Neck Pain Causes & Treatment Options

January 13, 2014June 24, 2014 / Thomas Cohn, MD

The cervical spine and neck can often cause pain, especially as the body ages. There are seven cervical vertebras with multiple joints contributing to the core structure. The spine and multiple nerves traverse the region. Multiple muscles and ligaments contribute to motion and stability.

On top of the neck is the head with all its structures and below are the torso, shoulders and arms. Pain perceived as from the neck may come from any of the structures in the region. All pain fibers from the mid shoulder blade and chest level on up travel through the same area of the brain. As a result, the brain can have difficulties in determining the exact location that is generating the pain signals.

Acute Neck Pain

Neck pain may be described as headaches that originate in the neck or it may be specific pain in the neck. Acute pain may be as simple as a muscle strain if there was no significant trauma. More chronic pain often comes from a deeper structure in the neck, such as:

Cervical facet joints
Cervical discs
Cervical nerve irritation
Degenerative changes irritating the nerves

Shoulder problems can also be misinterpreted as neck pain.

Chronic Neck Pain Causes

The most common causes of chronic neck pain are cervical facets joints, cervical degenerative changes, discs irritating nerves in the neck, and secondary muscle spasms in the neck. Trauma over time often contributes to the changes that have caused pain. The result is felt as neck pain, muscle tightness, and decreased range of motion of the neck. Determining the cause starts with a good history and physical exam. If simple solutions such as exercise, massage, heat and ice, and over the counter medications have not worked, then a physical medicine pain physician would be extremely helpful in coordinating future care.

Chronic neck pain that is limiting function warrants help from an expert. Muscle spasms and pain are the symptoms most commonly reported by patients. The cause is often a combination of problems such as:

Degeneration of discs, bones, and joints
Nerve irritation
Muscles tightening to prevent further pain and movement of the head

After age 30, almost everyone will show a degree of degeneration of the cervical spine and these normal changes can also contribute to pain.

Treatment Options for Chronic Neck Pain

Treatment of neck pain starts with determining the causes, and often requires a complex plan that addresses each of the contributing factors that are maintaining the symptoms. Chronic pain often involves multiple causes and a simple treatment is often not available. Patient frustration is common since we all want a simple treatment. If there are multiple structures involved and pain is chronic, expect that more than one thing will be necessary to manage the symptoms.

Pain Medication Tolerance vs. Addiction

January 8, 2014June 24, 2014 / Thomas Cohn, MD

Pain medications such as opioids and narcotics can be very helpful at relieving and managing pain. However, if these pain drugs are used in excess they can lead to tolerance and addiction. This article will investigate the similarities and differences of drug tolerance and addiction. Are they the same? Does one lead to the other? Read on to learn more.

Pain Medication Tolerance

Drug tolerance is a state that occurs when a medication dose ceases to be effective for a person who previously found the same dose to have a therapeutic effect. A higher dose is then required to achieve the same previous effect. Tolerance is a common phenomenon with many medications, especially opioids and narcotics.

Enzymes that metabolize a drug become more active over time as the presence of a drug becomes routine. These enzymes clear the drug out of the body faster and, as a result, it takes more of the drug to achieve the same previous therapeutic level.

Addiction to Pain Meds

Addiction to a drug is a physical and psychological state in which a person has a loss of control in their behavior and is unable to limit the intake of a drug despite negative consequences. In addiction, the drug provides a positive, pleasurable reward to the brain. An addict will seek out the drug even if it is ruining their health or involves illegal activity.

Addiction is a disease of the brain. It occurs with many drugs that stimulate the dopamine reward centers and is also seen with opioid medications and alcohol.

Dependence is usually coupled with addiction. When a person is dependent on a drug, they can function normally with the medication in their system, but experience a physical disturbance when the drug is removed. Opioid withdrawal can cause:

Nausea
Vomiting
Diarrhea

Dependence occurs with many medications, which is why many drugs have warnings not to suddenly stop taking the medication.

The Difference Between Tolerance & Addiction

The difference between tolerance and addiction is the psychological desire for the medication that occurs with addiction. Many drugs can develop tolerance effects. Sometimes changing the medication to a slightly different drug that is similar or changing the dose can overcome this issue.

Addiction is an abnormal craving for the drug since it gives the person some sort of psychological pleasure, and that the person will do anything to get the drug despite the consequences. Those who are tolerant (and not addicted) can be withdrawn from the drug and do not crave it once it is no longer available.

Tolerance to a medication does not equate to addiction. However, a person who is tolerant to a medication can also have addiction problems to the same medication. If you have questions, you should talk directly with your physician and be evaluated.

How Steroid & Corticosteroid Injections Relieve Pain

January 6, 2014June 24, 2014 / Thomas Cohn, MD

Corticosteroids, also known as steroids, are powerful anti-inflammatory compounds. They mimic the body’s own steroid hormones and can diminish inflammation by preventing phospholipid release and eosinophil action. In plain English, these are man-made compounds that reduce inflammation when tissue damage or irritation is occurring.

Inflammation and Pain

Many problems that cause pain are due to tissue damage or irritation, sometimes it is acute and at other times it is chronic and ongoing. Inflammation can result from any of the following:

Degenerative changes in the spine and joints
Disc bulges and herniation
Injury

The body can often deal with routine inflammation with its own mechanisms. The inflammation often stimulates sensory nerves and is perceived as pain.

When inflammation and pain is beyond normal control and impacts function, the use of corticosteroids is sometimes appropriate. These medicines can be given in a number of different ways. They are easily given orally and travel to everywhere in the body. Oral steroids, often prednisone or decadron, are inexpensive, and if given for a week or less have very little side effects or risk. They can often be very effective for acute or sub-acute pain in many areas of the body.

Corticosteroids

Corticosteroids are often used as injections targeted to very specific sites to treat pain caused by ongoing inflammation. Many joints, such as the knees, hips, and shoulders, can be injected to reduce pain, especially if it is just one isolated area. If multiple areas inflamed, injections are usually not used since the risk of too much steroid exposure may be a problem.

Severe spinal pain is often treated with steroid injections. The discs and spinal facet joints are deep structures with limited blood flow. The delivery of oral steroids to these regions may not be sufficient to decrease inflammation. Injection of these medications can deliver them to the specific structures that are inflamed and be maximally effective in controlling symptoms of pain for months at a time. These spine injections are best done by an experienced pain management physician and done with real time x-ray guidance to make sure they are delivered to the right spot and no other damage is done.

Since steroids can have significant side effects, and cause damage to the body if over used, the overall use must be closely monitored. Most pain physicians prefer that steroid shots be limited to 4 to 6 times in one year for safety reasons. There is not an absolute maximum and not a lifetime maximum. The risk and benefit needs to be evaluated for each individual and discussed between the patient and physician. Careful use may have a profound effect on pain control and often can be life changing in some pain patients. Since everyone is different, a pain physician can help guide a patient through a comprehensive strategy that maximally benefits each individual.