Neck Pain (Cervical Pain, Cervicalgia)

• Neck pain is discomfort in the body between the base of the skull to the torso.
• Neck pain ranges from mild to severe.
• There are many causes of neck pain, including
  • trauma,
  • degenerative spine and disc,
  • muscle injury,
  • nerve problems,
  • infections,
  • cancers, and
  • drugs.
• Risk factors for neck pain include trauma or strains during a car wreck or athletic event, poor neck positioning, exposure to cancer-causing items, exposure to infectious agents, and/or certain drugs.
• Symptoms and signs of neck pain may vary somewhat depending on the underlying cause (for example, neck muscle pain may have only mild discomfort while neck cancer discomfort may include difficulty breathing).
• Depending on the underlying cause(s), family medicine doctors, internists, pediatricians, orthopedists, ENT specialists, rheumatologists, neurologists, emergency medicine physicians, psychiatrists, and/or neurosurgeons may care for neck pain.
• Because there are so many causes of neck pain, caregivers rely on an extensive history, physical examination, and certain tests such as X-rays, CT/MRI, nerve condition tests, and others to get a diagnosis.
• Treatment of neck pains varies with the underlying cause; home remedies, medications, injections, and possibly surgery may be indicated.
• Home remedies such as yoga, exercises, over-the-counter NSAIDs, and massage may reduce neck pain.
• To reduce complications like inability to swallow or seizures, diagnosis of the underlying causes of neck pain should be done before relying on home remedies.
• Most neck pain problems have a good prognosis. Some neck pain can have severe complications (meningitis, neck cancers) and may have a fair to poor prognosis.
• Avoiding the causes of neck pain is possible by avoiding trauma and stress to the neck but, depending on the underlying cause of neck pain, some neck pains are not avoidable.

The neck contains blood vessels, nerves, muscles, esophagus, larynx, trachea, thyroid gland, parathyroid glands, lymph nodes, major blood vessels (the carotid arteries and jugular veins), the cervical vertebrae, and the top of the spinal cord.

Neck pain is discomfort in the part of the body between the head (base of the skull) and the torso. Neck pain ranges in severity ranging from mild to severe. The neck contains blood vessels, nerves, muscles, esophagus, larynx, trachea, thyroid gland, parathyroid glands, lymph nodes, major blood vessels (the carotid arteries and jugular veins), the cervical vertebrae, and the top of the spinal cord. Neck pain may involve one or more of the structures in the neck. Cervical pain is another name for neck pain.

Neck pain is a common medical condition. Neck pain can be caused by many disorders and diseases in any one of the components that make up the neck structures. 7 Possible causes of neck pain include the following:

• Trauma to the neck structures (for example, whiplash or penetrating trauma)
• Degenerative diseases of the spine such as degenerative disc disease
• Muscle injuries such as neck strain or sprain (poor posture, stress, abnormal sleeping positions)
• Nerve problems such as a herniated disc or pinched nerve
• Infections such as viral infections of the throat or tuberculosis of the neck
• Cancers such as cancer of the esophagus or thyroid cancer
• Drugs that predispose to neck muscle spasms (torticollis)

Neck pain symptoms and signs depend somewhat on the underlying cause or structure that is affected. However, dull aching discomfort is fairly common with most neck pains, regardless of the cause.

• Sometimes the pain is associated with headaches that may mimic a migraine (meningitis) and other parts of the body such as shoulder, face, and arm pain.
• In other instances, movement of the neck is increased with turning of the head or flexing in or extension of the head.
• Other symptoms include
  • sharp,
  • shooting pains,
  • the feeling of fullness,
  • dizziness,
  • numbness, and/or
  • tingling and nausea.
• Some signs include
  • swelling (lymph nodes, thyroid),
  • difficulty with swallowing (esophagus), or
  • breathing difficulties (trachea, larynx).
• A neck muscle spasm can result in torticollis (head twisted to the right side or left side), also termed wry neck or Loxia.

Risk factors for neck pain include injuries like automobile accidents or involvement in sports activities such as football, strains (such as poor positioning of the neck while sleeping), certain cancer-causing exposures such as overexposure to X-rays (thyroid cancers), and exposure to infectious agents that may affect the spinal nerves (meningitis, TB) or the bones in the spine (osteomyelitis). Individuals who take drugs like ketamine, amphetamines, cocaine, and neuroleptics are at risk of triggering painful neck muscle spasms.

The complications for neck pain depend on the underlying cause. Most individuals with only muscle strain as the underlying cause usually have no complications.

• Uncomfortable twisting of the neck (torticollis) may be a treatable complication of muscle strain or a drug reaction.
• However, with cancer in one of the neck structures, there may be serious complications such as loss of ability to swallow or to breathe.
• Meningitis is a cause of neck pain and has potentially life-threatening complications that can quickly develop (seizures, death).

The diagnosis of the underlying cause of neck pain begins with the history (for example, a recent car accident or chronic swallowing problems, sudden or gradual onset) of the symptoms and the physical examination to note the location, intensity, radiation (to ears, head, for example) of the pain, and how long the pain lasts (constant or intermittent). The neck will likely be moved in several directions to see if the pain is increased or decreased and to see if the back of the neck shows a stiff neck. Depending on the presumptive cause(s) the caregiver may require other tests. Tests may include one or more of the following:

• X-ray of the cervical vertebrae
• CT scan of the neck
• Nerve conduction test such as a nerve conduction velocity (NCV) test
• Endoscopy
• Myelogram
• MRI scan of the neck
• Biopsy

If meningitis is suspected, antibiotics are given immediately.

Many types of medical professionals can assess and treat neck pains, including family medicine doctors, internists, pediatricians, orthopedists, ENT specialists, rheumatologists, and neurologists.

• Other specialists may include emergency medicine physicians, psychiatrists, and/or neurosurgeons, depending upon the underlying causes.
• Chiropractors, physical therapists, massage therapists, and acupuncturists may be involved in treatment plans.

Again, treatment options for neck pain depend upon the underlying cause. Treatment options include

• rest,
• heat and/or cold applications traction (usually with a soft collar),
• physical therapy,
• cortisone injections,
• over-the-counter analgesics (acetaminophen, ibuprofen), and
• topical analgesics.

Although these may work for many patients to get relief from neck pain, others may require local injections of cortisone or analgesics, muscle relaxers, or Botox injections.

Some may require surgical procedures.

Home remedies are available for some neck pains. The home remedies may consist of neck pain relief exercises and stretches, yoga, especially designed neck pillows, warm heating pad applied to the neck, massage, Jacuzzi treatments, over-the counter NSAIDS, topical Bengay, or ice packs. However, if the neck pain cause is unknown, it is best to check with your health care provider before you decide on only home remedies.

The prognosis for neck pains depends on the underlying cause. Many individuals who have a minor injury to the neck muscles (strain or sprain) usually have an excellent prognosis. As the underlying cause becomes more serious, the prognosis decreases.

By avoiding stress and strain on the neck muscles and/or other injuries by wearing appropriate equipment to protect against injuries and/or neck radiation, it's possible to prevent many types of neck pain. Stopping the use of certain drugs may prevent some instances of neck pain. Although it may not always be possible to prevent neck pains, once an underlying cause has been found, there are usually ways to reduce the pain.