Ohhhh! My Aching Neck... What Can I Do?

Neck pain is one of the most common pain complaints. More than a third of adults report having had a painful neck episode at least once a year. Many patients with neck pain also appear to have postural problems which may contribute to the neck pain. And they also have an increased frequency of headaches associated with their neck pain.

The incidence of neck pain is increased with age as well as with certain occupations and is also correlated with a history of prior trauma (eg, whiplash).

In the absence of inflammatory causes of neck pain such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, most neck pain is degenerative in nature. Degenerative disc disease and posterior facet arthritis make significant contributions to pathology. The result is nerve root irritation and muscle spasm.

Treatment of cervicogenic (neck) pain varies. Among different treatments that are used include non-steroidal anti-inflammatory drugs (NSAIDS), physical therapy, chiropractic, osteopathic manipulation, neck traction, neck collars, electrical stimulation, epidural steroid injections (ESI), and surgery.

This article will focus on how patients with chronic neck pain are managed at the Arthritis and Osteoporosis Center of Maryland.

After the initial history and physical examination, an imaging procedure is obtained. Usually, by the time a patient comes to us they have already had plain films (x-rays), so a magnetic resonance imaging (MRI) study is also ordered. For patients who have a contraindication to MRI, a CAT scan is done instead. Some people may wonder if this might be a bit of overkill.

I think it''s important to understand that while a good history and physical exam are critical and x-rays are also useful, for the evaluation of a patient with severe chronic neck pain, it is important to be as thorough as possible. On at least three occasions in the last two years, the MRI brought attention to an abnormality that was significant, yet was not found with exam or x-rays. Any neck instability or cord compression issues are addressed by a neurosurgeon immediately.

If the patient has neck pain on the basis of degenerative disk disease and arthritis, we institute a program of NSAID, ultra high frequency (>20,000 bps) electrical stimulation using the Sanexas device, and sometimes peripheral nerve blocks. The Sanexas device is particularly useful since it allows the placement of four cups that cover a large surface area. The end result is pronounced relief of muscle spasm.

In refractory cases we have used Botox injections if muscle spasm remains unrelieved

Patients with nerve root signs and symptoms (pain radiating down the arm) often benefit from epidural steroid injection.

We will then start the patient on a Pronex pneumatic cervical traction unit. This device, manufactured by Glacier Cross Inc, allows the patient to deliver gentle traction at home. Pronex cradles the head and neck on two soft foam cushions. One cushion supports the neck and the other supports the shoulders. An air-inflated bellows provides up to 30 pounds of continuously adjustable traction. As the bellows expands, it lifts the head up and supports the neck maintaining an even distraction of the neck vertebrae. Patients have total control over the amount of traction applied. Unlike the old over-the-door traction, there is no pressure on the jaws. We have the patient use moist heat on the neck for 5 minutes, traction for 10 minutes, then ice for 5 minutes. This is done twice a day to start and then increased to three times a day. Patients are started on a neck stretching and strengthening program with physical therapy. In addition shoulder girdle strengthening is also undertaken.

Roughly 90 per cent of patients with uncomplicated chronic discogenic/arthritis related neck pain have found relief in our clinic using this protocol.

Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment