Neck Pain

Neck pain is not as common as back pain, still it affects many people. It is usually a result of chronic wear and tear of cervical spine tissues. Overuse and injury to muscles are also common cause. Neck pain can be very debilitating, especially for someone leading an active life style. Neck pain can get referred to surrounding areas and can cause headache, ear pain, pain radiating to shoulder etc. If there is nerve pressure in cervical spine, pain might also radiate down the arm. Neck pain also gets referred to upper back commonly.

Causes of Neck pain:

• Spinal causes: Any disorder affecting tissues of spinal column can cause neck pain.
  • Slip disc (cervical disc herniation)
  • Cervical spinal stenosis
  • Cervical spondylosis (disc degeneration, facet arthritis)
  • Spinal cord anomalies (myelomalacia, syrinx)
  • Spine deformity (scoliosis, kyphosis)
  • Vertebral pathologies: Fracture, infection, tuberculosis, tumors.
  • Osteoporosis
• Muscle spasm: Muscle spasm is one of the common cause of neck pain.
  • Sleeping with a bad neck position and not well supporting pillow.
  • Muscle spasm can be due to a primary spine pathology. This can becomes a chronic source of pain even after primary problem is subsided.
  • Patients with poor sitting posture, especially those who work with computers for long time are prone to muscle spasm.
  • Heavy weight lifting or sports activities can cause muscle or ligament strain
  • Nearby pathologies: Various organs are located in and aound the neck, e.g. lymph nodes, thyroid, trachea, tonsils etc. Any pathology involving these organs can lead to neck pain. Occasionally heart and brain problems (e.g. meningitis) can also cause neck pain.

Risk factor for Neck pain:

• Age: Older individuals are more affected by neck pain due to spondylosis.
• Obesity: Overweight individual are prone to have back pain due to increased stress on muscles. These people also have more spinal degeneration which can also cause neck pain.
• Lack of activity: Muscles get weaker when not used. They become painful with minimal stress.
• Heavy activities: People involved in heavy labor and sports activities have increased degeneration of spinal joints and ligament strain.
• Psychological stress: People with depression and anxiety suffer from neck pain more often.
• Smoking: Smoking leads to osteoporosis. Smoking also reduces blood supply to disc and slows healing process.

Prevention of neck pain:

Neck pain can be secondary to muscle spasm which usually subsides within few days.  There are certain Dos and Don’ts which can help us in preventing back pain and to reduce if we are already suffering.

• Regular exercises: Regular exercises will keep back muscles healthy. It will also increase blood flow to different spinal structures, especially disc, keeping them healthy. Exercises will also make vertebrae stronger. Exercise also help in maintaining correct posture and reducing muscle spasm. Yoga activities strengthen core muscles and stretch ligaments, making them less prone to damage.
• Weight reduction: Maintaining a healthy weight will not only reduce load on spine and back muscles, it will also reduce chances of developing many other illnesses, e.g. diabetes, hypertension.
• Quit smoking: If necessary, take doctor’s help.

Healthy Activities:

• Sitting: We should not sit in same position for long time. A 5-10 minutes break should be taken after every 1.5-2.0 hours of sitting. A short walk and neck stretching exercises are recommended for people involved in desk job. While sitting, back should be straight. Individuals who work with computers, should keep screen at eye level to prevent looking down for long time. While driving long distances, special care need to be taken. A cervical support can be used while driving or sitting for long time.
• Phone use: Excessive use of cell phone with flexed neck, e.g. while browsing internet or watching a web series, can put enormous pressure on cervical discs and muscles. Individual, who need to attend long calls on normal phone, might keep neck bent sideways , which is equally harmful.  Using phone in a sleeping/ semi-sleeping position is also not good. Use a blue tooth device/head phone and keep phone close to eye level to keep neck straight.
• Lifting: Lifting puts immense pressure on spine and cervical discs. Keep the weight near your body to reduce lever arm effect. It will be better if heavy weight can be divided in multiple lighter weights for easy lifting.
• Healthy sleep: It is very important to have a sufficient and relaxing sleep for a healthy back. A firm mattress is recommended. Pillow also should be firm. If you are already suffering from neck pain, a specialized cervical pillow can be used. Avoid using multiple or thick pillow which can flex neck too much.
• Other activities: Do not get involved in very heavy weight lifting exercises. Driving requires its own set of precautions. Avoid carrying heavy bags on one shoulder.

Treatment of neck pain:

In majority of the patients, neck pain is a self-limiting symptom. Following treatment can be taken at home for recent onset mild backpain.

• Local application of heat/ cold
• Local application of analgesic gel
• Gentle neck massage can be used
• Cervical collar while sitting, standing, traveling
• Cervical pillow while sleeping
• Paracetamol or locally available pain killer
• Avoid heavy activities

In 1-2 weeks, patients usually get significant relief. However, it is recommended to consult a spine specialist in following situations:

• Neck pain not subsiding with above treatment (significant pathology)
• Neck pain associated with radiculopathy (spinal nerve pressure)
• Neck pain with symptoms of myelopathy (spinal cord damage)
• Neck pain with fever (infection)
• History of fall/ injury (suspected fracture)
• History of cancer (could be spine metastasis)

Spine specialist will examine the patient and will decide if further course of medicine and physiotherapy should be tried or patient need further investigations. Usually following medical treatment is given:

• Powerful pain medicines to reduce pain
• Muscle relaxant to reduce muscle spasm
• Nerve medicines (Pregabalin, Gabapantene etc.) if there is associated nerve related symptoms
• Physiotherapy is usually added to reduce muscle spasm and strengthen neck muscles

If patient does not recover in a reasonable period of time, further investigations are required. Usually following tests are done.

• X-ray: It’s a baseline study to detect any bone abnormality.
• MRI Scan: MRI will assess internal structures of spine (disc, nerve, joints, ligaments etc.)
• CT Scan: A CT is required if detailed bone assessment is required.
• EMG NCV: These tests will assess functioning of the nerves.
• Blood tests: Various blood tests to detect infection, tumors, osteoporosis etc. are required based on suspected pathology.
• Other tests: DEXA scan (Osteoporosis), abdominal ultrasound (abdominal pathology), ECG/ 2D Echo (heart problems), x-ray of shoulder.

If a significant pathology is detected in investigations, further treatment with spinal injection or surgery (decompression with/ without fusion) might be required based on the severity of the symptoms and patient’s recovery with non-surgical treatment.