Chronic neck pain is a very common complaint that we encounter in our clinical practice. Multiple factors and conditions can either cause or contribute to neck pain. Additionally, we notice that up to 70% of patients with migraine may experience neck pain as part of migraine presentation. We believe that recognition and evaluation of neck pain help us better understand patient’s symptoms and find ways to more complete and comprehensive treatment.
Many conditions can cause neck pain. Some of the examples that we frequently see in our practice are myofascial pain syndrome (or simply chronically tight muscles in the neck), degenerative changes in the cervical spine (also known as arthritic changes), and cervical dystonia (a condition associated with increased muscle spasticity and postural changes).
Conditions described above frequently present with chronic pain located in the back of the neck and shoulders. The pain could be confined to the neck and/or shoulder area, or it may travel up or down the spine or into one or both upper extremities. The pain could be described as a pressure-like or tightening sensation and sometimes as burning or even sharp. The pain could be aggravated by stress, physical activity, or specific movements.
Depending on the patient’s history, clinical presentation, and examination findings, we may recommend patients obtain an x-ray or MRI/CT scan of the cervical spine. Will may also suggest patients undergo a nerve conduction study to better assess and evaluate nerve involvement. In some cases, we may also perform a diagnostic nerve block to better identify the pain source.
Different treatment approaches are available depending on the type of neck pain. Will may suggest starting physical therapy, a muscle relaxant, and/or an anti-inflammatory medication. Some patients may benefit from long-term pharmacotherapy. Depending on a specific type of neck pain, we may perform trigger point injections, cervical facet medial branch nerve blocks (which may be followed by a radiofrequency ablation if indicated), or recommend injections of Botox.
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