Neck pain (also commonly known as cervical pain, or simply ‘cervical’) is a common problem, with two-thirds of the population having neck pain at some point in their lives. Neck pain affects about 5% population and is more common in women than men. About one-half of episodes resolve within one year but remaining patients continue to suffer pain and associated disability.
Muscle strains: Overuse and poor posture , such as too many hours hunched over a steering wheel, laptops, mobile phones and other electronic gadgets often triggers muscle strains. Even such minor things as reading in bed or gritting your teeth can strain neck muscles.
Worn Joints: Just like all the other joints in your body, neck joints tend to undergo wear and tear with age, which can cause osteoarthritis in the neck.
Nerve compression: Herniated disks or bone osteophytes (abnormal growth) in the vertebrae of the neck can take up too much space and press on the nerves branching out from the spinal cord.
Injuries: Rear-end automobile collisions often result in whiplash injuries, which occur when the head is jerked backward and then forward, stretching the soft tissues of the neck beyond their limits.
Diseases: Neck pain can sometimes be caused by diseases, such as rheumatoid arthritis, tuberculosis, meningitis or cancer Neck pain can also come from conditions directly affecting the muscles of the neck, such as fibromyalgia
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 and dizziness or light-headedness.
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 getting 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.
In case of injury, one should seek medical advice immediately without any delay.
If there has not been an injury, you should seek medical care when neck pain becomes:
Acute neck pain: Home treatment includes applying heat or ice and using over-the-counter pain relievers. If these modalities don’t show effect, the patient should rush to a pain physician for further detailed evaluation.
Chronic neck pain: If the pain persists or becomes long standing pain then one should not waste any more time and contact a pain physician directly. The treatment options are defined by the exact cause of such a pain. The various options that are available are:
– Physical therapy: Ultrasonic, short wave diathermy, laser and controlled traction. Along with these neck strengthening exercises are performed. No exercises should be performed in acute painful conditions.
– Pharmacotherapy: This includes a combination of nerve medicines, safe pain killers, muscle relaxants and other drugs which are given depending on the exact cause of pain.
– Interventional therapy: If a combination of physical and pharmacotherapy is unable to provide adequate pain relief then we should go for interventional (injection) painmanagement techniques such as cervical epidural and trigger point injections. These techniques are absolutely safe, effective and produce rapid recovery in all age groups provided they are performed by the experts (pain physicians).
Mechanical problems: A mechanical problem is due to the way your spine moves or the way you feel when you move your spine in certain ways. Perhaps the most common mechanical cause of back pain is a condition called intervertebral disc degeneration, which simply means that the discs located between the vertebrae of the spine are breaking down with age. As they deteriorate, they lose their cushioning ability. This problem can lead to pain if the back is stressed. Another cause of back pain is the wearing down of the facet joints, which are the large joints that connect each vertebrae to another. Other mechanical causes of back pain include spasms, muscle tension, and ruptured discs, which are also called herniated discs.
Injuries: Spine injuries such as sprains and fractures can cause either short-lived or chronic back pain. Sprains are tears in the ligaments that support the spine, and they can occur from twisting or lifting improperly. Fractured vertebrae are often the result of osteoporosis, a condition that causes weak, porous bones. Less commonly, back pain may be caused by more severe injuries that result from accidents and falls.
Acquired conditions and diseases: Many medical problems can cause or contribute to back pain. They include scoliosis, which causes curvature of the spine and does not usually cause pain until mid-life; spondylolisthesis; various forms of arthritis, including osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis; and spinal stenosis, a narrowing of the spinal column that puts pressure on the spinal cord and nerves. While osteoporosis itself is not painful, it can lead to painful fractures of the vertebrae. Other causes of back pain include pregnancy; kidney stones or infections; endometriosis, which is the buildup of uterine tissue in places outside the uterus; and fibromyalgia, which causes fatigue and widespread muscle pain.
Infections and tumors: Although they are not common causes of back pain, infections can cause pain when they involve the vertebrae, a condition called osteomyelitis, or when they involve the discs that cushion the vertebrae, which is called discitis. Tumors, too, are relatively rare causes of back pain. Occasionally, tumors begin in the back, but more often they appear in the back as a result of cancer that has spread from elsewhere in the body.
Although the causes of back pain are usually physical, it is important to know that emotional stress can play a role in how severe pain is and how long it lasts. Stress can affect the body in many ways, including causing back muscles to become tense and painful. Untreated depression and anxiety can make back pain feel much worse. Likewise, insomnia, or the lack of sleep, can also contribute to back pain.
Sciatic pain or sciatica is the pain that occurs because a nerve coming from the spinal cord is pressed on (trapped) by a prolapsed disc, or is irritated by the inflammation caused by the prolapsed disc. Although the problem is in the back, you feel pain along the course of the nerve in addition to back pain. Therefore, you may feel pain down a leg to the calf or foot. Sciatic pain can range from mild to severe, but it is often worse than the back pain. With a prolapsed disc, the sciatic nerve is the most commonly affected nerve. The sciatic nerve is a large nerve that is made up from several smaller nerves that come out from the spinal cord in the lower back. It travels deep inside the buttock and down the back of the leg. There is a sciatic nerve for each leg.
Spinal Injections: Injections like the Cervical, Thoracic and Lumbar Interlaminar Epidural Injections and Transforaminal injection are injections into the opening at the side of the spine where a nerve roots exits. These injections reduce the inflammation and swelling of spinal nerve roots and other tissues surrounding the spinal nerve root and reduces pain, tingling and numbness and other symptoms caused by such inflammation, irritation or swelling.
Spinal cord stimulation: Spinal cord stimulation is a procedure that delivers low-level electrical signals to the spinal cord or to specific nerves to block pain signals from reaching the brain. Spinal cord stimulation is recommended when other treatments have not been successful, when surgery is not likely to help, or when surgery has failed.
Radiofrequency Ablation: Radiofrequency ablation (or RFA) is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area. RFA can be used to help patients with chronic (long-lasting) low-back pain. RFA has proven to be a safe and effective way to treat some forms of pain. It also is generally well-tolerated, with very few associated complications.
Ozone Discectomy (Ozonucleolysis): Injection of Ozone-Oxygen mixture into the disc is a new alternative method of treating patients suffering from back and leg pain (sciatica) caused by disc prolapse. Large number of international studies confirms the efficacy of this treatment and superiority of this treatment over conventional disc surgery.
Surgery: Having back surgery can be a difficult choice. Typically, people consider surgery for back pain only after all other treatments have failed to provide relief. Even then, surgery does not provide significant improvement for everyone. And while the risks of back surgery are generally low, they can be serious in some people.
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