Monday - Friday: 9.30 am to 5.30 pm,
Saturday - 9.00 am to 5.30 pm
Unit 3, Wilmington Cl, Watford WD18 0AF

MACS PAIN CLINIC

Tel: 07868118976
Neck pain

Neck pain

NECK PAIN

Neck pain is probably the second commonest pain after low back pain seen in a Pain Management Clinic; roughly 1 in 6 people could have neck pain.  The neck supports the weight of the head and brain and all the vital communications from the brain to the rest of the body is carried by nerves passing the neck.  The neck has a complex arrangement around the spine with nerves, ligaments, muscles, tendons as well as the blood supply to the brain.  Additionally, the neck is very mobile to enable us to turn our head to all directions.  Neck pains can severely impact on sleep, mobility, headaches and reduced quality of life.

Most people’s neck pain settle down in a few days  and is usually due to poor posture, (excessive use of computers and mobile phones is a common cause these days) or sleeping in an awkward position or after an episode of cough or sneezing or during contact sports.  Most people would find it very uncomfortable if the pain is not settling down after a few days.  In these instances it is advisable to discuss with the GP to rule out any significant underlying conditions.  Pain can be referred to the neck from the shoulder, upper chest-wall or even the head.

Differential Diagnosis

Cervical spondylosis

Whiplash

Spinal pain

Degenerative disease of spine

Disc prolapse/ Herniated discs

Discogenic pain

Radicular pain

SYMPTOMS & SIGNS

Neck pains can vary from dull ache and stiffness to sharp pain radiating down the arm (similar to sciatica in the leg) with numbness and tingling; it can be associated with headache and pain between the shoulder blades.  Some people will get dizziness, vertigo and is never comfortable in one position.  Most neck pains on investigating will have normal scan results other than age-related degenerative changes.  Severe neck pain following trauma with weakness in the arms and/or hands or associated with infection and fever or chest pains should be investigated without delay by seeking urgent medical attention.

  • WHAT ARE THE COMMON CONDITIONS THAT CAUSING NECK PAIN?
  • From the joints in the neck – The Cervical Facet joints are the joints that connect each vertebral body to the one above and below to form the spine and is at the back of the spine. Age-related wear and tear, osteoarthritis, cervical spondylosis with or without spondylolisthesis and degenerative changes are common reasons for pain here.  Patients who have rheumatoid arthritis or ankylosing spondylosis could also have these joints affected.
  • Myofascial pain – The muscles of the neck are very strong as it has to support the weight of the head. These muscles can go into spasm for a variety of reasons and cause pain’ it could be the whole muscle or tight spots or bands (trigger points) that are highly tender and an irritable foci of pain.  Weakening of these muscles can cause worsening pain in the neck joints,
  • Whiplash syndrome – This occurs with a sudden and vigorous movement of the head, forwards and backwards or sideways. This problem tends to occur after a car accident (rear-ending) or fall. MRI Scans can be normal, but tere could be microscopic disruption of soft-tissue and associated muscle-spasms leading on to severe neck pain.
  • Degenerative disc disease – this can be just neck pain or associated with arm pain (brachialgia). This could be due to bulging disc causing narrowing of the spinal canal or the foramen, and putting pressure on the spinal cord or cervical nerve roots.  Most of the time it is not harmful, but the presence of muscle weakness, lower limb weakness, loss of control of bowel and water works indicate myelopathy (affecting the spinal cord) and needs urgent neurosurgical attention.
  • Nerve pain
    • The most common site is the vertebral column and spinal nerve roots due to pressure on them due to pressure from a bulging disc or narrowing of the spinal canal or foramen due to degenerative changes – spinal stenosis. If associated with neurological signs and symptoms, it should warrant urgent medical attention.
    • Shingles, infection and autoimmune diseases can cause nerve pain in the neck and arm.
    • Post-surgical neuropathic pain is not uncommon following thyroid surgery, other surgeries on the neck and cervical spine.
  • Referred pain – Pain in the neck can arise due to myocardial infection, meningeal irritation and pathology at the back of the throat. Sometimes infections like tonsillitis and sinusitis can cause painful enlargement of the cervical lymphnodes.
    Some of the rarer but sinister causes of neck pain and TB of the spine.  The neck pain is usually associated with other signs and symptoms.

MANAGEMENT OF NECK PAIN

Neck pain can be debilitating and any pain lasting for more than three months, it should be reviewed by your doctor.  If referred to the Pain Consultant, they will carry out a history and clinical examination and if required, will arrange for suitable investigations.  A clinical diagnosis would be arrived and then various treatment options would be discussed with you and the most suitable treatment plan would be offered.

Frequently Asked Questions

Q: What are the side-effects of injections?

A:

Each injection can have different side-effects. Please refer to appropriate injections information leaflet in the section of treatments.

Q: How can injections help in pain management?

A:

In situations where the pain is disabling severe and not allowing you to do the day-to-day chores, medications have proven inadequate to reduce the pain; injections are targeted to be given either under x-ray guidance or ultrasound guidance at the presumed sources of pain. Injections mainly consist of local anaesthetic with or without steroid. This works as anti-inflammatory at the source of pain.

Injections are not a permanent cure. Injections help by reducing the intensity of pain. The aim is to reduce pain and break the cycle of pain, allow you to carry out rigourous physiotherapy and help and healing. We may have to repeat injections in order to achieve the goals.

There are other injections available when nerves can be ablated (burnt) or we can apply what is called a radio-frequency lesioning at lower temperatures. These treatments have intermediate to long-term benefits and also work to reduce inflammation. These can be offered if the initial injection does not last long enough to follow on with strengthening Physiotherapy. These injections are not operations or permanent treatments. They are used to improve your condition of pain in order for you to carry out rehabilitative strengthening physiotherapy and come out of the vicious cycle of pain.

Q: What can I do if I do not want medications for my pain control or medications have not helped, or I get too many side-effects from medications?

A:

We can offer you Non-injection interventions such as acupuncture. We can introduce you to other means of self management of pain such as using a TENS machine . We have a modalities to offer at our clinic for example Medical yoga therapy, deep electrical muscle stimulation, TENS treatment. If the pain is unbearable, not responding to medications, or you do not want to try the non-invasive modalities ; we could offer you injection therapies.

Q: What will happen then ?

A:

You will have a detailed consultation, examination and then be given information and advice about your condition. We may also organise investigations. We may be able to prescribe you medication and give you details about how to manage pain and other interventional options can be discussed.

Q: Who will be seeing me?

A:

You will be reviewed only by MACS clinic senior Pain Consultants for your condition.

Q: If I am unable to get a GP appointment or don’t want to wait for any appointments how can I get in touch with you?

A:

You could phone us On (020) 7078 4378 or 07868118976; from 9 am to 6 pm; to book an appointment. You could also email us on info@macsclinic.co.uk or you could also get in touch with us on our website www.macsclinic.co.uk

Q: I am concerned about my pain. What should I do?

A:

If your pain is very severe, not responding to over-the-counter painkillers you should contact your GP and get an appointment for review. If you are in severe disabling pain, unable to carry out any routine tasks, you could book an emergency appointment with your GP or go to the local A&E for a review.

Treatment Options

Most acute pain problems settle down following some analgesics and benzodiazepines for muscle relaxation and improving sleep.  Additionally, use of cold and heat packs, TENS machine, physiotherapy and neck strengthening exercises would help alleviate the symptoms.

Chronic neck pain needs proper assessment by a Pain Consultan for achieving meaningful pain relief and functional restoration.  Your Consultant would reassure you about your condition and recommend the best course of action.   A multi-modal multi-disciplinary approach is required based on the condition as well as the patient preference.  Most therapies involve physical therapy and to achieve the best results, good analgesia needs to be ensured.

TYPES OF TREATMENT

  • Physical Therapy & Rehabilitation – This is the mainstay of management, but best results are achieved if good analgesia is provided.
  • Medications – Most pains could be managed by Paracetamol and anti-inflammatories and over the counter weak opioids like Codeine phosphate. Some patients would benefit from neuropathic pain medications but strong opioids are not advisable for long term management of chronic non-malignant pain.
  • Pain interventions – These are useful to diagnose and manage mechanism based approach by targetting the nerves, muscles and joints. These include cervical epidurals, medial branch blocks , occipital nerve blocks and other targetted interventions.  If the diagnostic blocks are positive, but short-lived, radiofrequency denervations or cervical epiduroplasty might give longer-lasting benfit.  Some patients may require neuromodulation in the form of spinal cord or dorsal root ganglion stimulation.
  • Surgery – Patients having red-flags (neurological and/or autonomic disturbances) need surgical review. Prolapsed discs that is not responding to conservative management could benefit from microdiscectomy and decompression.  Very rarely, if the spine is unstable, spinal fusion and stabilization surgery.

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