Neck Pain

General

Two out of every three people suffer with neck pain that has lasted more than one day in the past year. Following back pain, it is the most common pain complaint that leads patients to seek care at one of our Novocur clinics. Many neck aches will resolve on their own, but you should seek immediate care for any injury to your neck or for pain that has persisted for longer than three days without improvement.

The spine in your neck area (cervical spine) consists of 7 moveable vertebrae with a shock absorbing pad (spinal disc) between each two vertebrae. Between each two vertebrae a nerve root branches off each side of the spinal cord and passes out of the spinal column to innervate various body parts as well as to receive feedback from these body parts. On the back side of the spine there are two facet joints that connect each two vertebrae together and allow for movement in the neck.

Very frequently, shoulder or radiating arm pain accompanies neck pain because the nerves exiting the cervical spine travel to these areas of the body.

Symptoms

Neck pain may begin gradually and present itself as stiffness or minor discomfort. At times, however, neck pain can onset quickly and and severely with little or no range of motion possible in the neck. Neck pain can occur after injuries, such as a “whiplash”, and often has a delayed onset of pain. Very frequently it takes hours or several days before pain from a neck injury becomes apparent. Whatever the cause, neck pain may be accompanied by inflammation, loss of range of motion, muscular weakness, arm/shoulder/hand symptoms or even headaches.

Headaches will sometimes accompany neck pain or stiffness as a result of the bony attachment of neck musculature at the base of the skull. Tight muscles pull at this bony attachment and cause head pain (cervicogenic headache).

Shoulder or arm pain frequently accompanies neck pain because of nerve compression or nerve stretching from trauma or degenerative changes. Arm symptoms may manifest as radiating pain, “pins and needles”, numbness or arm/shoulder/grip weakness.

Causes

The cervical spine requires greater range of motion than any other part of the spine. It is more susceptible to pain that originates in the moveable facet joints that join one vertebrae to another and allow for range of motion to occur. In addition to facet joints, other cervical bony structures, cervical spinal discs, nerve tissue, muscles and ligaments can also be sources of pain in the neck area. Common causes are listed below:

  • Abnormal Posture. Improper work station biomechanics and “whiplash” injury are two common causes of abnormal posture. Abnormal posture causes increased load bearing on certain joints, ligaments and discs in the lower neck and can lead to pain. Abnormal posture can greatly increase the work necessary by neck musculature to simply hold the head up against gravity.
  • Facet Syndrome. The facet joints in the cervical spine allow for maximal range of motion in your neck. These joints are at risk for injury, disease, and wear and tear. Facet syndrome is one of the more common causes of chronic neck pain
  • Sprain/Strain injuries. Many types of trauma can lead to stretching and/or tearing of neck musculature and/or ligaments. Healing time from these injuries varies depending upon the severity of the damage. Healing of soft tissue occurs by formation of scar tissue. Scar tissue cannot always function as strongly, with as great a range of motion or be able to cleanse itself of metabolic waste products as well as the original tissue and can lead to long term residual complaints. It is vital that scar tissue formation be managed by Physical Therapy or Chiropractic care, which can help modify and improve the healing tissue.
  • Auto Accident Injuries. Any and all of the pain producing structures in the cervical spine are at risk of damage in an auto accident, particularly when you are rear-ended. The rapid head extension followed by head flexion in a “whiplash” scenario happens faster than your reflexes can guard against. Proper head rest positioning and newer dynamic restraint systems in vehicles can help diminish the injury to your neck. Contrary to your intuition, low impact auto accidents can produce significant injury – it is all in the physics.
  • Head injury. Head injury from auto accidents, football, soccer and other sports, and falls can all lead to neck injury and increase your likelihood of damage to bony structures and nerve tissues in the neck. Head injury in an auto accident increases your chances for neck or head pain disability.
  • Nerve dysfunction. Stretch or compression forces on nerve roots in the neck often leads to pain in the neck, shoulder, arm or hand areas. Whiplash, head trauma, damage to cervical discs or degenerative changes can all lead to nerve pain.
  • Osteoarthritis or Degenerative Arthritis. Joints that are simply wearing out in the neck are often the cause of neck pain. Injuries to joints often accelerate degenerative changes.
  • Different types of arthritic conditions, such as Rheumatoid Arthritis can affect the cervical spine. Meningitis, metastatic cancer and other serious conditions can also be the underlying cause of neck pain.
  • Cervical Torticollis. Often noticed upon arising from sleep and characterized by severe muscle spasm, almost complete loss of range of motion and severe pain. The cause is unknown, but this condition is usually self-limiting over several days.
  • Degenerative Disc Disease. Thinning of cervical discs can lead to compression of nerve tissue as well as pain from the outer layers of the involved discs. Disc herniation is less likely in the cervical area as in lumbar spine, but is still possible.
  • Narrowing of the bony canals where the nerve roots exit, or the central canal that protects spinal cord can cause pressure on nerve tissue and thus pain. Arm or shoulder complaints often accompany neck pain.
Treatments

Novocur takes pride in taking our time to determine the most accurate cause of your neck pain and providing a custom treatment plan based upon your unique back pain problem. As a result of this priority, you will not see a mid-level provider and then at the last minute be handed off to the pain doctor, but instead, you will receive continuity of pain physician care from consultation through procedure. Novocur’s style of medical practice is becoming a rarity in our shifting healthcare delivery system, however Novocur will strive to continue to provide this superior level of service. This is one reason Novocur was voted one of the top 3 Pain Management Facilities in Arizona.

The type of treatment you will receive will depend upon your diagnosis, but could include any of the following services.

  • Facet Injection (medial branch block). For pain that originates in the moveable facet joints an injection of a corticosteroid mixed with an anesthetic around the medial branch nerve, which innervates the painful capsule surrounding the facet joint, can quickly reduce or eliminate pain. Facet Injection can act as a treatment as well as a diagnostic tool to help identify the origin of your pain.
  • Radiofrequency Ablation (RFA),/span>. When the medial branch nerve to the facet joints are identified as a source of your pain, then RFA can provide longer lasting relief than facet injection. The medial branch nerve is heated to 90 degrees Celsius for about 90 seconds. This heat lesion created around the nerve prevents transmission of pain signals for 6-12 months on average.
  • Pharmacological Intervention. NSAIDs, muscle relaxers, neuropathic pain medications and opioid pain medications may be utilized to control pain.
  • Epidural Injection. An injection of a corticosteroid into the epidural space may be utilized to rapidly diminish pain around painful nerve roots and discs. Interlaminar epidural injection is usually the only option to get medication to the painful area safely in the cervical spine.
  • Neuromodulation Therapy. As a last resort treatment, an electrical generator with tiny electrode leads may be implanted into the epidural space over the affected area. This spinal cord stimulator tricks your nervous system into feeling a pleasant vibration sensation instead of pain. This treatment is often tried following failed back surgery. It can also be utilized over the sacrum area for difficult sacroiliac pain.
 

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