Neck Pain (Cervical Pain)

Pain located in the neck is a common medical condition. Neck pain can come from a number of disorders and diseases and can involve any of the tissues in the neck. Examples of common conditions causing neck pain are degenerative disc disease, neck strain, osteoarthritis, cervical spondylosis, spinal stenosis, poor posture, neck injury such as in whiplash, a herniated disc, or a pinched nerve (cervical radiculopathy). Neck pain can come from common infections, such as virus infection of the throat, leading to lymph node (gland) swelling and neck pain. Neck pain can also come from rare infections, such as tuberculosis of the neck, infection of the spine bones in the neck (osteomyelitis and septic discitis), and meningitis (often accompanied by neck stiffness). Neck pain can also come from conditions directly affecting the muscles of the neck, such as fibromyalgia and polymyalgia rheumatica as well as from uncomfortable positioning of the neck while sleeping with the head on a pillow. Neck pain is also referred to as cervical pain.

Risk factors for neck pain include injury from involvement in contact sports, motor-vehicle accidents, bull or bronco horse riding, etc. Prevention of neck pain in the context of these activities should include neck strengthening exercises and often neck bracing.

Neck pain is a symptom commonly associated with dull aching. Sometimes pain in the neck is worsened with movement of the neck or turning the head. Other symptoms associated with some forms of neck pain include numbness, tingling, tenderness, sharp shooting pain, range-of-motion difficulties, fullness, difficulty swallowing, pulsations, swishing sounds in the head, dizziness or lightheadedness, and lymph node (gland) swelling.

Neck pain can also be associated with symptoms such as headache, facial pain, shoulder pain, and arm numbness or tingling (upper extremity paresthesias). These associated symptoms are often a result of nerves becoming pinched in the neck. Depending on the condition, sometimes neck pain is accompanied by symptoms such as upper back and/or lower back pain, as is common in inflammation of the spine from ankylosing spondylitis.

There are seven vertebrae that are the bony building blocks of the spine in the neck (the cervical spine) that surround the spinal cord and canal. Between these vertebrae are discs, and nearby pass the nerves of the neck. Within the neck, structures include the skin, neck muscles, arteries, veins, lymph nodes, thyroid gland, parathyroid glands, esophagus, larynx, and trachea. Diseases or conditions that affect any of these tissues of the neck can lead to neck pain.

Doctors who treat neck pain can include general medicine physicians, including family medicine doctors and internists, as well as orthopedists, rheumatologists, neurosurgeons, neurologists, ENT specialists, emergency physicians, physiatrists, and chiropractors. Other ancillary health professionals who treat neck pain include physical therapists, massage therapists, and acupuncturists.

In diagnosing the cause of neck pain, it is important to review the history of the symptoms. In reviewing the medical history, the doctor will note the location, intensity, duration, and radiation of the pain. Is the pain worsened or improved with turning or repositioning of the head? Any past injury to the neck and past treatments are noted. Aggravating and/or relieving positions or motions are also recorded. The neck is examined at rest and in motion. Tenderness is detected during palpation of the neck. An examination of the nervous system is performed to determine whether or not nerve involvement is present.

Further testing of undiagnosed neck pain can include X-ray evaluation, CT scan, bone scan, MRI scan, myelogram, and electrical tests such as electromyography (EMG) and nerve conduction velocity test (NCV).

The treatment of neck pain depends on its precise cause. Treatment options include rest, heat or cold applications, traction, soft-collar traction, physical therapy (ultrasound, massage, manipulation), local injections of cortisone or anesthetics, topical anesthetic creams, topical pain-relief patches, muscle relaxants, over-the-counter anti-inflammatory drugs, and surgical procedures. Self-care measures for treatment, such as Jacuzzi treatment, neck pain relief exercises and stretches, and neck pain relief products such as neck pillows for sleep and hot pads can be very beneficial for relief of some forms of neck pain. There are many treatment options, depending on the particular neck problem and past treatment experiences. Alternative treatments that have been used for relief of chronic neck pain include acupuncture.

The outlook for neck pain depends on the precise cause. Most forms of neck pain can resolve with conservative measures including rest, avoiding reinjury, and gradual rehabilitation.

Neck pain can really only be prevented by avoiding injury to the neck. This would include minimizing the risks of injury during sports activities. Athletes who participate in collision sports can prevent neck injury with appropriate equipment, neck strengthening exercises, and occasional neck bracing.