Most neck pain can be treated with nonsurgical methods, with self-care at home and/or with guidance from a medical professional.
Self-Care for Neck Pain
If neck pain is not debilitating and didn’t start as the result of trauma, then often the pain can be treated by oneself. Self-care options for neck pain can include:
- Rest. With most neck strains and sprains, going easy for a few days is all that is needed while the muscles and tendons heal on their own. It is important to be careful to avoid strenuous activities or movements that are causing more pain.
- Ice and/or heat. Applying ice can work as an anti-inflammatory to reduce swelling and pain. Initially, it’s better to apply ice or cold packs for neck pain because they can temporarily close small blood vessels and prevent swelling from becoming worse. After a couple days, ice or heat can be applied on an alternating basis. Applying continuous heat can cause increased swelling.
- Massage. Often employed after applying ice or heat, a massage can soothe muscle tension and spasms, reducing pain.
- Better posture. If poor posture is causing the neck pain, then simple changes might be the solution. This could include changing a workstation to become more ergonomically friendly, with a chair, monitor, and keyboard positioned in ways to keep the body, head, and neck more aligned in a natural position; or learning to sleep on the back (instead of the stomach or side) with an ergonomically-friendly pillow and mattress.
- Modify lifestyle. If certain activities are found to cause neck pain that keeps coming back, then those activities might need to be limited or avoided. For example, if someone spends a few hours every day with their neck craned over a smartphone while texting friends and checking updates, then that activity should be reduced; and the phone should be held up closer to eye level to keep the neck more upright while texting.
- Over-the-counter medications. Many over-the-counter pain relievers are available to either reduce inflammation or hinder pain signals from reaching the brain. However, these drugs must be used with caution. Read the pain reliever’s entire label for directions and warnings, and be careful not to overdose. For example, the active drug in Tylenol is acetaminophen, which is also found in many other common drugs, such as cold and allergy medications.
If neck pain lasts more than four weeks or keeps coming back, or if there are other troublesome symptoms (for example, neurological symptoms), then it is important to consult a medical professional for an evaluation.
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Nonsurgical Medical Care for Neck Pain
Medical care for most types of neck pain typically starts with nonsurgical treatments such as one or some combination of the following:
- Physical therapy. Most treatment programs usually include some form of physical therapy to improve neck strength and flexibility. The physical therapy program’s structure and length will vary depending on the specific diagnosis and situation. In the beginning, the person will typically have multiple sessions per week with a trained physical therapist, and then in time will progress to performing the prescribed exercises at home.
- Prescription pain medications. If an over-the-counter pain reliever hasn’t been effective, prescription-strength medications may be tried. Many pain medications are available, and each has its own potential risks and benefits. While opioids have commonly been prescribed for pain relief in the past, the CDC changed its guidelines in 2016 and recommends fewer opioid prescriptions for chronic pain management due to the risk for addiction and other possible complications.1
- Cervical epidural steroid injections. This procedure involves injecting cortisone steroid solution into the cervical epidural space, which is the outer layer of the spinal canal. To ensure that the injection goes into the epidural space near the inflamed nerve, X-ray guidance (fluoroscopy) is used. The goal of the injection is to reduce inflammation of the nerves, or nearby tissues caused by a disc herniation. These injections can help reduce the pain to enable the person to return to normal activities and/or make progress with a physical therapy program. This injection is not always effective and has some risks, including the possibility of infection, and its use might be limited to a few times a year.
- Cervical facet injections. If neck pain is caused by irritation of the facet joints, injections of steroids into the specific joints can reduce the pain. If the facet injections yield predictable but temporary pain relief, sometimes radiofrequency ablation (RFA) of the small sensory nerves that go to the affected facet joints may be recommended. While these RFA procedures may have longer effects, these injections are not designed to cure the problem, but rather to temporarily offer relief for the irritated facet joints.
- Trigger point injections. Irritation of specific muscle bundles can be the source of pain. Trigger point injections are designed to reset the normal orientation of these irritated muscle bundles. The injection materials can vary from saline, lidocaine, dextrose, or cortisone. This type of treatment may be nuanced but effective for well-defined trigger point irritations to the neck muscles. These treatments may not have long term efficacy, or may not have the desired pain reduction.
- Manual manipulation. A chiropractor or other health professional may make manual adjustments to the spine in an effort to improve range of motion and reduce pain. Also referred to as a chiropractic adjustment, manual manipulation is usually done in an office on a table. The chiropractor will typically use his or her hands to do the adjustments, but sometimes a machine can be used to make gentle adjustments. Some people report that chiropractic adjustment has helped reduce neck pain, but not everyone reports benefits. Also, while rare, there have been reports of high-velocity cervical spine adjustments being associated with negative outcomes, such as stroke or paralysis.
- Acupuncture. With its roots in Chinese medicine from thousands of years ago, acupuncture involves placing thin needles into the body at key points based on the condition being treated. A typical treatment might last less than an hour before the needles are removed. In the US, the needles must be disposed and not reused. It’s important that the acupuncturist is licensed and uses sterile needles. Acupuncture is usually well-tolerated by most patients and is generally considered safe.
The above does not cover every possible treatment available for neck pain.
In addition to the above treatments, anything the individual can do to lead a healthy life will also positively impact neck pain. For example, moderate aerobic activity several times each week, and stopping smoking, can be beneficial for most types of neck problems.