Pain in the Neck

By Julie Silver

Practically all of us will experience neck pain at some point in our lives. For many people, it is a transient condition that can be directly related to a specific event, for example, a car accident, sleeping in an awkward position or doing chores such as raking or snow shoveling. For others, though, neck pain is part of daily life.

This is particularly true in people who have disabilities and use their arms to compensate for a lack of strength in their legs. When I see patients in my office for neck pain, they often don’t recognize how much they use their arms and how using their arms engages the muscles in their necks, causing a vicious cycle of pain.

The good news is that there are many excellent treatments that can help.

Most neck pain is due to painful spasm of the muscles that surround the neck and help to stabilize the shoulders and move the arms. In this type of problem, there may or may not have been a precipitating injury. Common names for muscular neck pain include cervical sprain or strain, whiplash or myofascial pain.

Since this type of pain is the most common and easiest to treat, this article focuses on muscular neck pain. However, it is important to recognize more serious types of neck problems. Symptoms of a more worrisome condition that might involve the spinal cord or nerve roots would include numbness or tingling in any of the extremities, new weakness or new problems with bowel and bladder function. It is important to accurately report new symptoms to a doctor who is skilled at treating neck pain.

It is not unusual for me to see a patient in my office who has “tried everything” and found that “nothing has worked.” Invariably, if she follows the list of suggestions outlined below, she will have less pain (or even none at all).

As you read the list of five interventions for muscular neck pain, keep in mind that even if you have tried some of them before, it may be that you need to try them all together in order to get some relief. Of course, this does not apply to everyone. However, it is crucial to recognize that breaking a pain cycle can be difficult and that it often takes a comprehensive approach in which several things are tried simultaneously rather than just one at a time.

Avoid exacerbating activities.
This seems obvious: if it hurts, don’t do it. At least try to avoid doing anything that hurts, as this will keep the pain cycle going. Some examples of things to avoid include: bifocals (this makes you put your neck in awkward positions to see properly); telephone handsets (headsets or ear sets are much easier on your neck); and computer stations without good arm support (this puts strain on your neck) – try forearm rests or “data arms” that are available through office mail order catalogues or office supply stores.

Try physical or occupational therapy.
Even if you have tried PT or OT in the past, it might help now – especially if you are using it at the same time as other pain interventions. A good therapist will address a variety of things: posture and body mechanics when seated, transferring and walking; appropriate use of assistive devices such as canes and crutches; how to transfer most easily and safely; and exercises that will improve range of motion and strength in the affected muscles. Some therapists will also do “hands-on” muscle release techniques, which can be very helpful. Modalities, such as ultrasound, can also reduce pain – especially when combined with other treatments.

Prescription creams and pills may help.
There are several classes of medications that doctors typically prescribe to reduce pain. The most common are muscle relaxants, anti-inflammatory drugs, antidepressants (these often work by changing the level of serotonin in the brain, which can help with both mood and pain) and anti-seizure medications (it is not entirely clear how these medications work to reduce pain). Occasionally, doctors will prescribe strong pain relievers that contain opiates; however, people can develop physical and psychological dependence on these drugs. Finding the right medication or the right combination of medications is usually done by trial and error. Anyone who is taking medications for pain should work closely with his doctor to determine what works best with the fewest side effects.

Injected medications are also effective.
For muscular neck pain, both trigger-point injections and botulinum toxin injections can be helpful. Trigger-point injections involve a doctor injecting anesthetic medication, sometimes combined with a corticosteroid, into the muscle itself. Usually a few injections are performed during a single office visit. Recent research has revealed that botulinum toxin, which can cause paralysis and even death if ingested, is a very safe way to relax the muscles when it is delivered by a skilled doctor in injection form. Usually this is done once and can last for several months. If the cycle of pain is broken, it doesn’t need to be repeated.

Complementary medicine can be useful.
Individuals with neck pain often try acupuncture and massage, with some success. These are both generally safe to try. I always recommend that people talk to their medical doctors about any additional treatments they want to try in order to be sure that they are not harmful – especially in combination with what the physician is prescribing.

While neck pain can’t always be cured, there are certainly a number of treatments that can help. Reducing stress on the muscles by avoiding aggravating activities, while at the same time improving posture and strength, is essential to reducing neck pain. Even in someone who can’t do a lot of strengthening, there are many treatments that can be effective.

If you are experiencing neck pain, first examine your daily activities and look for ways to decrease the stress on your arms and neck. If you continue to have pain, talk to your doctor about the treatment options listed in this article. There is good reason to be optimistic that your neck pain will improve with proper treatment, and as Helen Keller once noted, “Optimism is the faith that leads to achievement.”

(Julie K. Silver, MD, is an Assistant Professor at Harvard Medical School and is a staff physician at Spaulding Rehabilitation Hospital in Boston, Massachusetts, U.S.A. Her newest book, “Chronic Pain and the Family” (Harvard University Press), will be published in August.)