Neck Pain |Dr. Jayesh Pawar

Neck Pain

Neck pain can be very debilitating, especially for someone leading an active life style. Neck pain can get referred to surrounding areas and can cause headache, ear pain, pain radiating to shoulder etc. If there is nerve pressure in cervical spine, pain might also radiate down the arm.

Causes

Spinal causes: Any disorder affecting tissues of spinal column can cause neck pain.

Slip disc (cervical disc herniation)
Cervical spinal stenosis
Cervical spondylosis (disc degeneration, facet arthritis)
Spinal cord anomalies (myelomalacia, syrinx)
Spine deformity (scoliosis, kyphosis)
Vertebral pathologies: Fracture, infection, tuberculosis, tumors.
Osteoporosis

Muscle spasm: Muscle spasm is one of the common cause of neck pain.

Sleeping with a bad neck position and not well supporting pillow.
Muscle spasm can be due to a primary spine pathology. This can becomes a chronic source of pain even after primary problem is subsided.
Patients with poor sitting posture, especially those who work with computers for long time are prone to muscle spasm.
Heavy weight lifting or sports activities can cause muscle or ligament strain.
Nearby pathologies: Various organs are located in and around the neck, e.g. lymph nodes, thyroid, trachea, tonsils etc. Any pathology involving these organs can lead to neck pain. Occasionally heart and brain problems (e.g. meningitis) can also cause neck pain.

Diagnosis

If patient does not recover in a reasonable period of time, further investigations are required. Usually following tests are done.

X-ray: It’s a baseline study to detect any bone abnormality.
MRI Scan: MRI will assess internal structures of spine (disc, nerve, joints, ligaments etc.)
CT Scan: A CT is required if detailed bone assessment is required.
EMG NCV: These tests will assess functioning of the nerves.
Blood tests: Various blood tests to detect infection, tumors, osteoporosis etc. are required based on suspected pathology.

Conservative Treatment

In majority of the patients, neck pain is a self-limiting symptom. Following treatment can be taken for recent onset mild back pain.

Local application of heat/ cold
Local application of analgesic gel
Gentle neck massage can be used
Cervical collar while sitting, standing, traveling
Cervical pillow while sleeping
Paracetamol or locally available pain killer
Avoid heavy activities

In 1-2 weeks, patients usually get significant relief. If not, it is recommended to consult a spine specialist. Spine specialist will examine the patient and will decide if further course of medicine and physiotherapy should be tried or patient need further investigations. Usually following medical treatment is given:

Powerful pain medicines to reduce pain
Muscle relaxant to reduce muscle spasm
Nerve medicines (Pregabalin, Gabapantene etc.) if there is associated nerve related symptoms
Physiotherapy is usually added to reduce muscle spasm and strengthen neck muscles

Surgical Treatment

If a significant pathology is detected in investigations, further treatment with spinal injection or surgery

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(decompression with/ without fusion) might be required based on the severity of the symptoms and patient’s recovery with non-surgical treatment.

Dr. Jayesh will decide which options are best for you depending on your specific circumstances.