Diagnosing neck pain – what’s the deal?
The purpose of this article is to help you understand what might be causing your chronic neck pain, and what treatment options are available to you.
There are 3 different types of pain:
- Acute: Pain that lasts less than 4 weeks.
- Subacute: Pain that lasts 4 to 12 weeks.
- Chronic: Pain that lasts 3 or more months.
Chronic pain is debilitating, and in most cases, will need some kind of treatment performed by a medical professional. Depending on the source and cause of the pain, there may be some treatments that work better for you than others.
Your neck, and your medial history
When you have had enough with the pain in your neck, the first step you should take is to see your primary care physician. They will conduct a thorough physical exam of your neck and back, and also ask you questions about your current lifestyle. These questions could include:
- When did the pain start? Does it come and go? Where is it located?
- What type of work do you do?
- What type of hobbies or activities do you enjoy?
- How do you sleep at night - side, stomach, or back? What type of mattress and pillows are used?
- Did you experience any recent injuries? Accidents or falls? Lifting anything heavy?
- Do you have any old injuries? Car accident? Fall? Etc.
After they have completed their evaluation, your doctor will suggest the next step in helping you find relief.
Treatment for your neck pain
If your neck pain is chronic, treatment options will most likely include help from a medical professional. Especially if you have exhausted the at home treatments like ice or heat, rest and over-the-counter pain medicine. Most physicians will start your treatment with nonsurgical options. According to spine-health.com, here are some common treatments:
- Physical therapy. Most treatment programs usually include some form of physical therapy to improve neck strength and flexibility. The physical therapy program’s structure and length will vary depending on the specific diagnosis and situation. In the beginning, the person will typically have multiple sessions per week with a trained physical therapist, and then in time will progress to performing the prescribed exercises at home.
- Prescription pain medications. If an over-the-counter pain reliever hasn’t been effective, prescription-strength medications may be tried. Many pain medications are available, and each has its own potential risks and benefits. While opioids have commonly been prescribed for pain relief in the past, the CDC changed its guidelines in 2016 and recommends fewer opioid prescriptions for chronic pain management due to the risk for addiction and other possible complications.
- Cervical epidural steroid injections. This procedure involves injecting cortisone steroid solution into the cervical epidural space, which is the outer layer of the spinal canal. To ensure that the injection goes into the epidural space near the inflamed nerve, X-ray guidance (fluoroscopy) is used. The goal of the injection is to reduce inflammation of the nerves, or nearby tissues caused by a disc herniation. These injections can help reduce the pain to enable the person to return to normal activities and/or make progress with a physical therapy program. This injection is not always effective and has some risks, including the possibility of infection, and its use might be limited to a few times a year.
- Cervical facet injections. If neck pain is caused by irritation of the facet joints, injections of steroids into the specific joints can reduce the pain. If the facet injections yield predictable but temporary pain relief, sometimes radiofrequency ablation (RFA) of the small sensory nerves that go to the affected facet joints may be recommended. While these RFA procedures may have longer effects, these injections are not designed to cure the problem, but rather to temporarily offer relief for the irritated facet joints.
When choosing a local pain management doctor, one of the most important things to consider is the physician's training and experience, as well as if the physician has experience with your specific pain condition and what types of treatments they offer. Firelands Physician Group’s Thomas P. Felter, MD, specializes in neck pain and is board certified in pain management and anesthesiology. In order to see Dr. Felter, talk to your primary care physician about getting a referral.