by Sanjay Trivedi, MD
Many types of neck pain are caused by sudden trauma like muscle strains and sprains that often heal quickly.
Neck pain treatment begins with conservative line of care in the form of pain medications, trigger point / tender spot injections, heat/ice modalities, chiropractic, physical therapy / muscle conditioning and therapeutic manual therapy.
Neck exercises for neck pain:
Neck exercises are common part of any treatment program for neck pain. Typical neck exercise program would consist of a combination of:
1. Neck stretches.
2. Neck strengthening.
3. Aerobic conditioning.
Trigger point exercises / manual therapy ( therapeutic massage ) for pain control.
Physical therapy is a standard conservative traditional way of getting rid of some of the inflammation that can help in reducing pain, increasing mobility and range of motion, in the effected neck area.
Use of cervical collars over lengthy period of time is not recommended, cervical pillows at night time while sleeping can be helpful.
Options available to manage neck pain are extensive, which includes:
1. Applying a heating pad prior to exercise to warm up stiff muscles and joints and make them easier to stretch.
2. After exercise, apply cold pack to reduce inflammation in the joints and muscles.
1. Use of over the counter / prescription non-steroidal anti-inflammatory medications to alleviate pain and reduce swelling.
2. Use of oral corticosteroids, COX -2 inhibitors, and narcotics (as necessary) to manage severe pain.
3. Muscle relaxers.
4. Topical Pain medications/gels/creams.
5. Medications for neuropathic pain ( Gabapentin, Pregabalin ).
Trigger point / Tender spot Injections:
Trigger point / Tender spot injections are a good treatment option for the healing of soft tissue and for relieving myofascial pain. The injections are combinations of local anesthetics ( Lidocaine, Marcaine etc. ) with corticosteroids (Depo-medrol, Dexamethasone, Kenalog etc.) OR in combination with natural medications like Sarapin, Trumeel/Zeel.—mixed along with some additives.
Time period for conservative neck pain treatment:
If the patient has presented with symptoms going on for a period of several weeks, certainly a period of 4-6 weeks should be given for conservative treatment, it takes a period of time to recondition the soft tissue and make it flexible and strong. If symptoms change or worsen patients are encouraged to get in touch with their physician and get reassessed.
In acute or sub-acute setting when symptoms are present for a few weeks (e.g. 4-6 weeks), 80-90 % of patients are going to improve with the treatments mentioned. Timeline for improvement may be weeks, but as long as the patients are improving and they can function, sleep, work and show improvement in the activities of daily living (ADLS). They should be encouraged to continue with the above-mentioned line of treatment.
Neck Pain Diagnostics: MRI
MRI is a good diagnostic tool to make anatomic diagnosis of the patients symptoms, it gives detailed information about the soft tissue, the muscles, the ligaments, the spinal canal, the nerve roots and the disc.
Evidence of bone spurs (osteophytes), disc herniation, spinal stenosis, corroborated with symptomology can point towards spinal origin of pain / neurological / functional compromise.
Interventional / Pharmaceutical Pain Management:
Typically, group of patients having more neurological symptoms, like radiating pain into the shoulders and arm or some tingling and numbness with correlative evidence seen on MRI, performing epidural steroid injections can certainly help. For facetogenic pain- facet block injections, Medial nerve branch block and Radiofrequency ablation ( RF ) can immensely alleviate pain. Specific nerve root and peripheral nerve blocks can be beneficial in some patients. Trigger point / Tender spot injections and advanced Prolotherapy can further help alleviate soft tissue / myofascial pain.
Interventional pain management is ideal, in combination with pharmaceutical / topical pain management.
Surgical Management of Neck Pain:
In a small subset of patients who have anatomical abnormalities along with neck pain, neck surgeries like discectomy, decompression laminectomy can be suggested / performed for pain relief, to help with any neurological / functional compromise, to improve functionality & also help improve the quality of life.