This is part two of our blog mini-series on Neck Pain. You can find the first installment here. Our first post focused on chronic neck pain causes and treatments at a general level. c
Cervical discs in the neck that cause nerve irritation can have both axial pain or pain in the arms. MRI or CT scans are necessary to see these structures and determine the severity of the changes. If the changes have been slow degeneration, the body can often adapt to them even if there is severe narrowing where the nerves travel. Treatment often includes cervical epidural steroid injections to calm spine irritation and inflammation. Controlling nerve sensitivity can be helped by medications known as neuropathics that include some seizure drugs and antidepressants. Physical therapy and behavioral health interventions are also beneficial.
Whiplash and cervical facets cause pain from abnormal movement or sensitivity of the joints between each of the cervical vertebra. Patterns of pain from these joints are fairly specific, and are mostly along the spine from the base of the skull, out to the shoulders, and down through the shoulder blades. Treatment ranges from heat and ice, massage, manipulation, acupuncture, anti-inflammatory medications, traction and physical therapy, to injections. Most pain responds to simple things, about 5-10 percent need the more complex treatment such as steroid injections, nerve blocks, and radiofrequency lesioning to prevent pain feedback from the joints.
Muscle spasms of the neck can be primary problems, or secondary to a deeper problem in the spine. If the spasms are chronic, it is more likely they are due to a deeper structure like the facets or discs, and treating those problems will significantly improve the spasms. At times, spasms continue despite treating all other problems and pain is chronic. For this type of problem, chronic use of muscle relaxers along with therapy is often necessary. Botox, which is a medication that is injected into the muscle to partly paralyze it for several months, is also helpful.
Neck pain that is chronic and ongoing is a difficult problem to treat due to its many causes. A Physical Medicine pain specialist can be especially helpful in the diagnosis and management of the problem. They often can determine all the factors that are contributing to ongoing issues and develop a comprehensive strategy to manage the symptoms. Treatment often is not simple, but working with an experienced specialist can help with a successful long-term solution to a frustrating problem.
Thomas Cohn, MD
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