutaneous Electrical Nerve Stimulation (TENS)- TENS works by introducing electrical stimulation through the skin of the affected area. The electrical signals interrupt pain signals causing a tingling sensation rather than pain.
• Botox- Botox works by paralyzing the nerve ending at the site of injection. Although Botox was originally used for cosmetic purposes, it can also be helpful in pain relief, especially if a patient suffers from whiplash injuries and cervical dystonia. This treatment will decrease pain, and often increases range of motion in the affected area.
• Trigger Point Injections are an effective treatment for muscle spasms. The procedure involves the injection of local anesthetic and steroids into a “trigger point,” or the origin of the pain.
• Peripheral Nerve Blocks and Ablation- The nerves near the spinal cord are called peripheral nerves. They can often be sources of pain which can be blocked using local anesthetic. If a block works, an ablation (the destruction of nerve endings) is also a possibility for longer term pain relief.
• Cryotherapy- Similar to an ablation, cryotherapy uses freezing cycles on painful nerves. Electrical stimulation is used to find the correct needle placement.
• Kyphoplasty and Vertebroplasty- These methods involve injecting acrylic cement into collapsed vertebra, which relieves pain and increases stability of the spine.
• (SCS)- A spinal cord stimulator is an electrical device that is implanted in the body to decrease pain by confusing the spinal cord and brain pain processing centers. A trial SCS will be externally placed in order to test how effective it will be to a particular patient. If pain is relieved during a trial period, a permanent SCS will likely bring great back pain relief.
• Peripheral Nerve Stimulation (PNS)- This treatment is similar to a spinal cord stimulator. Electrodes are placed near affected peripheral nerves instead of attached directly to the spinal cord.
• Prolotherapy- Also known as Regenerative Injection Therapy, prolotherapy is a technique of injecting irritating substances into painful ligaments or tendons in order to make the body start healing the damaged ligament or tendon.
• Occipital Nerve Stimulation- This method involves the placement of electrodes close to the occipital nerves. The electrodes produce mild electrical charges that interrupt the pain signal being sent to the brain.

For more information on how we can help treat your neck pain, please contact us at 470-424-8888.