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Neck Pain

Introduction

Neck pain is common and can have many reasons. About 20% of people experience acute neck pain. Chronic neck pain that lasts more than 3 months occurs in about 10% of people. Despite many studies the real causes of acute or chronic neck pains are poorly understood. However, there is enough evidence to delineate the more common mechanical neck pain from the more serious systemic neck pain.

Causes of Neck Pain 

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Mechanical neck pain: Compression fractures etc.(see under “osteoporosis“) , congenital malformations , degenerative changes of spine and disc herniation, facet joint disease (osteoarthritis), whiplash associated disease (from car accident etc.)

Back Muscle Spasm: CRPSfibromyalgia or myofascial pain syndrome

Systemic causes of neck pain: Infectious cause of neck pain (osteomyelitis of the neck) , Metabolic cause (osteoporosis, osteomalacia) , Myeloma or other malignancy , Polymyalgia rheumatica , Rheumatoid arthritisankylosing spondylitis

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Neck Pain

Neck Pain

Mechanical neck pain

As can be seen from the list of links above, there are a number of causes of mechanical neck pain. Some common causes are compression fractures, degenerative changes of the facet joints or of the intervertebral discs. Automobile accidents or personal injuries (whiplash injuries) that jar the neck are also frequently causing mechanical neck pain.

Non-specific chronic muscle spasm

Back muscle spasm in the neck region is getting more common. Fibromyalgia is one distinct form of this, which has been dealt with on a different page. Here specific trigger points are found that make it possible to classify it separately. In a bout 20% of traffic accident victims with whiplash associated disease there is a “posttraumatic fibromyalgia”, which is well described in the literature, and should be medically diagnosed early so that it can be treated accordingly. Often sleep disturbances are associated with this.

Myofascial pain syndrome is a less specific chronic painful muscle spasm that develops from disuse after an injury in he neck or arm region. Once the patient is dysfunctional, because of pain issues secondary muscle atrophy (loss of muscle mass) develops, and this predisposes the patient to more frequent muscle spasms. When this pain becomes chronic,the condition of post traumatic myofascial pain syndrome is established. It is extremely difficult to treat and often tends to be chronic (Ref. 1, P.7).

Complex regional pain syndrome I and II

(formarly called “RSD” or reflex sympathetic pain syndrome, and causalgia) are two regional pain syndromes, which are fairly well defined, but need early diagnosis (2 to 3 month after the initial trauma) to be treated effectively. Bone scans and thermography can help in the early diagnosis. Treatment may involve a sympathetic nerve block, corticosteroid epidural blocks and very intensive re-activation physiotherapy. For spinal malalignments (which the chiropractors call “subluxations of the facet joints”) gentle chiropractic manipulation and then active re-activation phyisotherapy may be needed.

Here is a link to a site with more info on CRPS (thanks to www.ninds.nih.gov for link).

Summary Regarding Neck Pain

As we have seen, there can be a multitude of reasons why a person may experience neck pain or pain in the cervical spine. Diagnostic tests need to be utilized to pinpoint the cause as accurately as possible. Treatment needs to then concentrate on early reactivation. Sometimes a home TENS machine can be used to reduce pain, which in turn may allow those to get reactivated who could otherwise not have done this because of too much pain.

Difficult cases may have to be referred to a neurosurgeon for surgical problems and to a physiatrist for the more chronic problems. The patient must get used to a much more active role as we have learnt that often the minor problems of an injury are aggravated by inactivity while awaiting tests and specialist referrals. Most of the time the specialist finds that nothing seriously is wrong, but that the patient should have been rehabilitated much earlier.

 

References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 2.

2. D Irnich et al. BMJ 2001 Jun 30;322(7302):1574.

3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 140.

4. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

5. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

6. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

7. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008

Last modified: November 14, 2014

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.