Neck pain treatment is one of the most frequently requested therapies. Neck pain is slightly more common in women, but most people experience some form of neck pain at some point in their life. There are many causes of neck pain and they can generally be separated into “acute” causes and “chronic” causes. If the pain is suddenly occurs and lasts less than three months then it is considered “acute.” Acute neck pain is commonly caused by disc prolapse, facet syndrome, acute muscle strain, or traumatic injury like whiplash. If the pain persists more than three months it is termed “chronic” neck pain. This pain can be from multiple sources, but is often due to facet joints irritation, discs, ligaments, and muscular sources.
We would advise to take expert opinion on diagnosis & then start treatment as a small muscular sprain may be just a symptom of underlying serious disease.
We have broadly divided treatment options into conservative management, image guided interventions, minimally invasive spine procedures & surgery depending upon specific diagnosis .
1. Conservative treatment: Consists of medication & exercises after confirming the problem to be myofascial.
2. Interventions : Image guided interventions are disease specific & done to reach to source of pain under live x-ray or ultrasound
3. Minimally invasive spine treatment: Instead of open spine surgery modern technique and equipments used to address the problem without destruction or destabilizing spine.
4. Open spine surgery : Surgical advise is only given when other modality fails or there are severe complications characterized by bladder and/or bowel incontinence, lower extremity weakness, spasticity, and/or loss of sensation.
• Medications – NSAIDs (Ibuprofen like drugs), Acetaminophen (Tylenol), muscle relaxants, and membrane stabilizing medications are often effective in treating low back pain.
• Cryotherapy – A probe is placed through a needle near affected painful nerves. Electrical stimulation is done to verify position and freezing cycles are initiated over the painful nerves.
• Transcutaneous Electrical Nerve Stimulation (TENS) – is a technique that relieves pain by applying mild electric current to the skin at the site of the pain. The electric impulses interfere with normal pain sensations and alter perceptions that were previously painful.
• Biofeedback – is a treatment that teaches a patient to become aware of processes that are normally thought to be involuntary inside of the body (such as blood pressure, temperature and heart rate control). This method enables you to gain some conscious control of these processes, which can influence and improve your level of pain. A better awareness of ones body teaches one to effectively relax and this can help to relieve pain.
• Soft Neck Collar – If your pain is severe, your doctor may recommend a soft neck collar to keep your neck still for short periods of time. Resting the muscles and joints can help calm pain, inflammation, and muscle spasm.
• Ice and Heat Applications – You might also be advised to place a cold pack on your neck for 10 to 15 minutes at a time, or you may be shown how to do a contrast treatment. Contrast treatments involve switching between a cold pack and a hot pack.
• Physical therapy – In order to decrease or prevent functional limitations, physical therapy and occupational therapy are recommended as well as medical treatments.
• Epidural Injection: Neck pain or pain that spreads down the arm may require treatment with an epidural injection. In an epidural, the medication mixture is injected into the epidural space around the nerve roots. Generally, an epidural is given only when other non-operative treatments aren’t working. If the injection takes away your pain immediately, this gives your doctor important information suggesting that the injected area is indeed the source of your pain
• Facet Joint Injection: When the problem is thought to be in the facet joints, an injection into one or more facet joints can help determine which joints are causing the problem and ease the pain as well. The fluoroscope is used to guide a needle directly into the facet joint. The facet joint is then filled with medication mixture. If the injection immediately eases the pain, it helps confirm that the facet joint is a source of pain. The steroid medication will reduce the inflammation in the joint over a period of days and may reduce or eliminate your neck pain.
• Trigger Point Injections: Injections of anesthetic medications mixed with a cortisone medication are sometimes given in the muscles, ligaments, or other soft tissues near the spine. These injections are called trigger point injections. These injections can help relieve neck pain and ease muscle spasm and tender points in the neck muscles.
• Radiofrequency Ablation of nerves: 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.
Minimally invasive spine treatment
• Endoscopic discectomy – is a minimally invasive spine procedure, which allows us to treat any problematic disc more safely with great success rate than open spine surgery. Endoscopic discectomy has proved of value not only for discectomy but also for many other back problems. With this minimally invasive technique all kinds of back & neck pain can be addressed in a very tissue-preserving way.
• Endoscopic Foraminotomy – is a minimally invasive spine procedure used to relieve pressure to spinal nerve roots, caused by compression from bone spurs, disc herniations, scar tissue, or excessive ligaments.
• Spinal Cord Stimulation (SCS) – an implanted electrical device that decreases the perception of pain by confusing the spinal cord and brain pain processing centers. Initially, a trial is done to see if this device will help you long-term. In the initial trial, your pain physician places a small electrical lead in the epidural space through a needle. Painful signals are replaced by tingling electrical signals. If you have success in your trial, you may decide to have a permanent SCS device implanted.
• Intrathecal Pump Implants – Implanted pain pumps are also available which can be extremely helpful providing long-term pain control. The effectiveness of intrathecal therapy in patients suffering from nociceptive pain showed a pain reduction in 66.7% of patients experiencing pain due to cancer (Becker 2000).
• Nucleoplasty – Percutaneous Disc Nucleoplasty therapy is designed to reduce the tissue volume of the spinal disc by evaporating part of the liquid core, this lowers the pressure on the walls of the spinal disc, which in turn reduces the painful protrusion of the disc. The pain related to bulging spinal disc walls will subside after the procedure.
• Percutaneous Spine fixation with or without vertebral graft
There are many different minimally invasive spine treatment procedure for neck pain. The goal of nearly all spine procedure is to remove pressure from the nerves of the spine, to stop excessive motion between two or more vertebrae, or both.
Open Spine Surgery
Only rarely is open cervical spine surgery scheduled immediately. Your doctor may suggest immediate surgery if there are signs of pressure developing on the spinal cord or if your muscles are becoming weaker very rapidly.