Neck pain is a common musculoskeletal complaint. Over twenty-five million Americans are absent from work for eleven days on average due to neck pain (1). Neck pain has many causes and is often considered multifactorial.
As a result, it is especially important to diagnose the cause of the neck pain so that it can be treated effectively. In this article, we will review the causes of neck pain and how it is diagnosed and treated.
Types Of Neck Pain
There are many ways to categorize neck pain. One method is to do so based on the duration of the neck pain. Neck pain is classified as acute if symptoms have been present for less than six weeks, while subacute if less than three months, or chronic if present for more than three months.
Neck pain can also be classified based on the cause of the pain. For example, mechanical (neck pain that comes from the ligaments or muscles), discogenic pain (from damage to the discs), or neuropathic pain (due to injuries to the nerves).
However, the type of pain can also reveal the cause of the pain. Here are the types of neck pain a person may experience:
- Tension Pain: Tension pain often feels like a tightness in the neck, and is commonly seen due to poor posture or muscles of the neck that have been overworked.
- Sensitivity To Touch: Sensitivity to touch or allodynia is a type of pain. This symptom is often seen in neurological causes of neck pain, but sometimes also vitamin deficiencies.
- Stinging/Stabbing: Neck pain can be stinging or stabbing, especially when it is localized to a particular muscle or joint.
- Burning/Tingling/Numbness: Burning neck pain is quite common in cervical radiculopathy. This may be accompanied by tingling and numbness all the neck and arms.
Common Causes Of Neck Pain
Since the neck houses the spinal cord, the cervical vertebrae, the carotid arteries, the jugular veins, and the trachea, injury to any of these structures can cause neck pain.
However, posterior neck pain is commonly due to the following causes:
Muscle strains occur when the muscle fibers of the neck muscle get overstretched and even tear. It is seen in torticollis when the neck twists and the muscles are over-strained.
Poor posture, stress, and overworking the neck muscles without a break, like bending or hunching over for long hours, can also lead to neck pain.
Ligaments sprains can occur over time with poor posture, loss of normal neck curve, and accumulated micro trauma. Also, accidents or whiplash trauma can injure neck ligaments. Neck ligament damage can directly cause pain or lead to chronic instability which will lead to further damage on other neck structures.
Compression of the cervical spinal nerves can lead to burning pain accompanied by tingling and numbness. A pinched nerve or cervical radiculopathy can lead to inflammation of the nerve which can be very painful. This occurs when the pain radiates to the entire area normally supplied by the nerve.
Vehicular accidents and trauma can injure the cervical spine and its ligaments leading to severe neck pain. This is commonly seen in whiplash injuries where the ligaments are hyper flexed and hyperextended, and can lead to weeks of persistent cervical neck pain. Vehicular accidents that fracture the cervical spine also cause neck pain.
Any form of arthritis such as rheumatoid arthritis, osteoarthritis, inflammatory arthritis, or gout, can cause neck pain. As the joints wear down and are attacked by inflammatory cells, the pain escalates. This is a vicious cycle, as the pain draws more inflammatory cells and they further attack the joints, leading to further breakdown and more neck pain.
In cervical spinal stenosis, the spinal canal becomes narrower either due to the wear and tear of the joints or due to the flattening of the disc. The space for the spine and the nerves emerging from the canal becomes less, leading to the compression of the nerve roots as they come from the spine, and this can cause neck pain.
Osteoporosis is a softening of the bones due to calcium deficiency. Commonly seen in older individuals and those taking steroids for prolonged periods, softer bones are more susceptible to compression fractures.
When the vertebral bodies fracture, they cause severe neck pain. Occasionally, if the fracture is too severe, the fractured vertebrae can compress the nerves which can worsen any neck pain.
A ruptured, slipped, or herniated disc occurs when the gel-like center of a disc slips out of its thick-walled capsule or annulus. The annulus is a protective cover for the disc. If the herniated disc encroaches on a nerve, it can cause severe neck pain.
Moreover, due to the collapse of the disc, the two spinal vertebrae grind on each other. This friction in the absence of the disc wears down the bones and the joint intersections which worsens the neck pain.
Diagnosing The Causes Of Neck Pain
Doctors usually assess neck pain after a detailed history and physical exam. To confirm a diagnosis, imaging may be necessary. The following imaging modalities are commonly used:
- X-rays: For structural abnormalities, like scoliosis, spondylolisthesis, and fractures, plain X-ray films are usually enough for a diagnosis.
- MRIs: MRIs are excellent for the diagnosis of soft tissue abnormalities like disc herniation or disc injury. It is an extremely sensitive test that picks up small injuries and magnifies soft tissue in detail. They can also detect flare-ups of inflammation.
- CT scans: Computed Tomography (CT) scans can view organs and soft tissues that cannot be seen on Xrays. They help doctors view the structures in and around the cervical spine.
- Blood tests: Blood tests are useful to determine if there is an infection or any inflammation. In meningitis, encephalitis, and bacterial infections, the blood has a high white cell count with high markers of inflammation like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Blood tests are also used to identify cancer markers in the blood.
- Spinal tap: A spinal tap or a lumbar tap is often done for neck stiffness accompanied by pain. A lumbar tap is also a form of therapy as it reduces intracranial pressure (ICP) and can relieve headaches and neck pain due to raised ICP.
- Electromyography: This is done when the findings on imaging are uncertain, and doctors want to evaluate the nerves more thoroughly. This is often done in inflammatory conditions and when peripheral neuropathy is suspected. In an EMG, the electrical activity of the skeletal muscles is recorded while electrical currents or signals are sent to the muscles.
Serious Conditions Accompanied By Neck Pain
Neck pain is often part of a triad of symptoms seen in other diseases. Therefore, do not ignore neck pain as just another muscle strain without having it evaluated by your primary care physician. Here are some serious conditions that are usually accompanied by neck pain.
Fever, headache, and painful neck stiffness are the hallmarks of meningitis. The Brudzinski sign is used to diagnose meningitis. Here, passive forward flexion of the neck causes a person with meningitis to raise their legs in response to the pain while the meninges are stretched. The presence of painful neck stiffness can guide a doctor to initiate meningitis treatment without delay.
- Heart attack
Heart attacks are characterized by a crushing substernal pain. However, it is not uncommon to have nonspecific pain like neck pain or pain radiating towards the neck and shoulders. This usually happens due to the irritation of the accessory nerve which supplies the trapezius muscles. It is possible to have referred pain in the neck and jaw during a myocardial infarction.
Fibromyalgia is a term that describes widespread musculoskeletal pain. This pain is commonly reported in the neck and the shoulders. Fibromyalgia is a diagnosis of exclusion and so every cause of neck pain, including inflammatory conditions, must be investigated before a person is diagnosed.
However, it is important to remember that neck pain is a common presenting symptom of this condition.
Painful lumps in the neck can be a sign of carcinoma or a tumor. Neck pain, along with weight loss and swollen lymph node glands, are a sign of cancer and should be investigated thoroughly.
When To Seek Medical Attention For Neck Pain
Neck pain can be a symptom of something more serious than just a strain or stress and needs to be evaluated by a health professional. If you see any of the symptoms listed below, then seek medical attention immediately:
- Neck pain after a vehicular accident
- Loss of sensorium or consciousness (along with the neck pain)
- Neck stiffness and rigidity (this may be a sign of meningitis)
- Loss of bowel and bladder control indicating injury to the spinal cord
- Swollen glands in the neck (which could indicate an infection or cancer)
- Fever (commonly seen in infections like encephalitis and meningitis)
- Pain that is not relieved by pain medications
- Dizziness (commonly seen in whiplash injuries with neck pain)
- Nausea and vomiting
- Limited mobility or hypermobility of the neck
- Pain radiating to arms and legs or any change in sensation in arms and legs
- Trouble swallowing or breathing (This is another dangerous sign that the nerve supply from the spine is compromised or affected. It can also be due to injury to the esophagus or the trachea itself due to an accident or trauma and needs to be looked at more carefully.)
- Chest pain or pressure (which could be a heart attack with pain radiating up the neck)
New Approaches To Neck Pain
Neck pain is treated according to the cause of the pain. Conservative treatment commonly used as a first line treatment to help alleviate neck pain. This includes physical therapy, pain medications, muscle relaxants, and manual therapies.
If these fail most patients may see a pain management physician and may be offered steroid injections, nerve blocks, or nerve ablations. While sometimes these procedures can help with pain, these medicines have many risks, do not address the underlying problems, don;t lead to healing and in fact can be detrimental to healing, and the results are temporary as a result.
At Centeno Schultz, our board certified musculoskeletal doctors use the newest treatment procedures for neck pain. At the Centeno-Schultz Clinic, we are experts in the diagnosis and treatment of orthopedic musculoskeletal problems including neck pain.
We have 18 years of experience treating the various neck problems such as the disk, facets, ligaments spinal nerves, tendons, etc. commonly with patient’s own PRP or stem cells.
In 2005, we were the first clinic in the world to inject stem cells into disks and we have been extensively using regenerative methods such as PRP and bone marrow concentrate containing stem cells that can accelerate healing and repair in musculoskeletal tissues, thus resulting in less pain, improved function and without the risk of steroid injections or major surgeries.
We use a functional spine unit approach instead of pain generator approach. This means we look at the neck as a whole treating all structures that are injured rather than just treating the symptoms. There is also substian research to support these approaches in treating neck pain causes (2).
Here is a list of how we use new regenerative approaches to neck pain:
Prolotherapy is the injection of an irritant solution,that causes small damage to tissue thus initiating a healing response. The most common solution is a hypertonic dextrose solution.
This is basically sugar water solution that has a higher osmolality than your body’s tissues so it causes stress to the tissue by drawing water out of the cells initiating stress/injury then a healing response.
The healing response is small so it often requires multiple treatments but can work very well for mild ligament and tendon injuries in the neck. It can help over neck stability leading to reduced pain.
Orthobiologics are substances made by the body that can facilitate healing. These orthobiologics can repair damaged tissue and address the root cause of problems instead of just masking symptoms with drugs or steroids that can have many side effects.
Autologous (meaning coming from the same person they are used in) orthobiologics such as PRP and bone marrow concentrate have been shown to be very safe. There is mounting research showing efficacy for a multitude of orthopedic problems including the neck.
However, the success of these treatments are highly dependent on skill and training of the practitioner, which is not standard across doctors so care much be given to choosing a provider.
Platelet Rich Plasma (PRP): PRP is made from taking your own blood, centrifuging (spinning it) to separate the components and concentrating the platelets. The concentrated platelets can then be injected into areas of tissue injury to initiate a healing response.
Platelets have growth factors, cytokines, proteins, exosomes, etc. that mediate that healing response. PRP can be used to treat cervical facet joint arthritis, neck ligament injuries, cervical disk tears, and used to repair irritated cervical nerves.PRP stimulates healing, has short recovery times, and can prevent the need for neck surgery.
Bone Marrow Aspirate Concentrate (BMAC)
Bone marrow concentrate (BMC) is a concentration of cells from the patient’s own bone marrow that contains live and functioning stem cells.
BMAC is used to promote healing by injecting concentrated stem cells, other healing cells, and growth factors directly into an injured or damaged area. Similarly, to PRP, bone marrow promotes healing in damaged neck tissues but can be used for more severe injuries.
At the Centeno-Schultz Clinic, all of these orthobiologics are injected directly into the damaged tissues to ensure safety and efficacy. We always use fluoroscopic (Xray) and or ultrasound guidance to ensure you are getting the best care possible.
Never have someone inject your cervical spine without image guidance (blindly). That ensures the treatment will not get to the desired areas reducing efficacy and has a higher risk of injecting an unwanted structure that can lead to a complication.
Why An Expert Treatment Opinion Is Crucial To Your Recovery
Seeing a physician who is an expert in cervical spine problems, preferably a non-surgeon, is crucial to figuring out what your problems are and your treatment options.
The general specialties that are trained to evaluate and treat spine problems are:
- Physical medicine and Rehabilitation (PMR) with a Spine or pain fellowship,
- Anesthesiology with a pain or spine fellowship,
- Orthopedics surgeons with spine training (only for surgical recommendations), and
- Neurosurgeon with spine training (for surgical recommendations.
These problems are not commonly diagnosed or treated well with the Emergency medicine doctor you may see after acute injury. Their role is to rule out life-threatening problems only.
Your family doctor, general practitioner, or internal medicine doctor does not have expertise in this area. Just having a doctor read an MRI report is also not sufficient. Seeing a chiropractor, naturopathic doctor, physician assistant, or NP for complex regenerative medicine procedures is also inappropriate.
Also, be wary of providers offering unapproved, poorly studied allogeneic (coming from someone else) products making miraculous claims. Such scams are clinics offering
- Birth tissue or umbilical cord stem cells: These US products have no lying functions cells at all, are poorly researched, and the FDA does not allow them for orthopedic uses. These products can have increased risk of tissue allergic reaction and infection as well.
- Exosomes: These products are not allowed by the FDA and have no clinical research showing that that may help orthopedic problems.
Get To The Root Of Your Neck Pain
The first step in the management of neck pain is promptly getting to the root cause of it. Once the cause is diagnosed correctly, talk to your doctor about the non-surgical treatment options.
If you have already tried conservative treatment, it might be time to try some of the newer and more advanced non-surgical treatments. They are not offered everywhere because they require specific skills and resources that may not be available with your local doctor.
At Centeno-Schultz Clinic, we can evaluate your neck pain to see if you are a suitable candidate for these newer regenerative medicine treatments.
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