Pain In The Neck
by Stephanie (Stevie) Reisinger, RN, PA |
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 While neck pain (cervicalgia), is extremely common, and often caused by muscular strain, many people are affected by numerous other spinal conditions. Pain, while often felt in the neck itself, can also be referred to other areas of the body, including the head, arms and hands, the shoulders and scapula, and even into the thoracic spine( the middle of the back).
The cervical spine is composed of 7 cervical vertebrae which are cushioned by intervertebral discs. These discs are composed of a fibrous cartilage with an inner jelly like substance called the nucleus pulposus.
Causes of Neck Pain:
Herniated Discs- When the inner portion of a disc herniates (ruptures), it can cause pressure on a spinal nerve. In the cervical area this can lead to problems with pain, numbness, or tingling in the arms and hands. There can also be varying degrees of weakness in the upper extremities. Herniated discs are best seen on an MRI exam.
Stenosis- this is a narrowing of the spinal canal, which can cause pressure on the spinal nerves.
Degenerative Disc Disease- a condition in which the discs lose moisture, flatten out and thereby lose their cushioning and shock absorbing abilities.
Spondylosis- a narrowing of the spinal canal caused by degeneration of the discs which leads to an increase of bony growth (osteophytes) as well as degenerative arthritis.
Spondylolisthesis- this occurs when a vertebral body slips forward on the one that is resting below it.
Diagnostics:
MRI is the gold standard. It will clearly show all of the above conditions, and it most definitely shows herniation of a disc which will not be visualized on plain X-ray exams.
Flexion and Extension X-rays are valuable to check for instability of the cervical spine.
Treatment:
Surgical treatment is done when there is compression on the cord, most usually from a herniated disc with the accompanying nerve pain into the arms and hands, or when weakness occurs.
There are other modalities used to treat neck pain, and depend upon the severity and the cause of the pain. They can range from Physical Therapy, Epidural Steroid Injections, Traction, Massage, Acupuncture, and self-help measures such as gentle stretching and strength building exercises. Swimming, using a snorkel to avoid neck turning is an excellent exercise for people with cervical pain, as it helps to build shoulder and neck muscles.
Medications:
First line medications generally include NSAIDS such as Ibuprofen, Naproxen, and Celebrex.
Opioid Analgesics are reserved for pain which becomes moderate to severe.
Local Anesthetics: Topical Lidoderm patches have been used successfully in some people. They may be cut and placed on the skin and worn normally for 12 hours on and 12 hours off.
Muscle Relaxants: Generally used for short term use.
Neurontin and Lyrica: These medications are reserved for the nerve-type pain that is referred from the neck into other areas of the body. They will not work on neck pain.
This article represents the author's opinions and not those of the website operator. We are not offering individualized diagnoses or medical advice, just general medical information
Published on site 10/11/08
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