Neck Pain Guide Understanding Causes, Treatment and Prevention Neck pain may be more than a nuisance; it could be a symptom of an underlying condition. Use this guide to help you understand common causes of neck pain and to discuss treatment options with your doctor. Advanced Pain Management is a caring organization that is committed to providing patients with innovative pain management services. APMhealth.com 888.901.PAIN
About APM Currently, Advanced Pain Management (APM) is one of the largest pain management groups in the United States. We offer the broadest array of pain management treatments, administered by the nation s top physicians. Our expert team of physicians focuses on identifying the source of your neck pain and finding the right treatment option for each individual patient. At APM, we practice pain management exclusively. Our multidisciplinary team has experience in the diagnosis and treatment of pain to help you restore your quality of life. Our priority is exceptional patient care and we mean it when we say, we know your pain. 83 million Americans indicate that pain affects basic functioning in their everyday lives. 1 Right now, 1 in 10 adults is hurting with neck pain. 2 Neck pain is reported more frequently in females than males. 3 1 The American Academy of Pain Medicine; http://painmed.org/patientcenter/facts_on_pain.aspx. 2 Neck Pain: A troubleshooting guide to help you find relief. Harvard Medical School Special Health Report. 3 Source: Summary Healthy Statistics for U.S. Adults: National Health Interview Survey, 2010. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. 1
Understanding the structure of the Neck Cervical Vertebrae are the seven bones of the upper spine. Facets are the joints between the vertebrae. Nerves branch from the spinal cord to the arms. Discs are cushions between the vertebrae. They absorb the shock of movement. Foramina are openings between the vertebrae where the nerves exit the spine. The neck or cervical section of the spine consists of seven neck bones, called vertebrae, labeled as C1 to C7. The top cervical vertebra (C1) is connected to the base of the skull. These bones are cushioned by structures called the discs. Discs have a structure similar to a jelly donut: they have a jelly filled center and a fibrous capsule around the outside. Joints in the back of the neck help provide stability and motion to each segment of the neck. Overall, the neck bones themselves act as a cage to protect the spinal cord and spinal nerves. Muscles and other soft tissues, such as ligaments, help to further stabilize the spine. Each of these structures including vertebrae, discs, spinal nerves, joints and soft tissues may play a role in neck pain. C3-4 C5-6 C2-3 C4-5 C6-7 Pain in the head, shoulders and arms can often be caused by problems with the structures of the neck. For example, nerve roots in the neck can be pinched or inflamed which can result in shooting pain, weakness or tingling down the arm or even headaches. The joints of the neck are common sources of neck pain as well, accompanied by stiffness and loss of range of motion. Pain patterns associated with cervical sections of the spine. 2
Neck Pain Facts 4 out of 5 neck pain diagnoses are for persons between the ages of 18-64. 3 In 2006, 13.2 million patient visits, or more than 1 percent of all health care visits to hospitals and physician OFFICES, were for neck pain. 3 15.1 percent of the American population reported that neck pain was their most common pain complaint. 4 Neck Pain Risk Factors As you age, you are more likely to have increased wear and tear on vertebrae, discs, muscles and joints. This can lead to degeneration of these structures, putting you at risk for common causes of neck pain. Traumatic Injuries, such as motor vehicle accidents or falls, also put increased stress on the structures of the neck and may be a cause of ongoing neck pain. If your job requires you to hold your head in the same position for prolonged periods (professional driver, computer work) you may increase your risk for neck pain. While neck pain risk factors may increase the likelihood of developing neck pain, simple treatments may help to reduce or eliminate the severity and duration of symptoms. Healthy lifestyle choices may help further reduce the risk of developing neck pain in the first place. 3 Source: Agency for Healthcare Research and Quality, Healthy Cost and Utilization Project, Nationwide Inpatient Sample, 2007. 4 National Centers for Health Statistics, Chartbook on Trends in the Health of Americans 2006, Special Feature: Pain. 3
Neck Pain symptoms It is important that you can appropriately describe your pain to your doctor so you can work together to identify the best course of treatment. The historical information you provide along with other testing is important and will help your doctor to develop a treatment plan with you. Where is my pain located? How severe is the pain? What movements or activities make my pain better or worse? Is my pain constant? What does my pain feel like? Diagnosing Neck Pain A precise and accurate diagnosis is necessary to develop the best treatment plan for each patient. The process of making this diagnosis begins with a detailed medical history and physical examination. You will be asked about your medical, family and social history, as well as what treatments you have already sought to deal with your neck pain. In many instances, imaging (such as x-rays or MRI) or nerve testing (called electromyography, or EMG ) can be helpful in diagnosing the specific cause of neck pain. X-ray images show bones and are useful to assess alignment and as a tool to diagnose fracture; MRI, on the other hand, can be used to evaluate soft tissues such as muscles strains, disc damage or even joint inflammation. EMG testing is used to determine the function of nerves and muscles. Sometimes, nerve blocks are used to help determine the function of certain structures and to see if they are contributing to your pain problem. Your pain management specialist will take all of the information gathered at your appointment and determine if further testing is needed to create a diagnosis. Once a diagnosis has been made, your doctor will work with you to develop an individualized treatment plan to fit your goals and specific needs. It is important to understand that you and your doctor will work as a team. While your doctor will work to help reduce or eliminate your pain, there may be things you can do at home to help reduce or even prevent future neck pain. These include staying active with a low impact aerobic exercise program, managing your weight and quitting smoking. 4
Types of Neck Pain Neck pain can arise from many different sources; it is not uncommon for pain arising from these different sources to have overlapping symptoms. There are times where the clinical information including the history, physical exam or imaging may not pinpoint the source of pain alone and further testing may be required. As the spinal column is essentially a bony cage surrounding the spinal cord and spinal nerves, causes of neck pain can often be broken down into two general categories: disorders which arise from impingement or irritation of the spinal cord or spinal nerves and disorders of the structures which provide the protective cage around the spinal cord, including the discs, vertebrae, soft tissues and joints. Disorders which affect the spinal cord and nerves: Disc Herniation In general, herniated discs are caused when the outer ring of a disc ruptures and the soft center of the disc begins to push through and release chemicals that are irritating to the surrounding nerve tissue. A herniated disc can result in localized pain at the location of the disc problem itself, but commonly the pain will radiate, or travel, to the area supplied by that nerve. This radiating pain is due to a bulge in the disc which causes compression of the nerve. Numbness, tingling or weakness may accompany the pain. If you have a herniated disc in your cervical spine, you may have pain in your neck that shoots down one arm, or feelings of weakness or tingling in your shoulder, arm or hand. The medical term for this is radiculopathy. Spinal Stenosis Spinal stenosis occurs when the spinal canal begins to narrow, which may be due to a large disc herniation or narrowing of the canal over time due to disc degeneration and/or arthritis. The narrowing of the spinal canal results in increased pressure and compression of the spinal cord, as well as the nerves and nerve roots. The compression of spinal nerves can cause neck pain, headaches and weakness, numbness and tingling in the arms. If the spinal cord itself is compressed, other problems such as loss of coordination may appear. People over the age of 50 are more at risk of developing spinal stenosis. Spinal stenosis is diagnosed using a combination of physical exam, history and imaging tests, like MRI. Arthritis Arthritis can occur in the joints of the neck, much like any other joint in the body. Arthritis refers to inflammation within a joint. When joints are inflamed over a long period of time, bone grows around the joint, sometimes known as bone spurs. When this bony growth occurs in the joints of the neck, it can sometimes narrow the holes in the spine where the spinal nerves exit the spine before they travel down the arm. This can also cause irritation of the nerves (or radiculopathy), resulting in neck pain, numbness, tingling or weakness. Disorders of the structures of the spine: Neck Sprain or Strain A neck sprain involves the stretching or tearing of ligaments, while a neck strain is the stretching or tearing of muscles or tendons. The neck is susceptible to injury because the neck has a tremendous range of motion. A neck sprain may cause pain, swelling, bruising and limited mobility. A neck strain will include the same symptoms of a sprain, but may also include muscle spasms. Whiplash Whiplash occurs when your head suddenly moves forward and then backward. This quick motion causes the supportive structures in the neck to stretch beyond their normal range of motion and can lead to a host of symptoms, including: neck pain and stiffness, headaches, blurred vision, dizziness, inability to sleep, difficulty concentrating, memory issues and fatigue. This motion can affect the structures of the neck, including joints, discs and soft tissues as well as create concussion-like symptoms. 5
Neck pain can arise from many different sources; it is not uncommon for pain arising from these different sources to have overlapping symptoms. Compression Fracture Compression fractures in the spine occur when there is a collapse of one or more spinal vertebrae. Symptoms are wide ranging and involve not only pain but also weakness and tingling sensations. This is because the fractured bone(s) can sometimes impinge upon the spinal canal, creating pressure on the spinal cord and nerves by protruding into the spinal canal. These fractures may occur as a consequence of aging, but can also be associated with trauma. Symptoms can include sudden, severe neck pain evolving to chronic neck ache sensations in the injured area. Pain may subside as the fracture heals, but individuals may continue to feel pain even after the fracture has healed. Disc Degeneration Disc degeneration is a natural part of aging and over time all people will exhibit changes in their spinal discs; it is not necessarily a painful process. Pain associated with disc degeneration is caused when the soft cushion-like discs between spinal vertebrae begin to breakdown or decay and the irritating chemicals from the inner portion of the disc are released to the outer portion of the disc. The painful type of disc degeneration typically occurs following trauma, like a motor vehicle accident. Disc degeneration affects millions of Americans from all age groups. While degeneration is most prevalent in older patients, it can be a source of neck pain in approximately 30 percent of people between the ages of 30 and 50. Disc degeneration is more common in people who smoke cigarettes, who are obese, or those who regularly perform heavy physical work. Arthritis Joints of the neck are a common source of neck pain. The pain may remain limited to a small, focal area or may refer or spread to a larger area. For example, it is common for patients with dysfunction of the joints high in the neck to have pain which refers to the back of the head and even around to the ear. Neck pain due to arthritis may be worse with certain movements, such as turning the head or looking upwards. Sometimes mistaken for migraine headaches, about 15-20 percent of all headaches arise from problems in the neck. Imaging and physical exam can provide some clues as to whether neck pain is due to a problem in the joints, but nerve blocks are typically used to make a definitive diagnosis. 6
Neck Pain Treatments For some neck pain sufferers, ice, heat and altered activities, in combination with physical therapy or chiropractic care, can provide relief from neck pain. Medications may be utilized to help treat muscle spasm, pain and inflammation. For persistent pain that lasts longer than six weeks and doesn t improve with conservative care, other interventions may be used. The most commonly used interventional treatments for neck pain are minimally invasive and require little or no recovery time. Recent studies have shown that minimally invasive procedures can help patients regain mobility and function, allowing patients to get back to work quickly and return to active lifestyles. At Advanced Pain Management, we offer the latest treatments and minimally invasive procedures available to help patients with neck pain including: Referral to physical therapy or chiropractic care Medical management of your pain Epidural injections Radiofrequency ablations Minimally invasive disc procedures Neurostimulation therapy Intrathecal drug delivery Diagnostic nerve blocks Surgical consultation Interactive Procedure Animation Step-by-step procedure animation Educational tools Free guides & programs Patient testimonials 7 www.apmhealth.com
Why choose a Pain Management Physician? Expertise and experience. The ability to prescribe pain relieving medications, physical therapy, and chiropractic care. The expertise to provide an accurate diagnosis to help you reduce your neck pain and regain your quality of life. Multidisciplinary approach and the connections to refer to excellent spinal surgeons if less invasive treatments prove to be ineffective. If you have persistent neck pain, there are many treatment options available to you. Only a pain management physician can provide the majority of the available treatment options for you over the course of a few appointments. At APM, our approach to patient care offers you a number of different treatment options that work together to provide you with the maximum benefit. - Douglas Keehn, DO To provide relief for neck pain, your APM physician will: Provide education to help you understand what is causing your painful symptoms. Consider medications with guidance on proper medication use. Consider the use of minimally invasive procedures to aid in diagnosing and treating your pain. Suggest lifestyle modification that may help reduce your pain sensations and improve your overall health. Make recommendations for at-home therapy that can help you minimize pain. Consider referrals to physical therapy, chiropractic care or a spine specialist for surgical options. 8
How You Can Keep Your Body Healthy While it is not possible to prevent all neck injuries or painful conditions, there are some simple steps you can take that can lower your risk for neck pain and even prevent the onset of neck pain. Here are a few helpful tips from our team of experienced, neck pain experts: 1 Eat a healthy, well balanced diet to keep your muscles and bones strong. 2 Maintain a healthy weight. Excess weight puts added stress on your joints and muscles and can cause increased pain. 3 Focus on good posture and body mechanics. This is a simple tip that will greatly reduce everyday aches and pains. Do not sit or stand in one position for a long period of time. Keep your back straight and head lifted and never slouch, especially in front of a computer. Take breaks at work to prevent neck stiffness and pain. 4 Exercise regularly. Staying in shape will help your joints and muscles stay loose and prevent aches and strains. 5 Quit smoking. Studies show that smokers are more at risk for developing pain. Nicotine interferes with blood flow to the muscles and intervertebral discs in the spine, inflames nerves contributing to pain, and can slow healing and reduce recovery. Additional research has shown that people who smoke also tend to perceive pain to be more severe than people who have never smoked or who have quit smoking. 9
Living With Pain In some circumstances, patients may have to manage pain for the long term. The good news is that there are many management techniques that can be helpful to minimize pain flare ups and keep pain at a tolerable level. 1 Medication compliance is important. If your APM provider has prescribed you pain medication for long-term use, it is important that you take your medication as prescribed. Pain medications can be used successfully to facilitate an active lifestyle and allow for increased mobility and functioning. 2 Lifestyle modification can make a big difference. Simple things you do at home can help prevent chronic pain from worsening. These include: maintaining a proper weight, eating a healthy diet and quitting smoking. 3 Exercise, stretching and strengthening. Many people find that exercise can actually help reduce feelings of pain. Gentle stretching can help keep joints and muscles loose and help reduce aches and pains. 4 Stress reduction. Stress can often increase feelings of pain. Reducing or eliminating sources of persistent stress can help you reduce your overall pain levels. 5 Stay active and involved. One of the best strategies for living with chronic pain is to maintain relationships and stay busy. Working, hobbies and social outings will allow you to keep a positive outlook on life, maintain self-esteem and may help distract you from pain. 10
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