Top Neck Pain Treatment

Top Neck Pain Treatment

Neck Pain 3 across horizontal

Neck pain is a common complaint seen at pain relief centers in San Diego. Neck pain can occur due to problems with the cervical spine or injury/damage to the neck structures.

What is the cervical spine?Neck pain 2

The cervical spine is the top portion of the spinal column made up of 7 small irregular-shaped bones called vertebrae, as well as intervertebral discs, the spinal cord, nerve roots, blood vessels, muscles, and ligaments. The cervical spine must support the head, and it allows the head to move in various directions.

How common is neck pain?

In a large population-based cohort study, the annual incidence of neck pain was found to be around 14.6%. Every year, 0.6% of the general population develops disabling neck pain, with women more likely to be affected than men.

What causes neck pain?

Nerve roots stem off the spinal cord much like tree branches. They go through the foramen in the vertebrae and transmit nerve impulses to and from the chest, arms, shoulders, and brain. In addition, the neck has 4 large arteries and brains that circulate blood between the heart and brain. Ligaments, muscles, and joints facilitate movement and stabilize the cervical spine and neck. A problem with any of these structures can cause neck pain.

The main causes of neck pain are:

  • Accidents and injury – Whiplash (cervical strain) is the most common cause of neck pain. This occurs in accidents where the neck is hyperextended and hyperflexed in a violent whipping motion (hence the name). This forceful, unnatural movement strains the ligaments and muscles of the neck.
  • Aging – Degenerative changes occur with age, resulting in conditions such as spinal stenosis, degenerative disc disease (DDD), and osteoarthritis (OA). Spinal stenosis causes narrowing of the spinal column, which results in nerve entrapment and pain. With osteoarthritis, bony osteophytes (spurs) impact vertebral motion and compress nerves. DDD is a condition where the discs lose water content, leading to bulging, vertebra displacement, and pain.
  • Everyday occurrences – Obesity, poor posture, and weakened abdominal muscles will affect the spine’s balance and lead to compensation with forward neck bending. This stress on the neck muscles lead to contraction and tension, which in turn causes stiffness and pain.
  • Disease processes – These include spinal infection, vertebral fracture, tumors, and spinal cord compression.

How is neck pain diagnosed?

To diagnose the cause of neck pain, the doctor will ask questions about your symptoms, take a detailed medical history, and conduct a physical examination. The doctor will observe your posture, physical appearance, and neck range of motion. In addition, a detailed neurological evaluation is done to assess muscle strength, sensory changes, reflexes, pain distribution, and motor changes. To check for bony deformities, fractures, and arthritis, x-rays are taken of the cervical spine. Nerve damage and soft tissue structures must be evaluated using a magnetic resonance imaging (MRI) scan.

How is neck pain treated?

Treatment is aimed at alleviated the underlying problem. With chronic conditions, treatment focuses on relieving symptoms. Options include:

  • Transcutaneous electrical nerve stimulation (TENS) – This is a small unit worn on the outside of the body. Wires run from the unit and attach to electrodes placed on the skin near the cervical spine. The unit delivers mild electrical impulses that interfere with pain signal transmission. TENS was evaluated in a recent medical study involving 30 people with neck pain. Researchers found TENS to have a 73% efficacy rate.

 

  • TENS unit 1Physical therapy – The therapist works with the patient for correct posture, alignment, and strengthening exercises. In addition, pain relief measures used in therapy include electrical stimulation, heat therapy, and ultrasound.

 

  • Chiropractic Manipulations – the San Diego chiropractor performs adept neck manipulation, which typically achieves excellent pain relief quickly!

 

  • Spinal Decompression Therapy – this is an FDA cleared treatment utilizing intermittent traction, which has been shown to provide over 85% neck pain relief.

 

  • Epidural steroid injection (ESI) – Often given in a series of three, an ESI involves injecting the space around the spinal cord with a corticosteroid, with or without an anesthetic agent. Clinical studies show that ESIs have a 90% success rate.

 

  • Medial branch block (MBB) – This procedure is done using x-ray guidance for correct needle placement of a catheter needle inside tiny facet joints. These joints are along the posterior region of the spine. The doctor injects a corticosteroid agent, and sometimes, an anesthetic is added. A recent medical report showed MBB to have an 85% efficacy rate.

 

  • Radiofrequency nerve ablation – To destroy a portion of the nerve roots along the cervical spine, the doctor can insert a small needle and use radiofrequency energy on the nerves. This procedure involves fluoroscopy to assure correct placement of the needle probe.

 

  • Decompression surgery – This involves removal of tissue that presses on a nerve root. With a discectomy, the surgeon removes a portion of the damaged disc. With transcorporeal microdecompression (TCMD), the surgeon decompresses both the spinal cord and nerve. With some types of cervical decompression surgery, the surgeon must remove a large portion of the vertebra, which often involves vertebral fusion or implantation of an artificial disc.

Resources

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

Cote P, Cassidy JD, Carroll LJ, & Kristman V (2004). The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain, 112(3), 267-273.

Maayaha M & Al-Jarraha M (2010). Evaluation of transcutaneous electrical nerve stimulation as a treatment of neck pain due to musculoskeletal disorders. J Clin Med Res, 2(3): 127–136.

Riew KD, Yin Y, Gilula L, et al. (2000). 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, 82-A(11):1589-93.

Son JH, Kim SD, Kim SH, et al. (2010). The efficacy of repeated Radiofrequency medial branch nurotomy 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, 27(1):11-6.

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