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Neck Pain

  • Chris Woolston, M.S.
  • Posted March 11, 2013

The neck and the lower back lie at opposite ends of the spinal column, but they have much in common. They both support heavy loads, and they both tend to hurt. According to a report in the Annals of Internal Medicine, roughly 13 percent of American adults suffer from neck pain at any given time. Half of all adults can at least remember a time when their neck felt sore and stiff.

Like back pain, neck pain can be extremely frustrating. It tends to come on quickly and go away slowly. That's also the good news: For most people, it does go away. All it usually takes is a little self-care, a lot of patience, and, perhaps, some help from a doctor.

What causes neck pain?

The muscles and ligaments in the neck are strong and flexible, but they have their limits. If you have poor posture or stretch your neck too far or twist it too quickly, you can develop painful sprains or strains: minor injuries to muscles and ligaments. If your pain is at its worst during the morning, you may be straining your neck while you sleep. Sprains and strains are also very common after falls and car accidents.

Arthritis is another common cause of neck pain. Both rheumatoid arthritis and osteoarthritis can damage the joints in the neck, causing pain and stiffness.

As with back pain, some cases of neck pain can be traced to the disks that cushion the joints between vertebrae. The disks in the neck can wear thin with age, putting extra stress on the joints. And, like disks in the lower back, disks in the neck can become herniated or "ruptured." The jelly-like center can ooze out of the disk and press against a nerve, causing neck pain.

Very rarely, neck pain is a symptom of a life-threatening disease, such as meningitis (a brain infection) or cancer.

What can I do about neck pain?

In most cases, time is the best remedy for neck pain. If you can avoid further straining your neck, the pain should gradually fade. Be patient: According to the National Institutes of Health, the healing process might take as long as several weeks. Over-the-counter pain relievers such as aspirin or ibuprofen can make the wait much more bearable. You can also try loosening tight muscles with a hot shower or a heating pad. If your neck hurts in the morning, a firm mattress and flat pillow (or no pillow at all) might help speed relief and prevent future problems.

When should I call the doctor?

If you have severe neck pain after an injury such as a fall or car accident, someone should call an ambulance right away. You neck should be immobilized by an emergency technician and you should seek emergency medical attention.

In more routine cases, you should seek medical attention when your neck pain is severe and unrelenting, or if it lasts more than a week. You should also seek immediate help if you have painful or swollen neck glands; pain that doesn't respond to over-the-counter pain relievers; pain, numbness, tingling, or weakness in one or both hands or arms; or a change in bladder or bowel habits. Finally, get medical help right away if your neck is extremely stiff, you can't touch your chin to your chest, and you have a fever along with a severe headache. These symptoms are the hallmarks of meningitis.

What can a doctor do to treat neck pain?

A doctor's first job is to find the source of pain. Here are some of the questions he or she might ask:

  • Is it a muscle strain? If so, is it due to chronically tense muscles in the back or neck as a result of stress, poor posture, or trauma?
  • Is it related to a bony injury? (If so, ask your doctor whether you need to get x-rays.)
  • Is there pain or numbness radiating down the arms or to other parts of the body? If so, your doctor will decide whether you need an MRI to rule out nerve impingement, or whether a soft collar and anti-inflammatory agents would be worth trying in the short run to see if your neck gets better on its own.
  • Do you have any allergies to anti-inflammatory medications or muscle relaxants? If your neck pain seems to be a simple case of overexertion, your doctor will advise you to move your neck as little as possible until the pain goes away. You may need to wear a neck brace for a while to keep your neck still. Your doctor may also prescribe prescription pain relievers or muscle relaxants.

In very rare cases, if you have other symptoms that raise red flags, your doctor may suspect a systemic illness such as meningitis or a spinal tumor.

What about chronic neck pain?

Chronic neck pain calls for a different approach. According to the American Academy of Orthopaedic Surgeons, motion -- not rest -- is often the best remedy for lingering neck pain. Your doctor or physical therapist may recommend specific exercises to help keep your neck strong and flexible. Exercise can be especially valuable for people with arthritis.

A very small number of people need surgery to relieve their neck pain. If a herniated disk in your neck is causing nerve damage, a surgeon may need to remove part of the disk to relieve pressure on your nerves.

Are there any alternative treatments for neck pain?

When traditional medicine can't offer any quick answers to pain, many people look elsewhere for relief. It's no surprise that millions of Americans with neck pain have sought help from acupuncturists or massage therapists. For some, it just might have been the right move.

A study published in the British Medical Journal found that five sessions of acupuncture brought more immediate relief to neck pain patients than five sessions of massage. The effect was fleeting, however: Three months later, patients who received acupuncture were no better off than other patients. Later reviews of clinical studies have found similar results: acupuncture appears to help with short term pain, but more studies of its long-term effectiveness are needed.

It's always important to consult with your doctor before trying an alternative treatment, especially chiropractic. Although chiropractic treatment may be useful, manipulation of the neck has the potential to make a herniated disk worse, neurology journals report.

There may be another, more serious risk: Several years ago a group of Canadian neurologists warned that vigorous chiropractic treatment for neck pain can cause strokes, some of which are fatal. Although such complications are rare, the neurologists ranked chiropractic manipulation of the neck as one of the leading causes of strokes in people under 45.

However, a Canadian population-based study published in 2008 found that the increased risk of stroke associated with chiropractic was likely due to the fact that patients with headache and neck pain (two common symptoms of vertebrobasilar artery VBA dissection, which commonly precedes a VBA stroke) are more likely to seek chiropractic care. The study found no evidence of excess risk of a VBA stroke associated with chiropractic care compared to primary care.

Neck pain may be frustrating, but it's almost never an emergency. Take the time to find the right treatment for you, and prepare yourself for a long healing process. Whether it takes weeks or months, relief is worth the wait.

References

Mayo Clinic. Neck Pain. February 17, 2010.

American Academy of Orthopaedic Surgeons. Neck pain. Updated November 2009.

Cassidy, JD, et al. Risk of vertebrobasilar stroke and chiropractic care: Results of a population-based case-control and case-crossover study. Spine. 2008 Feb 15; 133 (4 Supp): S176-83.

Walling AD. Acupuncture therapy for chronic neck pain. American Family Physician. http://www.aafp.org/afp/20020115/tips/15.html

Trinh, K, et al. Acupuncture for neck disorders. Spine. 2007 Jan 15; 32(2): 236-43.

Gemmell, H, Miller P. Comparative effectiveness of manipulation, mobilization and the activator instrument in the treatment of non-specific neck pain: a systematic review. Chiropractic and Osteopathy. 2006 April 19; 14:7.

Posner, J and Glew, C. Neck pain. Annals of Internal Medicine. May 21, 2002. 136(10): 758-759.

Irnich, D. et al. Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain. British Medical Journal. June 30, 2001. 322:1574-1576.

Malone, DG. Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice. Neurosurgical practice. December 2002. (13)

K.P. Lee et al. "Neurologic complications following chiropractic manipulation: a survey of California neurologists." Neurology, June 1995.

N. Klougart et al. "Safety in chiropractic practice, part I: the occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978-1988," Journal of Manipulative Physiological Therapy. July 1996.

N. Klougart et al. "Safety in chiropractic practice, part II: treatment to the upper neck and the rate of cerebrovascular incidents." Journal of Manipulative Physiological Therapy, November 1999.

Arthritis Foundation. Pain center: Exercise regularly. http://www.arthritis.org/conditions/pain_center/exercise.asp

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