What is Chronic Neck Pain?

Chronic neck pain is neck pain that lasts more than 3 months. In some cases, neck pain may have been present for years. Chronic neck pain causes are often multifactorial. The most typical causes of chronic neck pain is age related degeneration of the spine (spondylosis or facet joint arthritis) and myofascial pain (muscular and ligamentous). Stress can increase the symptoms and perception of neck pain, and can also lead to muscle tightness and fatigue. Less common causes of chronic neck pain are spinal deformity, infection, fracture, or a tumor. Chronic neck pain can sometimes be associated with spinal stenosis, cervical radiculopathy, or cervical myelopathy which can cause radiating arm pain or difficulty with coordination and balance. Spinal stenosis itself does not cause chronic neck pain.

Symptoms of chronic neck pain

Chronic neck pain symptoms include:

  • Neck pain
  • Fatigue
  • Stiffness
  • Headaches
  • Muscle tightness and knots

If chronic neck pain is associated with spinal stenosis, or decreased space available for the nerves or spinal cord, symptoms of chronic neck pain can also include:

  • Radiating pain down one or both arms
  • Difficulty with coordination or hand dexterity
  • Lack of grip strength
  • Loss of balance and decreased ability to walk

How is chronic neck pain diagnosed?

Patients with chronic neck pain should be evaluated by their primary care doctor initially and if initial treatment has failed to give chronic neck pain relief then they should be evaluated by either a non-operative spine specialist (physiatrist or pain management doctor) or a spinal surgeon. Proper diagnosis begins with a good history and physical exam. X-rays are also recommended to rule out dangerous pathology such as a spinal deformity, fracture, or a tumor destroying the bone. This is usually sufficient to begin the initial chronic neck pain treatment. If symptoms fail to improve despite initial conservative measures then an MRI of the cervical spine (neck) is recommended to rule out more serious pathology. Other tests which may be sometimes performed include a CT scan (for better evaluation of the bony anatomy) or a CT myelogram (in patients that cannot get an MRI).

Chronic neck pain treatment

Conservative, non-invasive treatment strategies are recommended for chronic neck pain relief. These include:

  • Physical therapy
  • Regular low-impact aerobic exercise
  • Cervical traction
  • Heat or ice
  • Massage
  • Acupuncture
  • Yoga
  • Anti-inflammatories (NSAIDS)

When these non-invasive treatments fail to give adequate chronic neck pain relief, spinal injections such as epidural injections, facet injections, or RF ablations can also help with pain relief. Opioid or narcotic medications should be avoided as they rarely help and can be addictive and make the pain worse in the long run.

Surgery is rarely indicated for the treatment of chronic neck pain itself, but if there is severe arm pain from a pinched nerve or myelopathy symptoms from spinal cord compression surgery may indeed be beneficial to help with these symptoms and to prevent permanent spinal cord or nerve dysfunction.

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