Neck Pain
Neck pain is one of the common problems we encounter in our clinical practice.
Most of us will experience neck pain at some point in our lives. It is not uncommon for the first occurrence of neck pain to occur during childhood or adolescence.
Neck pain ranks fourth among the causes of disability, following back pain, depression, and joint pain.
Half of the population experiences a significant period of discomfort due to neck pain at least once in their lifetime. Every year, 37 out of 100 people report complaints of neck pain.
Neck pain is more common in women than in men and is associated with various conditions such as headaches, back pain, joint pain, and depression.
What Are The Most Common Causes Of
Neck Pain?
- Degenerative disc disease
- Neck strain/sprain
- Osteoarthritis/Cervical spondylosis
- Spinal stenosis
- Poor posture
- Traumatic events (Whiplash injury)
- Disc herniation (Cervical herniated disc)
- Infections
- Fibromyalgia
Who Is More Likely To Experience Neck Pain?
- More common in women
- Middle age
- Genetic factors
- Psychopathology (depression, anxiety, poor coping mechanisms, somatization)
- Sleep disorders
- Smoking
- Sedentary lifestyle
- Obesity (increased inflammation, increased mechanical stress, structural changes, decreased muscle strength, psychosocial factors, fear of movement)
- Trauma (traumatic brain and whiplash injuries)
- Specific sports (wrestling, soccer, etc.)
- Some occupations (office and computer workers, healthcare professionals, manual laborers)
- Job dissatisfaction
- Perception of a poor work environment
What Are The Other Symptoms Associated With Neck Pain?
- Numbness
- Tingling
- Reduced range of motion
- Difficulty swallowing
- Ringing in the ears
- Dizziness
- Swelling of lymph nodes
- Headaches
- Shoulder pain
- Facial pain
- Numbness or tingling in the arm
- Back and lower back pain
What Are The Anatomical Structures In
The Neck Region?
- 7 cervical vertebrae
- Neck muscles, arteries, and veins
- Lymph nodes
- Thyroid gland and parathyroid gland
- Esophagus
- Larynx
- Trachea
How Do We Classify Neck Pain?
In terms of duration, we classify neck pain as acute (lasting less than 6 weeks), subacute (lasting less than 3 months), and chronic (lasting more than 3 months). Additionally, we can classify it based on its severity, cause, and type.
The duration of neck pain is particularly important for treatment outcomes. The shorter the duration, the better the results we can achieve.
Neck pain can also be classified as mechanical, neuropathic, or secondary pain. Mechanical pain originates from structures such as the spine or supporting tissues like ligaments and muscles. Conditions like disc-related pain, facet joint degeneration-related pain, and myofascial pain fall under mechanical pain.
Neuropathic pain, on the other hand, arises from diseases or injuries affecting the peripheral nervous system and often involves mechanical or chemical irritation of nerve roots. Radicular symptoms (pain radiating from the neck to the arm or hand) caused by disc herniation or calcification are common causes of peripheral neuropathic pain.
Central neuropathic pain results from myelopathy or spinal cord damage. Neuropathic-nociceptive pain conditions can occur in cases of failed neck surgery (post-laminectomy syndrome) and degenerative disc conditions, where both mechanical pain and radicular symptoms are present.
Determining whether the pain is mechanical or neuropathic is crucial in guiding our treatment approach.
Therefore, during the patient’s history and physical examination, we make this distinction to understand the nature of the pain.
What Specialties Can Individuals With Neck Pain Consult?
- Physical Medicine and Rehabilitation Specialist
- Family Medicine Specialist
- Orthopedics and Traumatology Specialist
- Neurology Specialist
- Neurosurgery Specialist
- Ear, Nose, and Throat Specialist
How Is the Diagnosis Made For Neck Pain?
The diagnosis of neck pain is heavily reliant on the patient’s history and physical examination. The location, intensity, duration, and radiation of pain should be explored. Does the pain worsen or improve with changes in head position or movement?
A history of trauma involving the neck region and any prior treatments for neck pain should be inquired about. It’s essential to note which movements exacerbate or alleviate the pain.
Examination of the neck region and a neurological examination should be conducted. Based on the history and examination findings, diagnostic imaging such as X-rays or MRIs may be performed.
How Long Does Neck Pain Take To Resolve?
Most newly onset acute pains resolve within 2 months. Studies show that approximately 50% of patients continue to experience some level of pain or experience frequent recurrences within the year.
Factors that contribute to the prolonged persistence of acute pain include female gender, advanced age, accompanying psychosocial conditions, and the presence of radicular symptoms.
There is a significant body of literature suggesting that in neck pain caused by cervical disc herniation, the herniated disc can resorb over time, reducing pressure.
What Treatment Methods Are Used For
Neck Pain?
The choice of treatment is determined by the underlying cause of the pain. Treatment methods can include hot-cold applications, rest, the use of a neck collar, traction, physical therapy, local injections, topical creams, muscle relaxants, pain relievers, exercise programs, and surgical interventions.
Complementary medicine techniques like acupuncture, ozone injections, prolotherapy and mesotherapy are also used in treatment.
Patient compliance is crucial during the treatment of neck pain. I observe that many patients who come to me often exacerbate their already tense muscles due to the panic of not being able to bend or turn their neck. Reducing tension is essential above all else.
Patients should seek medical attention promptly if they experience symptoms such as pain that wakes them up at night, fever, sweating, weight loss, pain and/or numbness radiating down to the arm, or morning stiffness.
In cases of neck pain without these symptoms, rest, at-home hot/cold applications, and simple pain relievers often lead to recovery.
Is It Possible To Prevent Neck Pain?
Preventing neck pain is important to avoid injury. It is recommended to maintain proper posture, exercise regularly, minimize the risk of injury during sports activities, use appropriate equipment, and perform neck strengthening exercises.
Many of us spend long hours at the office and in front of computers nowadays. Poor sitting posture and poorly planned desk/chair setups can lead to neck pain and loss of productivity.
To prevent neck pain, it is essential to create a comfortable working environment.
What Should Be Considered For This?
- The computer screen should be at least 65 cm away from our eyes. The monitor should be as far as possible, and the font size should be increased.
- The computer screen’s viewing area should be at 15-50° from the horizontal line of sight.
- While sitting, our feet should touch the ground flat, knees at a 90° angle, back supported, shoulders relaxed, elbows at a 90° angle, and wrists in a neutral position.
- If your feet do not touch the ground while sitting, it’s a good idea to place additional support under your feet.
- It is recommended to place the phone on the non-dominant hand side so that other activities can be performed while talking on the phone.
- Using a headset or microphone set while using the phone is advised to avoid poor posture.
- When working on a computer, ensure that the light comes from the side, not directly on the computer.
- Adjusting the keyboard height and ensuring that the wrist-hand plane is horizontal is recommended. Keep your wrist straight.
- The chair you sit in should be stable, capable of 360° rotation, adjustable in height, have lumbar support, not put pressure on the hips from the side, and have a seat edge that does not disrupt blood flow. Maintain a neutral head position while sitting in the chair.
- In our workplaces where we spend stressful hours under pressure to get more work done in less time, it is recommended to reduce tension and prevent neck pain through rest (e.g., 50 minutes of work, 10 minutes of rest), relaxation (e.g., deep breathing), and recovery (allowing problem areas to heal).
