What is Neck Pain Management and Why Do We Use Them?

Diagnosis

Your health care provider will take a medical history and do an exam. The exam will include checking for tenderness, numbness and muscle weakness. And it will test how far you can move your head forward, backward and side to side.

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Imaging tests

Imaging tests might help find the cause of the neck pain. Examples include:

• X-rays. X-rays can reveal areas in the neck where the nerves or spinal cord might be pinched by bone spurs or other changes.
• CT scan. CT scans combine X-ray images taken from many different directions to produce detailed cross-sectional views of structures inside the neck.
• MRI. MRI uses radio waves and a strong magnetic field to create detailed images of bones and soft tissues. The soft tissues include the disks, the spinal cord and the nerves coming from the spinal cord.

It's possible to have X-ray or MRI evidence of structural problems in the neck without having symptoms. Imaging studies are best used with a careful history and physical exam to determine the cause of pain.

Other tests

• Electromyography (EMG). An EMG can determine whether neck pain might be related to a pinched nerve. It involves inserting fine needles through the skin into a muscle. The test measures the speed of nerve conduction to determine whether nerves are working properly.
• Blood tests. Blood tests can sometimes provide evidence of inflammation or infections that might be causing or contributing to neck pain.

Treatment

The most common types of mild to moderate neck pain usually respond within two or three weeks to self-care. Pain relievers and the use of heat might be all that's needed.

Medications

Pain relievers might include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), or acetaminophen (Tylenol, others). Take these medications only as directed. Overuse can cause serious side effects.

If pain relievers you can buy without a prescription don't help, your health care provider might suggest prescription NSAIDs or muscle relaxers.

Therapy

• Physical therapy. A physical therapist can teach correct posture, alignment and neck-strengthening exercises. Physical therapy might also involve the use of heat, ice and other measures to help ease pain.
• Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on the skin near the painful areas deliver tiny electrical impulses that may relieve pain. However, there's little evidence that TENS works for neck pain.
• Soft neck collar. A soft collar that supports the neck may help relieve pain by taking pressure off the neck. However, if used for more than three hours at a time or for more than 1 to 2 weeks, a collar might do more harm than good.

Surgical and other procedures

• Steroid injections. A health care provider might inject steroid medications near the nerve roots, into the spinal joints or into the muscles in the neck. Numbing medications, such as lidocaine, also can be injected to relieve neck pain.
• Surgery. Rarely needed for neck pain, surgery might be an option for relieving nerve root or spinal cord compression.

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Lifestyle and home remedies

Besides taking pain relievers, self-care measures that might relieve neck pain include:

• Alternate heat and cold. Reduce inflammation by applying cold, such as an ice pack or ice wrapped in a towel, for up to 15 minutes several times a day during the first 48 hours. After that, use heat. Try taking a warm shower or using a heating pad on the low setting.
• Home exercises. Keeping the neck moving is important. Begin daily gentle stretching, including neck rolls and shoulder rolls, once the worst of the pain lessens. Gently tilt, bend and rotate the neck. Warm the neck and back with a heating pad or in the shower or bath before doing these exercises.

Alternative medicine

A number of alternative treatments might ease back pain. Always discuss the benefits and risks with your health care provider before starting a new alternative therapy.

• Acupuncture. A practitioner of acupuncture inserts thin, sterilized needles into the skin at specific points on the body. Achieving best results might require several acupuncture sessions. Acupuncture is generally considered safe when performed by a certified practitioner using sterile needles.
• Chiropractic. Performed mainly on the spine, a chiropractic adjustment applies a controlled, abrupt force to a joint. Chiropractic treatments to the neck can provide short-term pain relief and, for many people, carry minimal risks.
• Massage. During a massage, a trained practitioner kneads the muscles in the neck. Massage might help people with chronic neck pain from tightened muscles.

Preparing for your appointment

You might initially contact your primary care provider about your neck pain. You then might be referred to:

• A doctor who specializes in nonoperative treatment of musculoskeletal conditions (physical medicine and rehabilitation specialist)
• A doctor who specializes in arthritis and other diseases that affect the joints (rheumatologist)
• A doctor who specializes in treating nerve-related disorders (neurologist)
• A doctor who operates on bones and joints (orthopedic surgeon)

What you can do

Before your appointment, be prepared to answer the following questions:

• When did your symptoms begin?
• Have you ever injured your neck? If so, when?
• Do certain neck movements improve or worsen the pain?
• What medications and supplements do you take regularly?

What to expect from your doctor

Your provider might ask some of the following questions:

• Where exactly is your pain?
• Is the pain dull, sharp or shooting?
• Do you have numbness or weakness?
• Does the pain radiate into your arm?
• Is the pain made worse by straining, coughing or sneezing?
• Do you have other physical problems?

1. Neck pain. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Living-Well-with-Rheumatic-Disease/Neck-Pain. Accessed June 30, .
2. Isaac Z, et al. Evaluation of the adult patient with neck pain. https://www.uptodate.com/contents/search. Accessed June 30, .
3. Miller M, et al., eds. Degenerative conditions of the cervical and thoracolumbar spine. In DeLee, Drez, and Miller's Orthopaedic Sports Medicine: Principles and Practice. 5th ed. Elsevier, . https://www.clinicalkey.com. Accessed June 30, .
4. Neck pain. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/neck-pain. Accessed June 30, .
5. Isaac Z. Management of non-radicular neck pain in adults. https://www.uptodate.com/contents/search. Accessed June 30, .
6. Neck pain. American Association of Neurological Surgeons. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Neck-Pain. Accessed June 30, .
7. Kazeminasab S, et al. Neck pain: Global epidemiology, trends and risk factors. BMC Musculoskeletal Disorders. ; doi:10./s-021--4.
8. Too much screen time? Sit up straight to avoid painful tech neck. Doctors of Osteopathic Medicine. https://findado.osteopathic.org/too-much-screen-time-sit-up-straight-to-avoid-painful-tech-neck. Accessed June 30, .

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What is neck pain (cervicalgia)?

Neck pain, sometimes called cervicalgia, is pain in or around your spine beneath your head. Your neck is also known as your cervical spine. Neck pain is a common symptom of many different injuries and medical conditions.

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You might have axial neck pain (felt mostly in your neck) or radicular neck pain (pain that shoots into other areas, such as your shoulders or arms). It can be acute (lasting from days to six weeks) or chronic (lasting longer than three months).

Neck pain can interfere with your daily activities and reduce your quality of life if it’s not treated.

Fortunately, most causes of neck pain aren’t serious and improve with conservative treatments, like pain medicine, exercise and stress management.

What does neck pain feel like?

Some people describe the pain as:

• A persistent ache.
• A stabbing or burning pain.
• A shooting pain that travels from their neck to their shoulders or arms.

Other symptoms

Neck pain may involve other symptoms, including:

• Headache.
• Stiffness in your neck, shoulders and upper back.
• Being unable to turn your neck or tilt your head.
• Numbness or tingling (pins and needles) feeling in your shoulders or arms.

Who is affected by neck pain?

Neck pain is common, affecting 10% to 20% of adults. It’s more common in women. Your chance of developing it increases with age.

How is neck pain diagnosed?

Usually, a medical history and a physical exam are enough for a healthcare provider to diagnose the cause of neck pain. A healthcare provider will first eliminate serious causes of neck pain, like pressure on your spinal cord, myelopathy, an infection or cancer.

• Medical history: Your provider will ask about previous neck injuries that may have caused whiplash or a herniated disk. They may ask about work or other activities that could strain your neck. They’ll ask about your pain, including when it started, where it’s located, how long it lasts and how intense it is.
• Physical exam: Your provider will check your head and neck alignment and observe your range of motion when you move your neck. They’ll feel your neck and supporting muscles to check for tenderness and signs of strain.
• Imaging tests usually aren’t necessary to identify what’s causing neck pain. Still, a provider may take images of the inside of your neck if they suspect a serious injury or if you’re experiencing severe pain that doesn’t improve.
• X-rays: X-rays can show problems with your bones or soft tissues that may be causing neck pain. An X-ray can show issues with cervical alignment, fractures and slipped disks, and they can detect arthritis.
• Magnetic resonance imaging (MRI): An MRI can show problems with your spinal cord, nerves, bone marrow and soft tissue. It can show if a disk has slipped out of place, signs of infection and masses that may be causing neck pain, like a cyst or tumor.
• Computed tomography (CT) scan: A CT scan may be used if an MRI isn’t available. It can show bone spurs and signs of bone deterioration.

In rare instances, your provider may order additional tests, including:

• Electrodiagnostic tests: These tests check the function of nerves and your muscle response. Tests include nerve conduction studies and, rarely, a myelogram if an MRI is contraindicated.
• Lab tests: These tests can help your provider identify causes of neck pain other than musculoskeletal injuries, like infections, rheumatological conditions or cancers. Tests include a complete blood count (CBC), urinalysis and markers of inflammation, among others.

How is neck pain managed or treated?

Treatment aims to relieve your pain and improve movement in your neck. Most causes of neck pain eventually improve and can be managed at home. Your provider will suggest treatments to manage your symptoms, including:

• Pain medications and muscle relaxers: Medicines, including nonsteroidal anti-inflammatory drugs (NSAIDs) to ease neck pain and inflammation, and muscle relaxants to help your neck muscles heal, are common first-line treatments for neck pain.
• Physical therapy: You may work with a physical therapist or a fitness trainer to learn exercises and movements that strengthen the muscles and tendons in your neck and improve flexibility.
• Transcutaneous electrical nerve stimulation (TENS) unit: A TENS unit applies a low-level electrical current to your skin near your nerves to disrupt the pain signal causing discomfort. Always check with a healthcare provider before using a TENS unit.
• Steroid injections: A shot near the nerve roots can reduce inflammation and relieve pain.
• Alternative therapies: Your provider may recommend acupuncture to relieve pain, or massage to help loosen tightened muscles contributing to your discomfort. You may see an osteopath or chiropractor to align your spine.
• Surgery: Most causes of neck pain don’t require surgery. Still, you may need surgery if one or more of the vertebrae in your spine has shifted out of place or is putting pressure on your nerves.

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If your pain is severe, you may need to work with a spine or pain specialist.

What can I do to relieve neck pain at home?

In addition to taking pain relief medications, you can take steps at home to relieve neck pain, including:

• Hot therapy: Take a hot shower or place a hot towel or heating pad (on the lowest setting) on the site of your pain for 15 minutes every few hours. The heat loosens your muscles and promotes blood flow.
• Cold therapy: Place a cold pack or a bag of frozen vegetables (wrapped in a thin towel to protect your skin) for 15 minutes every few hours. The cold narrows your blood vessels, reducing inflammation and swelling. Use cold instead of heat immediately after an injury.
• Exercise: Follow your healthcare provider’s guidance on neck exercises you can try to relieve neck pain and improve your range of motion. Don’t attempt exercises if you have a serious neck injury or a pinched nerve.
• Stress reduction techniques: Mindfulness, meditation, breathing exercises and yoga can help relieve tension in your body that may contribute to neck pain.
• Quit smoking: Smoking damages bone structure, accelerates degenerative disk disease and slows healing.

How long does neck pain (cervicalgia) take to heal?

Healing time depends on what’s causing your neck pain. Neck pain caused by common issues like strains and stress usually improves within a week or two. It may take a few months before the pain disappears entirely.

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How can I prevent neck pain?

You can take steps to prevent neck pain related to strains and tense muscles.

• Practice good posture. Position electronic devices, like computers and phones, so you don’t have to slouch or strain your neck when using them. Keep your shoulders aligned and your back straight when seated so you’re not straining your neck. Adjust the seats in your car to maintain good posture while traveling.
• Adjust your sleep position.Maintain good posture when you’re asleep. If you sleep on your back or side, use a pillow to support your head so your head and neck are aligned with the rest of your body. If you sleep on your back, place a pillow underneath your knees to take additional pressure off your low back. Avoid sleeping on your stomach with your head turned.
• Stay active.You can use many of the same exercises used to relieve neck pain to prevent it. If you work a job that involves sitting for long periods, take occasional breaks to move around and stretch your entire body, including your neck muscles.
• Don’t carry heavy weight on your shoulders.Avoid carrying heavy objects like book bags or suitcases over your shoulder. Instead, consider using luggage or bags with wheels.
• Exercise your upper back extensor muscles. It’s normal to lose strength in your upper back as you age. As a result, your shoulders rock forward, and your head tips forward in a position in front of your spine. This positioning puts additional strain on your neck and upper back.

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Exercises that can help strengthen your upper back extensor muscles include:

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• Scapular squeezes: Pinch your shoulder blades together 10 times.
• Standing push-ups: Do push-ups in a doorframe, allowing your shoulders to go past your hands 10 times.
• Theraband rowing: Wrap the middle of a theraband around a doorknob so it’s stable. While standing, grab an end with each hand. Pull your hands toward your waist 10 times.