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A Pain in the Neck
By Borimir Darakchiev, MD

Neck pain is a common complaint, and most people will experience some type of neck pain at some point in their lives.   The pain can be acute (lasting several hours to several weeks) or chronic (lasting more than several weeks).  Fortunately, most causes of neck pain are not serious, and usually resolve themselves after a few days of self-care.
Typical symptoms of neck pain include stiffness, tightness, aching, burning, stabbing or shooting pains, pressure, or tingling. These complaints can spread to the shoulders and arms. As a result, your ability to move your neck may be severely restricted—perhaps you cannot turn your head past a certain point. When the nerves are involved you may experience radiating pain, numbness and tingling down your arms and hands.

Neck pain can result from injury, stress, natural wear and tear, disc disorders, muscle strains (typically from overuse) and other causes.  Some specific conditions that cause neck pain include:

• Trauma.  Trauma can cause fracture of the vertebrae, tearing of the ligaments and muscles of the neck and lead to disc herniation. This will result in significant pain and neck stiffness. If there is damage to the spinal cord or nerves, a paralysis of the extremities can occur.
• Bulging or herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding disc wall. Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve.
• Pinched nerve: When a spinal nerve is compressed, pain may run down your arm into your hands or fingers.  
• Osteoarthritis (degenerative disc disease): As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get narrower. These changes lead to stenosis or disc herniation.
•  Stenosis: Narrowing of the spinal and nerve root canals occurs as discs bulge or protrude, facet joints enlarge, and ligaments stiffen over time. As the spinal canal narrows, it compresses the cord and nerves, causing them to swell and inflame.

If you think you may have any of the above conditions, you should call you doctor. You may need to be examined by a neurosurgeon. Additional tests typically needed to make a definitive diagnosis include X-rays, CAT scan, MRI and sometimes nerve testing.
You should seek immediate medical attention if:

• You start to experience severe neck pain, especially if associated with “shooting” arm pain and numbness,
• You notice arm/hand weakness and begin dropping objects,
• Your gait becomes difficult and your legs become spastic (stiff),
• You start loosing bowel and bladder control,
• Your neck pain is associated by a headache, fever, or nausea –this could be a symptom of infection in the spine or brain (meningitis).

In any of the above situations – don’t wait. Call your doctor or go to the closest emergency room for evaluation.

The management of your condition will depend on the exact diagnosis and its impact on your musculoskeletal and nervous system. The treatment plan usually involves a combined use of anti-inflammatory medications (Advil or Motrin) and muscle relaxants, as well as a 6-week course of physical therapy. In cases where the pain is severe and resistant to the above, you may need to see a pain management specialist. In the course of your treatment it is very likely that a neurosurgeon specialized in spine disorders will evaluate you and review your spine X-rays and MRI. The surgical treatment of herniated discs and spinal stenosis is usually reserved as a “last resort” option.  However, if your condition causes acute loss of strength or sensation, you may require urgent surgical intervention.

Most people with acute neck pain respond rapidly to treatment; 90% are symptom-free within 1 to 2 weeks. A positive mental attitude, regular activity, and a prompt return to work are all very important elements of this recovery. If regular job duties cannot be performed initially, it would be in your best interests to return to some kind of modified (light or restricted) duty.
You play an important role in the prevention and healing process of neck pain. Strong, flexible muscles help to promote a healthy neck that maintains good alignment, allows movement, and provides structural support.