Since many types of neck pain are caused by sudden trauma like muscle strains or sprains that heal quickly, neck pain treatment generally begins with conservative care in the form of pain medications, heat/ice therapy, and even physical therapy and muscle conditioning.
While such neck pain treatment methods typically relieve neck pain in a large percentage of patients, other instances in which chronic neck pain is present may require more interventional care.
Dr. Stephen Montgomery, MD, is an orthopedic spine surgeon in Raleigh, NC and a contributing Spine-health author who often examines and treats patients with different types of neck pain.
In this article, Dr. Montgomery and another frequent contributor to Spine-health, Dr. Grant Cooper, MD, discuss conservative and interventional neck pain treatment methods, including:
- non-surgical neck pain treatment
- neck immobilization
- conservative neck pain treatment time frames
- supplemental treatment for conservative neck pain care
- diagnostics for neck pain treatment
- other neck pain treatments.
Common Conservative Neck Pain Treatments
Dr. Cooper: Dr. Montgomery, we've got this patient with neck pain and he had this sort of indolent course with the neck pain not going away. It's isolated to the neck, it gets worse as the day goes on. We do a history and we do a physical exam. We find that he has a decreased range of motion, he has some tender points in the neck, and we get some X-rays and the X-rays show some fairly non-specific degenerative changes, osteoarthritic changes, within the neck. What's next?
Dr. Montgomery: Well, if there are no other worrisome findings, in particular nothing that would point us to any more major changes on X-ray or in the physical exam such as neurological changes, then we probably have what we would call cervical spondylosis or inflammation, and we would then come up with a formulated treatment plan.
One of the main things that we would emphasize with our patient is that we're very optimistic that they should get over this relatively acute episode. Well over 90% of patients will make a recovery.
There are some accepted treatments that can be helpful, and to outline those we would talk about activity modification. If the patient is involved in some high-risk activities, perhaps certain types of recreational activities, impact-type activities, heavy weight-lifting, we might restrict them there.
We would talk about their posture and the proper mechanics. There's a lot of information that patients can get in printed material and on the internet that are excellent sources of conservative treatment for spinal conditions like this.
We would talk about the possibility of using pain medications. We tend to start with the medications like acetaminophen (e.g., Tylenol), anti-inflammatories (e.g., aspirin, ibuprofen, naproxen) if the patient has no risk factors to cause problems with that class of medications, and, depending on the degree of symptoms, we might suggest some physical therapy.
Physical therapy is a very standard traditional way of helping patients to get rid of some of the inflammation that they have in their spine, and then progressing into a rehabilitation program. So we might use any or all of those recommendations.
In This Article:
Neck Immobilization Treatments and Effectiveness
Dr. Cooper: Terrific. There are some good conservative treatments available. Since you didn't plug the website that you're affiliated with, I will, that's www.spine-health.com. There are some really terrific articles about some of the more conservative as well as the more interventional treatments there. You mentioned physical therapy and activity modification. People sometimes wear neck collars, but I think that used to be more popular than it is today. How do you feel about putting patients in neck collars?
Dr. Montgomery: We don't use those very often. I'm an orthopedic surgeon and we've learned a great deal from our sports medicine colleagues, and we really like to emphasize a functional restoration, and that is getting over the acute symptoms, but then rapidly progressing into range of motion, strengthening, flexibility, conditioning types of exercise. We know that resting, immobilizing parts of the anatomy, leads to decreased range of motion and deconditioning the muscles very rapidly, so we don't like to use collars for any lengthy period of time in a setting like this.
Dr. Cooper: Something that I've seen done is to use a neck collar only at night, when they don't realize that as they sleep their muscles might be more relaxed and they might tweak their neck that way. Do you ever use a neck collar at night?
Dr. Montgomery: I do, and of course the other thing that we would do at night is various cervical pillows which can help cradle the neck and restore more of an anatomic alignment of the neck when patients are sleeping. I think all of those things can be tried.
Time Periods for Conservative Neck Pain Treatment
Dr. Cooper: How often do you try these conservative measures? For example, you get the patient enrolled in all of these things and the patient is not getting better. How long do you say "just keep at it" until you think that something else might be needed?
Dr. Montgomery: Well, if the patient has presented with symptoms going on for a period of several weeks, we would certainly give that patient a period of four to six weeks of conservative treatment. If we're talking about a conditioning program or a rehabilitation program, we know, again from our sports medicine colleagues, that it takes a period of time to recondition the soft tissue and to get the muscles and soft tissue flexible and strong, so unless the patient is having worsening of their symptoms…If the symptoms change, patients are encouraged to get in touch with their physician and reassess.
Dr. Cooper: Right. Suppose the symptoms aren't changing per se, but they're just not getting better. First of all, I'll back up a second. Of the patients that you see, what percentage of patients would you say respond to that conservative care?
Dr. Montgomery: In the acute setting or the subacute setting, of the symptoms being present for just a few weeks, say four to six weeks, I would say 80-90% of patients are going to improve. Now, the timeline to improve may be a period of weeks, but as long as patients are improving and they can function, they can sleep, they can work, they can do their daily activities, then we encourage them to continue with the conservative measures.
Dr. Cooper: Terrific. Now, that's great for the 80-90% that get better. What about the 10-20% of people who after six weeks say, "You know what? I'm just not better." What kind of things can we offer them?
Supplements to Conservative Neck Pain Treatment
Dr. Montgomery: Well, we might ramp up our pharmacologic input. Some patients, if they're having a great deal of inflammation, we may try a short dose of steroids, what's called a Medrol Dose Pack (Editor's note: Oral steroids come in many forms, but are usually ordered as a Medrol Dose Pack in which patients starts with a high dose for initial pain relief and then taper down to a lower dose). That's a very powerful anti-inflammatory that can sometimes help folks. We might add things like a muscle relaxant or some pain medicine if they're having a lot of functional difficulty.
We might have physical therapy try a little bit more aggressive program, sometimes cervical traction or a home cervical traction unit. If the patients aren't making progress as the weeks go on, they're getting discouraged and we feel they're not making much progress, we may decide to do some further diagnostic studies. The next diagnostic study we might think about would be an MRI.
Neck Pain Diagnostics: MRIs
Dr. Cooper: And what might you see on the MRI?
Dr. Montgomery: Well, once again we're looking for more detail on the anatomy. We're trying to make an anatomic diagnosis of the patient's symptoms. The MRI is a very detailed evaluation that gives us information about the soft tissues, the muscles, the ligaments, the spinal canal, the nerve roots, the disc, so it gives us a great deal more detail about the anatomy in this particular case.
Dr. Cooper: Okay, so you get the MRI. What would be the most common finding you would say that you would see on the MRI in a patient such as this?
Dr. Montgomery: Well again if we're talking about a patient who just has predominantly neck symptoms and doesn't have a lot of arm symptoms, we would probably expect to see perhaps some bone spurring (called osteophytes), that form with some degeneration of the disc and the spine. We might expect to see some narrowing of the disc space. We might be able to see some nerve root compression, if the spurs are large. Those would be the most common findings.
Ergonomics, Alternative Care, and Surgery for Neck Pain
Dr. Cooper: Okay. Say that you see those common findings. What might be the next thing that you would do?
Dr. Montgomery: Well, if we have gone through a very vigorous rehab program, then each time the patient returns we're going to take another history, we're going to go through the physical exam like we started with initially, and see if anything's changed.
One of the points that I wanted to make earlier in the history of the patients is that we want to explore their work situation. We want to know what kind of work they do. In my experience, we're seeing more and more patients that work at a computer workstation and that may spend their whole working day either on the telephone or on the computer or both and sometimes simple things like changing a workstation, doing what's called an ergonomic evaluation of their workstation, can improve their symptoms as well.
If nothing's helping, patients may want to try some alternative treatments. Certainly we know that our patients go to chiropractors, sometimes they'll try things like acupuncture, and once in a great while if patients don't respond to anything, if they've got some anatomic abnormalities, then we might talk about neck surgery, but that's a very, very small subset of patients.
Dr. Cooper: How about things like epidural injections or facet injections. We know that we do those in the back sometimes. Do we ever do them in the neck?
Dr. Montgomery: In my experience we will occasionally try the epidural steroid injections. That would typically be in a group of patients having more neurologic symptoms, perhaps having radiating pain into their shoulders or arms, or some numbness and tingling. Maybe we're concerned about some nerve root compression. I have not had as much experience with the facet injections. Our pain doctors, our physiatry colleagues, who do a lot of pain management, would try things like nerve root blocks or trigger point injections. I have not seen as much of the facet injections in the cervical spine as I have in the lumbar spine or the low back.
Additional disclaimer: Spine-health.com does not offer medical advice or treatment. This information does not replace the physician-patient relationship, and the information is not medical advice or treatment. It should only be considered as a physician's opinion. Patients should always seek the advice of a trained health professional for back pain or any health condition. Please note that the contents of this section have not been peer reviewed by Spine-health.com's Medical Advisory Board.