Gulf Coast Pain Management
NECK PAIN
 

What causes neck pain?

Neck pain may result from abnormalities in the soft tissues - the muscles, ligaments, and
nerves - as well as in bones and joints of the spine. The most common causes of neck pain
are soft tissue abnormalities due to injury or prolonged wear and tear. In rare cases, infection
or tumors may cause neck pain. In some people, neck problems may be the source of pain
in the upper back, shoulders, or arms.

Degenerative and inflammatory diseases - Degenerative diseases that cause neck pain include
osteoarthritis and rheumatoid arthritis. Osteoarthritis usually occurs in older people as a result 
of wear of the joints between the bones in the neck. Rheumatoid arthritis can cause
destruction  of the joints of the neck. Both of these major types of arthritis can cause
stiffness and pain.

Cervical disk degeneration also can cause neck pain. The disk acts as a shock absorber
between the bones in the neck. In cervical disk degeneration (typically age 40 onwards),
the normal gelatin-like center of the disk degenerates and the space between the vertebrae
narrows. As the disk space narrows, added stress is applied to the joints of the spine causing
further wear and degenerative disease. The cervical disk may also protrude and cause
pressure on the spinal cord or nerve roots when the rim of the disk weakens. This is known
as a herniated cervical disk.

Injury - Because the neck is so flexible and because it supports the head, it is extremely
vulnerable to injury. Motor vehicle or diving accidents, contact sports, and falls may result
in neck injury. The regular use of seat belts can help to prevent or minimize injury. A "rear
end" automobile collision may result in hyperextension, a backward motion of the neck
beyond normal limits, or hyperflexion, a forward motion of the neck beyond normal limits.
Most common injuries are to the soft tissues, i.e., muscles and ligaments. Severe injury with
fracture or dislocation of the neck may damage the spinal cord and cause paralysis
(quadriplegia).

Much less common causes of neck pain include tumors, infections, or congenital
abnormalities of the vertebrae.
 
When should you seek medical care?

If severe neck pain occurs following an injury (motor vehicle accident, diving accident, fall),
a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of
further injury and possible paralysis. Medical care should be sought immediately. Immediate
medical care should also be sought when an injury causes pain in the neck that radiates down
the arms and legs. Radiating pain or numbness in your arms or legs causing weakness in the
arms or legs without significant neck pain should also be evaluated.

If there has not been an injury, you should seek medical care when neck pain is:

• continuous and persistent
• severe
• accompanied by pain that radiates down the arms or legs
• accompanied by headaches, numbness, tingling, or weakness

• MRI (magnetic resonance imaging). This non X-ray study allows an evaluation of the spinal cord and nerve roots.
• CT (computed tomography). This specialized X-ray study allows careful evaluation of the bone and spinal canal.
• Myelogram (injection of a dye or contrast material into the spinal canal). This specific X-ray study also allows careful evaluation of the spinal canal and nerve roots.
• EMG (electromyogram). This test evaluates nerve and muscle function. Your orthopaedist may supplement your evaluation with blood tests, and, if necessary, will consult with other medical specialists.

How neck pain is treated depends on what the diagnosis reveals. However, most patients
are treated successfully with rest, medication, immobilization, physical therapy, exercise,
activity modifications, nerve blocks, or a combination of these methods.

For example, if pain is caused by inflammation as a result of stretching muscles and ligaments
beyond their limits, Lynne Carr Columbus, D.O. may prescribe rest and a neck collar for a
specified period of time, as well as medication to reduce inflammation. If medication is
prescribed to reduce pain, it should be used only as directed and should not be taken for
extended periods of time.

When neck pain persists or is chronic, Lynne Carr Columbus, D.O. may recommend a
rehabilitation program that includes an exercise program and various types of physical therapy
to help you relieve your pain and prevent it from coming back. Cervoid Epidural steroid
injections may be very helpful in relieving pain due to a herniated disc, spinal stenosis, or
degenerative disc disease. Epidural steroid injections are helpful in conjunction with physical
therapy. These injections decrease inflammation and pain, so you can gain more benefit from
the physical therapy.

Very few patients require surgery to relieve neck pain. For the vast majority of patients, a
combination of rest, medication, physical therapy, and nerve blocks will relieve neck pain.
Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is
caused by a herniated disk or bony narrowing of the spinal canal. Surgery may also be
required  following an injury, to stabilize the neck and minimize the possibility of paralysis
such as when a fracture results in instability of the neck.
 

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