Common conditions causing Neck Pain

What is Neck Pain?

Pain located in the neck is a common medical condition. Neck pain can come from a number of disorders and diseases and can involve any of the tissues in the neck. Examples of common conditions causing neck pain are degenerative disc disease, neck strain, neck injury such as in whiplash, a herniated disc, or a pinched nerve. Neck pain can come from common infections, such as virus infection of the throat, leading to lymph node (gland) swelling and neck pain. Neck pain can also come from rare infections, such as tuberculosis of the neck, infection of the spine bones in the neck (osteomyelitis and septic discitis), and meningitis (often accompanied by neck stiffness). Neck pain can also come from conditions directly affecting the muscles of the neck, such as fibromyalgia and polymyalgia rheumatica. Neck pain is also referred to as cervical pain.

Risk factors for neck pain include injury from involvement in contact sports, motor-vehicle accidents, bull or bronco horse riding, etc. Prevention of neck pain in the context of these activities should include neck strengthening exercises and often neck bracing.

What are the types and causes of Neck Pain?

Neck pain is common. About 2 in 3 people develop a bout of neck pain at some time in their lives. One survey done in the UK found that, of adults aged 45-75 years, about 1 in 4 women and about 1 in 5 men had current neck pain.

Types and causes of neck pain include:

• Nonspecific neck pain
  • This is the most common type. This is sometimes called ‘simple’ or ‘mechanical’ neck pain. Often the exact cause or origin of the pain is not known. It may include minor strains and sprains to muscles or ligaments in the neck. Bad posture may also be a contributing factor in some cases. For example, neck pain is more common in people who spend much of their working day at a desk, with a ‘bent-forward’ posture.

• A ‘whiplash’ jolt to the neck
  • This is most commonly due to an accident involving a vehicle, such as a car crash. It can cause neck pain. See separate leaflet called Whiplash Neck Sprain for details.
• Sudden-onset (acute) torticollis
  • This is sometimes called ‘wry neck’. A torticollis is when the head becomes twisted to one side and it is very painful to move the head back straight. The cause of acute primary torticollis is often not known.
  • However, it may be due to a minor strain or sprain to a muscle or ligament in the neck. Some cases may be due to certain muscles of the neck being exposed to cold (‘sleeping in a draught’). It is common for people to go to bed feeling fine and to wake up the next morning with an acute torticollis. The pain usually eases and clears away over a few days without any treatment.
  • Occasionally, torticollis is due to more serious causes. See separate leaflet called Torticollis for details.
• Wear and tear (degeneration)
  • Wear and tear of the spinal bones (vertebrae) and the discs between the vertebrae is a common cause or recurring or persistent neck pain in older people. This is sometimes called cervical spondylosis.
  • However, most people over the age of 50 have some degree of degeneration (spondylosis) without getting neck pain. See separate leaflet called Cervical Spondylosis for details.
• Cervical radiculopathy
  • When the root of a nerve is pressed on or damaged as it comes out from the spinal cord in the neck (cervical) region, the condition is known as cervical radiculopathy. As well as neck pain, there are symptoms such as loss of feeling (numbness), pins and needles, pain and weakness in parts of an arm supplied by the nerve. These other symptoms may actually be the main symptoms rather than neck pain.
  • The common causes of a radiculopathy are cervical spondylosis and a prolapsed disc. (A prolapsed disc is sometimes called a ‘slipped disc’, but the disc does not actually slip. What happens is that part of the inner softer area of the disc bulges out (prolapses) through the outer harder part of the disc, pressing on the nerve as it passes out of the vertebra.)
  • Various less common disorders can also cause cervical radiculopathy. This is discussed in more detail in the cervical spondylosis leaflet.

How Are Neck and Shoulder Pain Diagnosed?

• X-rays: Plain X-rays can reveal narrowing of the space between two spinal bones, arthritis-like diseases, tumors, slipped discs, narrowing of the spinal canal, fractures and instability of the spinal column.
• MRI:Magnetic resonance imaging is a noninvasive procedure that can reveal the detail of neural (nerve-related) elements, as well as problems with the tendons and ligaments.
• Myelography/CT scanning: Sometimes used as an alternative to MRI.
• Electrodiagnostic studies: Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnose neck and shoulder pain, arm pain, numbness and tingling.

How to Ease Neck Pain at Home

If you have minor neck pain or stiffness, take these simple steps to relieve it:

• Apply ice for the first few days of your neck hurting. After that, apply heat with a heating pad, hot compress, or hot showers.
• Take over-the-counter pain relievers such as ibuprofen or acetaminophen.
• Take a few days off from sports, activities that aggravate your symptoms, and heavy lifting. Resume normal activity slowly as symptoms ease.
• Exercise your neck every day. Slowly stretch your head in side-to-side and up-and-down motions.
• Use good posture.
• Avoid cradling the phone between your neck and shoulder.
• Change your position often. Do not stand or sit in one position for too long.
• Get a gentle neck massage.
• Use a special neck pillow for sleeping.
• Do not use a neck brace or collar without checking with your doctor’s approval. If not used properly, this can actually make the problem worse.

What are other symptoms that are associated with Neck Pain?

Neck pain is commonly associated with dull aching. Sometimes pain in the neck is worsened with movement of the neck or turning the head. Other symptoms associated with some forms of neck pain include numbness, tingling, tenderness, sharp shooting pain, fullness, difficulty swallowing, pulsations, swishing sounds in the head, dizziness or lightheadedness, and lymph node (gland) swelling.

Neck pain can also be associated with headache, facial pain, shoulder pain, and arm numbness or tingling (upper extremity paresthesias). These associated symptoms are often a result of nerves becoming pinched in the neck. Depending on the condition, sometimes neck pain is accompanied by upper back and/or lower back pain, as is common in inflammation of the spine from ankylosing spondylitis.

What are the treatments for nonspecific Neck Pain?

Exercise your neck and keep active

Aim to keep your neck moving as normally as possible. At first, the pain may be quite bad and you may need to rest for a day or so. However, gently exercise the neck as soon as you are able. You should not let it ‘stiffen up’. Gradually try to increase the range of the neck movements. Every few hours gently move the neck in each direction. Do this several times a day. As far as possible, continue with normal activities. You will not cause damage to your neck by moving it.

Medicines

• Painkillers are often helpful.
• Paracetamol at full strength is often sufficient. For an adult this is two 500 mg tablets, four times a day.
• Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They can be used alone or combined with paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac or naproxen need a prescription. Some people with stomach ulcers, asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.
• A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. To prevent constipation, have lots to drink and eat foods with plenty of fibre.
• A muscle relaxant such as diazepam is occasionally prescribed for a few days if your neck muscles become very tense and make the pain worse.