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Chronic Neck Pain

What is Chronic Neck Pain?

Neck pain can be acute or chronic. Chronic neck pain is usually defined as lasting for more than 6 months.

Chronic Neck Pain is a condition usually brought on by chronic wear and tear, rather than one specific injury. Small repetitive injuries and stresses on the spine combined with the effects of gravity and motion can eventually cause significant degeneration of the spine resulting in chronic neck pain.

Despite wear and tear and injuries, relatively few people will develop chronic neck pain. The things that can help avoid chronic neck pain are genetics, our individual ability to heal, and the ability of our support structures of the spine to prevent damage (muscles, tendons, ligaments).

What are the most common conditions of the Cervical Spine causing Neck Pain?

The most common spine conditions which result in chronic neck pain are:

  1. Cervical Osteoarthritis (spondylosis)
  2. Degenerative Disc Disease (DDD)
  3. Cervical Disc Herniation
  4. Cervical sprains and strains
  5. Spinal Stenosis (narrowing of the spinal canal)
  6. Cervical Radiculopathy (pinched nerve in the neck)
  7. Fibromyalgia
  8. Rheumatoid Arthritis                        

What are the symptoms of Chronic Neck Pain?

While the symptoms associated with chronic neck pain can vary from patient to patient, here are some examples:

  1. Neck pain
  2. Neck stiffness
  3. Headaches
  4. Upper back pain
  5. Pain spreading to the shoulders and arms
  6. Numbness or tingling in the arms or hands
  7. Weakness in the arms or hands

How do Spine Specialists make the diagnosis of Chronic Neck pain?

Spine specialists use information from the patient history, physical examination and special tests to make this diagnosis:

  1. History

The spine specialist will start with getting a complete history of your neck pain. After reviewing the information you provided on the History Form, the focus may involve asking questions which can narrow down the diagnosis by excluding certain conditions. Here are some examples of questions which a spine specialist may ask:


a. Family history of spine problems

b. History of injuries to the spine, especially whiplash

c. Known problems with the discs or joints in the spine

d. Weakness in the arms of legs

e. Change in sensation in the arms or legs

f. Problems with gait

g. Activities which worsen pain

h. Activities which improve pain

i. Chronic exposure to stress

j. History of spine surgery

k. Problems with bowel or bladder function


2. Physical Examination

The physical examination may involve the following tests:

  1. Palpating (touching and pushing) the spine to look for pain and swelling
  2. Range of motion testing (mobility of the spine)
  3. Sensation testing in the arms and legs
  4. Motor (muscle strength) testing in the arms and legs
  5. Reflexes of the arms and legs

3. Imaging

A. X-Rays

Basic spine X-Rays are a good screening tool to get a basic idea about the patient’s anatomy of the spine. The bone anatomy, spine curvature and the height of each disc can be evaluated. However the softer structures such as the disc itself, the spinal nerves and spinal cord cannot be evaluated in any detail.

B. MRI Scans

MRI scans are the study of choice for many patients suffering from chronic neck pain. While this study is not as good as a CT scan to evaluate the spinal bone structure, it provides excellent views of the spinal discs, spinal cord, spinal nerves, and joints. It can be used to see if a specific problem such as a disc herniation is responsible for a patient’s chronic neck pain.

C. CT Scans

CT Scans are excellent studies to evaluate bone structures in the spine. However details about the softer structures such as the spinal cord or spinal nerves cannot be seen clearly. The high radiation dose of a CT scan compared to no radiation exposure of a MRI often discourages ordering this study as a basic screening tool for spine problems.

D. Nuclear Bone Scans

Nuclear bone scans are an excellent tool to evaluate the spine for a chronic fractures, infection or bone cancer. However, it does not show detailed images of the spine which show the anatomy in detail.

 How is Chronic Neck Pain treated?

The treatment of chronic neck pain often depends on the specific condition, severity of the symptoms, as well as the presence of neurological problems. Surgery is typically reserved for patients who suffer from a poor quality of life or have significant neurological symptoms. Here are some treatments which can be offered.

  1. Non-Surgical Treatments

A. Alternative Health Care

Alternative Health Care can offer Massage Therapy, Acupuncture, Meditation, Herbal Remedies and Aromatherapy amongst others.

B. Chiropractic Care

Chiropractic spine manipulation can be very helpful, especially in cases where a misalignment of the spine contributes to the symptoms of neck pain.

C. Spine Exercises

Spine exercises are often recommended for chronic neck pain. They can maintain the muscle tone and mobility, which can help with the symptoms.

D. Physical Therapy (PT)

PT has many different interventions to offer. They include neck traction, ultrasound treatments and spine exercises amongst others.

E. Self Help Devices

There are many Self Help Devices available. They include Neck Braces, Neck Pillows, and Back Mattresses amongst others. Ergonomic devices such as specific ergonomic chairs and desks can be helpful.

F. Medications

Here are some medications which can be helpful for chronic neck pain conditions:

  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
  2. Muscle Relaxants
  3. Acetaminophen
  4. Pain Killers

G. Injections

Here are some spine injections available for chronic neck pain. The kind of injection will depend on the specific condition which is causing the neck pain. Here are some general examples:

  1. Cervical Trigger Point Injections
  2. Cervical Facet Joint Injections
  3. Cervical Radiofrequency Facet Joint Rhizotomies
  4. Cervical Interlaminar Epidural Steroid Injections
  5. Cervical Transforaminal Epidural Steroid Injections
  6. Cervical Nerve Root Blocks



      2. Surgical Treatments

Here are some surgical treatments for Chronic Neck Pain. They are typically reserved for patients with severe pain or nerve dysfunction who have failed conservative spine care. The specific surgery depends on the actual spine problem which is causing the Chronic Neck Pain:

  1. Anterior Cervical Discectomy and Fusion (ACDF)
  2. Cervical Artificial Disc Replacement (C-ADR)
  3. Posterior Cervical Fusion
  4. Cervical Laminectomy and Fusion
  5. Cervical Corpectomy