FAQs on Neck Pain

The cervical (neck) spine is composed of seven vertebrae that start in the upper torso and end at the base of the skull. These irregular-shaped bones are held together with ligaments and muscles. The neck supports the head and is vulnerable to injury and degeneration. Neck pain occurs when disorder of the neck develop.

What causes neck pain?

Neck pain is caused from any abnormalities of the soft tissues, such as the nerves, ligaments, and muscles. In addition, vertebrae and discs degenerate and cause neck pain. The most common causes of neck pain include:

  • Whiplash – Also called cervical strain, the neck structures are forced out of alignment in a violent action, which is much like cracking a whip. This causes serious neck trauma and damage.
  • Degenerative disc disease (DDD) – As the disc degenerate from age, the vertebrae become displaced, pressing on nerves. This causes significant discomfort and radiculopathy (hand arm tingling, numbness, and weakness).
  • Neck pain is also caused by tumors and infection. Neck problems are the source of upper back, arm, and shoulder pain.
  • Cervical disc spondylosis – The discs act as shock absorbers between the neck vertebrae. When the disc loose water content of the gel-like center (nucleus), the bones move forward and are displaced. This causes serious nerve impingement and pain.
  • Nerve compression – Herniated discs and bone spurs cause nerve compression and severe pain.

What symptoms are associated with neck pain?

Neck pain does not occur alone for most patients. When nerves are compressed or impinged, the patient may have arm numbness, tingling, weakness, and burning. In addition, neck pain often causes headaches. The pain is often called severe, and it is persistent and continuous for many patients.

How is neck pain diagnosed?

When you present in the office with neck pain, the doctor will take a medical history and conduct a physical examination. To uncover the diagnosis, the doctor will conduct x-rays (to assess for bone changes and alignment), MRIs (to check for soft tissue and disc problems), and CT scans (give detailed images of the spine). Nerve conduction studies and electromyography (EMG) involve inserting fine needles through the skin and into the muscle. Blood tests can confirm rheumatoid arthritis and infectious diseases.

What is the treatment of neck pain?

The treatment of neck pain aims to correct the underlying problem. For chronic conditions, treatment involves:

  • Physical therapy – The therapist will teach you alignment, correct posture, and strengthening exercises. In addition, mechanisms for pain relief include heat, ice, electrical stimulation, and ultrasound therapy.
  • Transcutaneous electrical nerve stimulation (TENS) – Electrodes are placed on the skin near the neck to deliver electrical impulses. These electrical current interferes with pain signals.
  • Epidural steroid injection (ESI) – The doctor can inject the space around the spinal cord (epidural space) with a corticosteroid agent. A long-acting anesthetic is often included for additional benefit. Based on clinical studies, the efficacy rate of ESI is 75-90%.
  • Medical branch block (MBB) – Also called a facet joint injection, this involves using x-ray guidance to inject the tiny facet joints along the posterior spine. These joints produce neck pain, and the block alleviates nerve irritation and inflammation. In a recent study, MBB had an 85% success rate.
  • Radiofrequency nerve ablation – This minimally invasive procedure is performed under x-ray guidance to treat neck and back pain. The procedure involves use of special device with a small tiny probe that emits radiofrequency energy.

Resources

Botwin KP, Gruber RD, Bouchlas CG, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil. 2002 Dec. 81(12):898-905.

Riew KD, Yin Y, Gilula L, et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am. 2000 Nov. 82-A(11):1589-93.

Son JH, Kim SD, Kim SH, et al. (2010). The Efficacy of Repeated Radiofrequency Medial Branch Neurotomy for Lumbar Facet Syndrome. Journal of Korean Neurosurg Soc, 48(3), 240-243.

Vad VB, Bhat AL, Lutz GE, et al. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine. 2002 Jan 1. 27(1):11-6.