Neck Pain

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Neck pain

Description

Neck pain is a nonspecific symptom of discomfort that has a number of possible causes. Depending on the cause, neck pain may be experienced as limited to the neck itself (localized), or as radiating to the shoulders and upper arm. The patient may experience the pain as a dull ache, a sharp stabbing or burning sensation, or a feeling resembling a muscle cramp. Neck pain is often accompanied by stiffness or difficulty in moving the neck.

Causes & symptoms

Possible causes of neck pain include:

Trauma. Whiplash injuries from car accidents and fractures or sprains from rough contact sports or fights are examples of traumatic causes of neck pain.
Chronic strain on the muscles and tendons of the neck. This stress is often related to the patient's occupation, as some jobs require workers to hold their neck and shoulders in one position for long periods of time.

Computer programmers, dentists and dental hygienists, professional musicians (especially string and woodwind players), dancers, and long-distance truck drivers are especially vulnerable to this type of neck pain. In addition, teenagers who work are at higher risk of chronic neck pain than teenagers who participate in sports. Poor posture can also contribute to chronic strain on the neck.

Degenerative disorders that affect the neck and spine. These include osteoarthritis, ankylosing spondylitis (an inflammatory disorder of the spine most often seen in young men), and osteoporosis .
A herniated disk in one of the cervical (neck) vertebrae. In a herniated disk, the disk projects outward between the vertebrae.
Congenital abnormalities. People who are born with abnormally shaped vertebrae or loose joints in the neck region may develop neck pain when the vertebrae begin to put pressure on the spinal cord.
Rheumatoid arthritis (RA).
Fibromyalgia .
Infectious diseases. One of the earliest signs of mumps, meningitis , encephalitis, and poliomyelitis is stiffness and soreness in the neck.
Cancer . Malignant tumors in the neck cause pain when they grow large enough to press on nerve endings and the spinal cord.
Climatic factors. People whose jobs require them to work in drafty areas or outdoors in cold weather are at higher risk of developing neck pain.

Diagnosis

Differential diagnosis of neck pain is complicated not only by the number of possible causes but also by the fact that many patients suffer from two or more conditions at the same time. In most cases, the physician will begin by trying to determine whether the neck pain is caused by a primary disorder in the neck and shoulder region itself, or whether the pain is the result of a systemic disease that is affecting the neck.

Patient history

The taking of a careful patient history is particularly important in cases of neck pain because of the number of possible causes. A thorough history will include questions about the patient's occupation and sports or hobbies as well as medical history.

Physical examination

The physician will begin by touching, or palpating, the patient's neck and shoulder girdle. Because the underlying bones and muscles in the neck are close to the surface, an experienced examiner can feel swollen glands, tumorous swellings, muscle spasms, or abnormal protrusions between the vertebrae. The doctor will then turn the patient's head gently from side to side to determine the neck's range of motion and whether or not the pain is worsened by movement. Examination of the inside of the patient's mouth and throat allows the doctor to check the salivary glands, which are swollen and inflamed if the patient has mumps.

Diagnostic imaging

The doctor may order an x ray of the neck if he or she suspects traumatic injury, osteoarthritis, osteoporosis, rheumatoid arthritis, a herniated disk, or congenital deformities. Chronic strain disorders of the neck do not always appear on a plain x ray. If cancer is suspected, the patient may be given a computed tomography (CT) scan of the head, neck, and chest, as well as a gallium scan and a bronchoscopy, laryngoscopy, and esophagoscopy. The reason for examining the patient's lungs and upper gastrointestinal tract is that most cancerous tumors in the neck are secondary tumors (metastases) from primary cancers located elsewhere in the body. The doctor may also order a CT scan before scheduling a lumbar puncture if the patient appears to have meningitis or another infection of the central nervous system.

Laboratory tests

The doctor may order a blood test to distinguish rheumatoid arthritis from lupus or other inflammatory diseases. Abnormal values for the proteins in blood serum are often present in RA. In addition, a sample of the patient's joint fluid may be taken. Laboratory tests are most important, however, if the doctor suspects that neck pain is due to a central nervous system infection. These diseases are medical emergencies and require rapid treatment with antibiotics. Following a CT scan, a sample of the patient's spinal fluid will be withdrawn through a lumbar puncture and cultured in order to identify the specific organism causing the infection.

Treatment

Most forms of alternative treatment for neck pain are directed at the milder forms of chronic pain caused by occupational or emotional stress. Many of them can be performed as self-help or self-treatment.

Lifestyle modification

Neck pain caused by chronic stress on the muscles of the neck can interfere significantly with overall quality of life as well as efficiency at work. Work-related neck pain may require a change in occupation or a modification of the equipment that the patient uses. Patients with poor posture may benefit from various types of exercise or movement therapy . In some cases, psychotherapy may help to lower stress or relieve the painful feelings that are often associated with poor posture.

Acupressure and acupuncture

Acupressure and shiatsu are traditional Chinese and Japanese therapies that make use of pressure points (sometimes called acupoints) on the body to release muscular pain and tension. For most types of neck pain, the therapist would make use of acupoints on the neck and upper shoulders. Acupuncture as an alternative treatment for neck pain has become increasingly popular in the West since the early 1990s. While some studies indicate that acupuncture is effective in relieving pain in the neck and upper shoulders, other researchers are not yet convinced.

Chiropractic

Neck pain is a common reason for seeking chiropractic treatment. A chiropractor would treat neck pain by checking the cervical vertebrae for misalignment, which is called subluxation in chiropractic terminology. The misaligned vertebra would then be moved back into proper position with manual pressure. A chiropractic adjustment is thought to restore normal functioning by reducing the stress on the joints, by lowering muscle tension resulting from subluxation, and by minimizing pressure on the spinal nerves.

Movement therapies

Both traditional hatha yoga and breema , a relatively new form of movement therapy, claim to treat neck pain by reducing or eliminating some of the underlying causes. Teachers of yoga maintain that the postures improve the flexibility of the spine and keep the disks between the vertebrae well nourished by spinal fluid. In breema, instructors individualize the exercises, so that persons with neck pain can be given a set of exercises for that specific problem. In addition, both yoga and breema emphasize the importance of cultivating healthy spiritual and emotional attitudes toward the body, thus lowering the level of psychological stress that often contributes to neck pain. Other systems that help to re-educate patients in body movement include Feldenkrais , the Alexander technique , and Hanna somatics .

Reiki, reflexology, and polarity balancing

These methods of treatment rely on light or indirect contact with the affected area rather than on touching it with the techniques used in traditional massage. All three systems of treatment regard neck pain as a symptom of energy imbalance in the body. Reiki and polarity therapy practitioners seek to realign the energy flow by placing the hands lightly on or over parts of the body that are thought to redirect the energy. In reflexology , the feet are regarded as a map of the entire body. Neck pain would be treated by massaging the base of the large toes, which represent the neck area.

Traditional Chinese medicine

In traditional Chinese medicine , neck pain is treated by Tui na massage followed by a herbal poultice on the neck; by suction cups, a traditional remedy for arthritis; or by skin scraping, a technique often used for ailments in the neck area. To perform cupping , the practitioner flames the inside of a glass suction cup with a cotton ball dipped in alcohol and lighted. The heat from the fire reduces air pressure inside the cup, which is then pressed on the sore area and removed after 15–20 minutes. This treatment withdraws excess moisture from the tissues. In skin scraping, the skin on the back and sides of the neck is scraped with a coin dipped in salt water, or by pinching a fold of skin, pulling sharply, and letting it fall back. These motions are performed rapidly until bright red stripes appear. Skin scraping is done to release excess heat and energy from the treated area.

Magnetic field therapy

Magnetic field therapy, which involves the application of a pulsed magnetic field to an injured area of the body, has been gaining in popularity as a treatment for chronic muscular and joint pain. It is thought that magnetic treatments relieve pain by increasing the flow of oxygenated blood to injured tissue. Some studies indicate that magnetic field therapy is useful in relieving chronic neck pain, particularly pain associated with whiplash injuries.

Allopathic treatment

Medications

Some forms of neck pain can be treated by medication. Osteoporosis is often treated with a combination of hormone therapy and such compounds as alendronate (Fosamax) or etidronate (Didronel). These medications are intended to prevent further weakening of the bone. Pain caused by osteoarthritis, fibromyalgia, rheumatoid arthritis, or ankylosing spondylitis is usually treated with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). Patients with RA may also be given injections of gold salts or methotrexate (MTX, Rheumatrex). Pain from severe fibromyalgia may be treated with local anesthetics or muscle relaxants.

Appliances

Patients with neck pain caused by traumatic injury, chronic muscular strain, a herniated disk, some forms of osteoarthritis, or congenital deformity may need to have the neck temporarily kept from moving (immobilized) in order to heal. A cervical collar may be used in milder cases. Chronic or severe pain may require more extensive bracing, or traction and a period of bed rest.

Surgery

Surgical treatment may be needed to replace damaged joints in severe cases of osteoarthritis or rheumatoid arthritis. Herniated disks occasionally require surgery to fuse the vertebrae around the disk. Some patients with severe cases of ankylosing spondylitis may need to have the cervical spine stabilized by surgery. Most cancers of the neck are removed surgically after a course of radiation treatment.

Expected results

The results of treatment for neck pain vary widely because of the number of possible causes. While mild arthritis and minor stress injuries in the neck respond well to treatment, cancers in the neck have low survival rates because they are often stage III or stage IV metastases of cancers elsewhere in the body.

Prevention

Some potential causes of neck pain are difficult to prevent because they involve a genetic predisposition or component. These include ankylosing spondylitis, osteoarthritis, and RA. Others are easier to prevent by lifestyle choices. Attention to proper posture, the choice of office chairs and other furniture proportioned to the person's height and size, and exercise breaks from office work, study, or musical practice can help to lower the risk of neck pain from chronic muscular stress. Diet as well as exercise is a prominent factor in the prevention of osteoporosis. The risk of trauma to the neck can be lowered by observing safety guidelines and wearing protective equipment during contact sports. The use of certain types of shoulder harness while driving appears to lower the risk of whiplash injuries. Lastly, meditation and other spiritual practices are effective in lowering the level of emotional stress that often underlies chronic neck pain.

Resources

BOOKS

Aminoff, Michael J., MD, FRCP. "Nervous System." In Current Medical Diagnosis & Treatment 2000. Edited by Lawrence M. Tierney Jr., MD, et al. New York: Lange Medical Books/McGraw-Hill, 2000.

Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Fife, WA: Future Medicine Publishing, Inc., 1995.

Feuerstein, Georg, and Stephan Bodian, eds. Living Yoga: A Comprehensive Guide for Daily Life. New York: Jeremy P. Tarcher/Perigee, 1993.

Hellman, David P., MD, FACP, and John H. Stone, MD, MPH. "Arthritis & Musculoskeletal Disorders." In Current Medical Diagnosis & Treatment 2000. Edited by Lawrence M. Tierney Jr., MD, et al. New York: Lange Medical Books/McGraw-Hill, 2000.

Reid, Daniel P. Chinese Herbal Medicine. Boston: Shambhala, 1993.

Theodosakis, Jason, MD, MS, MPH, Brenda Adderley, MHA, and Barry Fox, PhD. The Arthritis Cure. New York: St. Martin's Press, 1997.

PERIODICALS

Andersen, J. H., A. Kaergaard, P. Frost, et al. "Physical, Psychosocial, and Individual Risk Factors for Neck/Shoulder Pain with Pressure Tenderness in the Muscles Among Workers Performing Monotonous, Repetitive Work." Spine 27 (March 15, 2002): 660–667.

Constantoyannis, C., D. Konstantinou, H. Kourtopoulos, and N. Papadakis. "Intermittent Cervical Traction for Cervical Radiculopathy Caused by Large-Volume Herniated Disks." Journal of Manipulative Physiology and Therapeutics 25 (March-April 2002): 188–192.

Ehrmann-Feldman, D., I. Shrier, M. Rossignol, and L. Abenhaim. "Risk Factors for the Development of Neck and Upper Limb Pain in Adolescents." Spine 27 (March 1, 2002): 523–528.

Hildebrandt, V. H., P. M. Bongers, F. J. van Dijk, et al. "The Influence of Climatic Factors on Non-Specific Back and Neck-Shoulder Disease." Ergonomics 15 (January 2002): 32–48.

Thuile, C., and M. Walzl. "Evaluation of Electromagnetic Fields in the Treatment of Pain in Patients with Lumbar Radiculopathy or the Whiplash Syndrome." Neurorehabilitation 17 (2002): 63–67.

Zhu, X. M., and B. Polus. "A Controlled Trial on Acupuncture for Chronic Neck Pain." American Journal of Chinese Medicine 30 (2002): 13–28.