Consultant in Pain Medicine

Neck Pain

NECK PAIN

woman suffering with neck pain

Why does my neck hurt?

Are you suffering from pain in your neck that’s interfering with your sleep or daily activities?

Maybe you’re experiencing pain in your arm, or tingling in your hand?

Neck pain is very common, and usually it’s self-limiting, but sometimes it can be very intrusive or persistent.  This is where I come in as a neck pain specialist.

In understanding neck pain, it’s helpful to understand the anatomy of neck.

Our neck is essentially the uppermost part of the spine, known as the cervical spine. It’s made up of seven vertebral bones, and in between each of the vertebrae is a shock-absorbing intravertebral disc.

 

The spinal cord runs through a central channel with the vertebrae, and at each level in the cervical spine, a pair of nerves exits the spinal cord (like a motorway slip road) and leaves the neck via holes called foramen.

One nerve passes to the left-hand side of the body and one nerve to the right, and there are eight pairs in total. These cervical nerves innervate different areas of the top of the shoulders, the arms, and the hands.  

At the back of the neck are small joints called facet joints – a pair at each level in the spine. The enable rotation and movement in the neck.

 

 

Common neck symptoms

woman with stiff neck
  • Pain or stiffness in your neck

  • A headache that’s generated by your neck (aka cervicogenic headache)

  • Pain referring into the shoulders, arms or hands

  • Pins and needles (tingling) in the arms or hands

  • Restriction in the range of movement of your neck (e.g. making it difficult to look over your shoulder when you’re driving)
  • Clunking or grinding in your neck

  • Dizziness or vertigo

  • If there is severe compression of the spinal cord within the neck, this may very occasionally lead to more serious symptoms (known as myelopathy), such as difficulty walking, pins and needles in the legs, difficulty walking, and even bladder or bowel control problems- thankfully, this is rare.

What causes neck pain?

Most neck pain resolves quickly, and may be caused by working at a desk with a prolonged uncomfortable posture, activity you’re not used to (e.g. carrying a very heavy bag on one shoulder) or sleeping awkwardly.

Some neck pain can be caused by a sudden injury or sprain to the neck (e.g. whiplash), but very occasionally, neck pain can be caused by a fracture, a bone tumour, or an inflammatory condition (such as rheumatoid arthritis, or ankylosing spondylitis).

As we age, it’s common to experience neck pain as a result of mild wear and tear in the structures of the neck (sometimes known as cervical spondylosis, or cervical osteoarthritis). Over time the intravertebral discs lose some of their flexibility, and may become stiffer and lose height. The facet joints at the back of the neck may also become worn, which can lead to pain and inflammation. 

Thankfully, most people won’t experience an escalation of their symptoms, and much can be done to help.

Cervical Radiculopathy

Cervical radiculopathy is a diagnostic term, and it means symptoms relating to the irritation or one of more cervical nerves (sometimes known as a nerve root), as it exits the spine.

This can happen for a number of reasons including:

Irritation of the nerve by degeneration of the cervical spine:

Wear and tear of the cervical discs and facet joints can create narrowing of the foraminae (holes) where the cervical nerves exit the spine.

Irritation of the nerve by a ‘slipped’ or herniated disc

A herniated disc, also known as a slipped or ruptured disc, occurs when the soft, gel-like centre of the intervertebral disc bulges out through a tear in the outer ring of the disc known as the annulus.

This can put pressure on the nerve, causing pain, numbness, tingling or even muscular weakness.

Cervical Facet Syndrome (Facet Joint Pain)

If you’re experiencing pain in your neck, that feels worse when you’re tilting your head backwards, it may be arising from the facet joints.

This kind of pain can also refer into the shoulders, and upper back, and you might also experience stiffness and difficulty rotating your neck, as well as grinding sensation.

 

Muscle spasm around the joint is also common, and it’s important to understand that although unpleasant, these symptoms are sinister or a sign that something terrible is happening to your neck.

Much can be done to help these symptoms.

How I assess and diagnose neck pain

When you come to clinic, I will ask you questions about your neck pain, and the symptoms you’ve been experiencing. I want to understand how it is impacting your life, and any treatments you may have tried.

I will take you through a detailed examination, watching how you move, and carefully palpating along the joints, the discs, the nerve roots, and the soft tissues. 

Through listening to your symptoms and examining you, I’m usually able to ascertain which are the problematic areas. Sometimes, I may advise we carry out some imaging (such as an MRI scan) to get more of an understanding of your problem.

Most people will recover quickly from an episode of neck pain, but if your symptoms are persisting for several, despite simple painkillers, here’s where I come in.

 

Physiotherapy

 

I work with carefully selected physiotherapists, who are highly experienced in managing neck pain.

Physiotherapists can help with manual techniques to improve areas of stiffness or muscle tightness, and sometimes gentle joint manipulations can be helpful. They can also give tailored exercises to help restore natural movement and activate supportive muscles (such as the deep neck flexors).

TENS (Transcutaneous electrical nerve stimulation)

Transcutaneous Electrical Nerve Stimulation (TENS) is a treatment that uses low-voltage electrical current to stimulate the nerves in order to relieve pain. The electrical current is delivered to the skin via electrodes placed on the skin near the area of pain. TENS is believed to work by blocking the pain signals that are sent to the brain, releasing endorphins (natural pain-relieving chemicals in the body), and increasing blood flow to the area.

Acupuncture        

I’m a firm believer in the power of acupuncture to reduce pain and muscle spasm.

Neck Pain Treatment

physiotherapy for neck pain

Transforminal injection /dorsal root ganglion blocks

There is sometimes a place for injection treatment for neck pain. This is a procedure aimed at reducing pain related to the cervical discs, particularly if there is referred pain down the arm (cervical radicular pain). This injection procedure bathes the irritated nerves with a low dose of corticosteroid and is carefully carried out under X-ray control in a sterile, hospital environment, usually with a light sedation.

Facet joint injections and medial branch blocks

If there is wear and irritation of the facet joints, I will occasionally  suggest facet joint injection can help to reduce inflammation and pain.

Cannabis-based medications

Traditional pain killers may give some relief for the neck pain sufferer, but they don’t cure.

Some medications designed to help with pain related to nerve irritation (such as ‘Pregabalin’) may cause some unpleasant side effects, and many opiate-based medications can cause excessive sedation and dependency. In my practice, I have found that medical cannabinoids can be very helpful for a person who has tried many other pain treatment but isn’t getting sufficient relief. If this is you, I can help.

If you’re struggling with neck pain,  get in touch. I’m here to help.