Neck Pain Management

By Yolanda Smith, B.Pharm.Reviewed by Dr. Liji Thomas, MD

The management of neck pain usually involves a combination of physical therapy, lifestyle changes and medications. There are also some other non-pharmacological techniques that are commonly used to manage neck pain. Surgery is also an option in some cases, although this is typically reserved as a last line option when other treatments have failed, due to its possible side effects.

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Physical therapy

Exercises to keep the neck moving is important to increase and to maintain the strength and flexibility of the muscles and connective tissues that are responsible for providing support to the neck. These exercises can be painful initially, so it is important to start gradually and slowly introduce the exercises. It is also essential to make sure that the neck is not allowed to become stiff.

Other physical therapy techniques to improve neck pain include:

• Heat or cold therapy
• Massage
• Yoga, Pilates or the Alexander Technique

Lifestyle

As far as the pain allows, patients should be advised to continue with normal activities as they usually would. Maintain regular movement in the neck. It is important to avoid long periods of inactivity.

Patients should be advised to improve or maintain good posture. In particular, a bent-forward posture while working at a desk or computer is linked to neck pain. For this reason, focusing on sitting upright while working can be beneficial.

The sleeping position is another important factor in causing neck pain and should be addressed in affected patients. It is best to use a single firm and supportive pillow at night.

Medications

Medications can offer quick and effective relief of neck pain. Simple analgesic medications such as paracetamol (acetaminophen) or aspirin are commonly recommended and are readily available over-the-counter for easy access by patients.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac or naproxen may be more effective for moderate to severe neck pain. However, they are linked to a higher incidence of side effects, such as stomach ulcers, renal impairment, and worsening of asthma symptoms.

Opioid medications such as codeine or oxycodone can also help to relieve neck pain. These are often used in combination with simple analgesics such as paracetamol. These medications are associated with side effects such as constipation, so patients should be advised to increase their intake of fluids and fiber to prevent this from occurring.

Other medications such as diazepam or amitriptyline are also sometimes recommended for the treatment of neck pain. These drugs are traditionally used for other purposes, such as anxiety or depression. They can also be helpful for neck pain caused by compression of nerves.

In some cases, localized injections may be indicated to help relieve the pain. This may involve a cervical epidural steroid injection, facet joint injection (selective nerve root block), or a trigger point injection.

Other non-pharmacological techniques

There are also several other techniques that may be useful in the management of neck pain. These include:

• Neurostimulation
• Pain psychology
• Acupuncture
• Radiofrequency ablation
• Low-level laser therapy (LLLT)

Surgery

For some patients, surgery may be necessary to address the cause of neck pain. Some such causes include cervical radiculopathy, myelopathy or degenerative disc disease. There are various types of surgical procedures that may be recommended, depending on the specific situation and type of pain. These may include:

• Discectomy
• Cervical fusion
• Anterior interbody fusion
• Posterior fusion
• Instrumented cervical fusion
• Laminectomy
• Corpectomy and Strut graft

The appropriate procedure should be selected on a patient by patient basis to address the particular needs and risks of each case.

References

1. https://apmhealth.com/
2. http://patient.info/health/nonspecific-neck-pain
3. http://www.nhs.uk/conditions/Neck-pain/pages/introduction.aspx
4. https://medlineplus.gov/ency/article/003025.htm
5. http://umm.edu/programs/spine/health/guides/neck-pain-overview

Further Reading

• All Neck Pain Content
• Causes of Neck Pain
• Living with Neck Paint