The causes and treatment of chronic neck pain

Statistics show that chronic neck pain is a common condition for people in the UK, with four in 10 people having it.  But what are the causes? And how is it treated?

Dr Rafik Sedra, leading consultant in pain medicine and anaesthesia, answers these frequently-asked questions about this frequently-reported - and possibly serious - condition. 

What are the causes of neck pain?

Neck pain affects around 40 per cent of the UK population, so it's quite significant. In every 10 people there are four that have neck pain, and actually that can be due to various causes.

The most common one is due to the muscles and ligaments from the musculoskeletal system. It can really affect your day-to-day; if you're doing a desk job every day for 10 hours a day and you're not taking care of the position you're sitting in, your chair isn't comfortable, that can give you muscle and neck pain.

Also, how you sleep on a daily basis; if you have the correct pillow in relation to your neck and head, that can give you neck pain if the adjustment in your position of your head and neck on a daily basis isn't very good. If you do too much, and, for example, you lift lots of weight on the shoulders and neck, more than what you're supposed to do, this again can give you neck pain. All of this is related to musculoskeletal causes. There are some other reasons, as well.

The neck has seven vertebrae, so at some point, the joints between the vertebra can be affected. We call them the facet joints. There is a pair of them between each vertebra, and this can be part of arthritis or osteoarthritis. It can occur in different bones as well; it can happen in the spine and sometimes you can see it in younger patients, sometimes in older patients who are 70 or 80 years old.

The other thing is the disc. Between each vertebra is a disc which is like a pillow. These discs, just changing over time can result in neck pain. Sometimes these discs can slip, which means they move away from their original anatomical position. When it moves out of place, it will touch the nearby structure which are the nerves. That's sometimes why people get neck and arm pain. If your arm starts to feel weak or numb, you need to seek advice quite quickly.

Also with the older population, they can have low calcium and changes in hormones can lead bones to become quite fragile. They can have osteoporosis, which can lead to fractures. It can happen, and it's very painful. This is a warning sign and you need to seek advice.

You can also have a trauma, for example, a car accident and have a whiplash injury to the neck. That affects the muscles and ligaments, and has an effect on the joints between the vertebrae, the discs and the nerves, which I mentioned before. It can be quite bad actually, and it can really affect what you're doing on a daily basis.

Those are the causes; muscles and ligaments, discs, nerves and bones. There are some other things that are quite dangerous, like when some people who have cancer that's metastasized into the bones.

When can I seek advice from a specialist for my neck pain?

In terms of seeking advice, I'm always worried about any patient that has a trauma and has significant neck pain. You need to seek advice just in case the bones have been fractured or the disc has slipped, and is touching the spinal cords in the middle. This can lead to serious problems and especially when you have neck pain and arm weakness, you need to seek advice quite quickly.

After trauma, when you have arm weakness with neck pain, and when it is excruciating and severe in the midline this means there might be a fracture in the vertebrae.

Definitely, as well, with cancer patients; you know they have cancer and they start to have severe pain in the midline of your neck, this might be one of the signs that the cancer has gone to the bones. You need to seek advice with this.

How can I manage my chronic neck pain?

When the pain has lasted over three months, affecting your daily activities; how you sleep, work, and for example 'I cannot play with my kids', or 'I can't look after my dad or mum'. When it starts to affect your daily activities, it can make you feel low and depressed, so it can also affect your wellbeing. When it starts to be like that, you need to start looking to what you can do for it, and see a specialist. It isn't something dangerous but it's starting to affect your life so you need to do something about it.

How can you manage it? There are three main ways of managing it. First of all is physiotherapy. Physiotherapy is quite successful treatment for neck pain. Some people will need manual hands-on physiotherapy to try to release the stiffness of the neck muscles, and it's quite successful if you have efficient and good physiotherapy.

Sometimes a chiropractor is related to physiotherapy. They will do manual manoeuvres to try to get the muscles back to normal, acting physiological status. Before going to the chiropractors, you need to have a scan on your neck and ensure there isn't any compression of the nerves. If you have any weakness in your arm, or numbness in your hand you need to tell your chiropractor and they will be very careful about the manoeuvres. Unfortunately, you have for example a disc compressing on the nerve and you do quite aggressive manoeuvres this can lead to severe problems in compression of the nerves, and becoming more and more weak in the arm. You need to have a neck scan when you get neck pain or arm pain before you go to any chiropractors. They will ask you about your scan results, or if you have any pain in your arm.

In terms of adjusting your daily environment, get the right chair for you, and the right pillow for when you're sleeping overnight. Try to adjust the things around you to help you and to experience less muscle pain.

If that works, very good, and if not, you need take the next step. This would be medications. Neck pain can be due to various reasons, however there are medications with muscle relaxant and medication which reduces inflammation if you have osteoarthritis, arthritis, or something irritating the nerves. Also, if you have neck and arm pain, so you have nerve pain in your neck, sometimes there are medications which work on the nerves. We call them anti-neuropathic and it helps to calm down the nerves. Those are the three main medications.

There's also a TENS machine, which you place near to the midline. It creates a nice, tingly sensation for your muscles and tried to decrease the pain in pulses through the nerves.

If you try physiotherapy, adjust your environment, your workplace and your medication, and it still isn't working for you, you might need interventions. You might need injections related to what type of pain you have. For the muscles, sometimes, we do some injections more specifically for the muscles.

Sometimes with the shoulders; patients ask if it's chronic in my neck, or shoulders. It's a difficult question and we need to examine the patient, or when we have problems with the joints between the vertebrae - the facet joints - they can be injected as well. There are quite good results with this and we can offer electric current treatment with this - we call it radiofrequency - for the nerves supplying the joints. This can last up to one and half years, and throughout that time when you're pain free, patients work their muscles, they go to physiotherapy and go to the gym to do the right exercises and getting your muscles stronger. Hopefully this means you don't have to come back to me to see if anything else can be done, or not.

If the pain from the neck is relating to a disc touching a nerve, again there are some injections for the nerve and this will offer immediate relief. Finally, if you have discs which compress on your nerve, and you've had injections, medications and physiotherapy but it still doesn't work you might sometimes need to seek advice from a spinal surgeon to see if anything needs to be done or not. Very rarely, it depends on the cause, but the main treatment would be physiotherapy, medication and some people need specialist intervention.

If you're concerned about chronic neck pain, arrange an appointment with Dr Sedra via his Top Doctors profile.