Neck Pain

The neck pain complaints are commonly seen in the general practice of medicine. Of course there are several acute pain syndromes in the neck such as sprains, strains, and other physical injuries to the structures of the neck, which can themselves, become chronic. The success of pain management is to correctly visualize these structures and correctly identify the source of the pain. The process of visualizing is a two-fold one: first there are the technological tools such as x-ray and MRI which can produce a variety of images. Secondly and more important is the physician who can further visualize using his knowledge of anatomy, nerve function, and the specific physical examination of the patient who is sitting before him, and initiate a plan of action to control and alleviate that patient’s pain.

The cervical spine is perhaps the most prone to developing chronic pain syndromes. This is no doubt due to the fact that it moves more than any other part of the spine. Also it is by virtue of its function and location, most inclined for wear and tear and injury. It is not uncommon to see large beak-like projections of inflamed bone between the vertebrae. In addition to making movement painful, they can sometimes impinge upon nerves running in the area. Initial management might be starting a NSAID drug to reduce the inflammation. Also a short course of corticosteroids might further reduce the pain. Sometimes specific points of pain can be identified and injected with local anesthetics and small doses of corticosteroids. Let’s say the acute severe part of the neck pain is better, but now there is the pain that is felt largely through the day and night. It would probably be appropriate at this point to refer the patient to a physical therapist. A program could be devised to gradually increase the strength and range of motion of the neck. The physical therapist might then instruct the patient when to use either heat or cold to alleviate the pain.

Another common cause of chronic neck pain is degeneration of the disc cushions between the vertebrae. This can allow the bones to ride abnormally upon one another. Sometimes the disc itself is squeezed out or herniated and inflames nerve roots in the area. Initial management would probably be like that for arthritis. However the pain management physician must watch for specific nerve root irritations that might require a referral to a neurosurgeon.

Sometimes, all things being checked and stabilized as much as possible, the patient has chronic episodes of pain which can cause interruption of quality of life. It is at this point the pain physician may consider the use of ongoing prescription narcotic and non-narcotic pain medicine. This has to be carefully worked out with the pain management clinic and is considered management of a chronic medical problem. Certain agreements, tests, and follow-up procedures must be worked out in order for this to occur.

It is the pain management physician’s job to manage and coordinate all efforts to relieve the patient’s neck pain. He must continually monitor for changes in pain and also whether pain treatments are successfully reducing chronic pain.

The pain management of chronic neck pain is a model of how other pain managements may be maximized and handled. The process involves diligence to understand the specific origin and nature of the pain, acute treatments when possible, and ongoing management of chronic pain with the use of narcotic and non-narcotic pain medications as required.