A Pain in the Neck

This is quite common in the adult population….you are not alone!

It accounts for up to 15 percent of Physical Therapy visits in the USA.

Very little is known know about its causes!

We do know, however, that neck pain often goes “hand-in-hand” (pardon the pun) with upper extremity pain and headaches.

We also know that chronic neck pain usually comes from the following structures: the jelly cushions between the vertebral bodies in our spine (intervertebral discs), the facet joints in the spine (pain when you turn your head to one side), the Atlanto-Axial and Atlanto-Occipital joints (these are joints in the spine just below a line drawn between the ears.

They often cause headaches.), muscles, ligaments, nerves and fascia – that cover all these things.

Origins

Many scientific studies have shown that neck pain,  with or without arm pain or headaches, originates from the facet joints 36 – 67 percent of the time and from the actual discs 16 – 20 percent of the time.

Studies have also shown that cervical radiculopathy (the pins-and-needles sensation that shoots or crawls down the arms) is usually caused by disc protrusion (imagine blowing bubble gum gently), and cervical spondylosis (wear and tear).

The “radiculopathy” is due to three things:mechanical compression of the nerveirritation of the nerve by painful chemicals (this is why NSAIDS  and steroids may help), and specific toxic damage to the nerve.

Therapy

So what can a Pain Doctor do to help YOU?

Your Pain Doctor should offer you one or any of these treatment plans:

Physical therapy

Medications

Injections

Your overall care may involve other “therapies” e.g.Occupational therapy

Psychological therapy, Exercise therapy, Massage therapy, Aquatics therapy (especially for the low back), Electrical therapy (with a TENS machine).

Medications

Medications may require very strong pain medications, non steroidal anti-inflammatory drugs, muscle relaxants, antidepressant-like drugs and antiepileptic-like drugs.

Injections may be to the spine (e.g. epidural, facet joints), to the muscle (e.g. trigger points), to specific nerves. Acupuncture also has a place in treatment.

Cervical Epidural Steroid Injection

This is the typical spine injection treatment in the USA (and UK). It is used to treat “radicular pain” (the pins-and-needles feeling shooting or crawling down your shoulder/arms/legs).

Be cautious about what you read online. And be careful about others people’s experiences; each person is different. What works for one may not work for another. NEVER let an untrained, inexperienced person perform Cervical Epidural Injection on you.

The injection may be repeated once or twice, two or three weeks apart.

Most people will enjoy up to a year’s pain relief after the series is completed; some get relief up to 2 years. Few may have to come back sooner.

For some the single series is all they ever need; and for a very rare few, the injections may not work at all.

If physical therapy, medications and injections fail to improve your pain, there are other options such as spinal cord electrical stimulation, or, in rare and exceptional circumstances, surgery.

Prevalence

The lifetime prevalence of Chronic Neck Pain ranges between 26 – 71 percent, but, in any given 12 months period 30 -50 percent of us will suffer neck pain.

Next time you hear someone call another person a “pain in the neck”, they may be quite right.

•Dr. Femi Ogunyemi, FRCA, FWACS, is a member of the British Pain Society, American Pain Society, the North American Neuromodulation Society and the Aerospace Medical Association. He is a Diplomate of the American Academy of Pain Management and a Fellow in Pain Medicine from Emory University.