Neck Pain

What is neck pain?

Neck pain can occur anywhere in your neck, from the bottom of your head to the top of your shoulders. It can spread to your upper back or arms. It may limit how much you can move your head and neck.

Neck pain is common, especially in people older than 50.

What causes neck pain?

Most neck pain is caused by activities that strain the neck. Slouching, painting a ceiling, or sleeping with your neck twisted are some things that can cause neck pain. These kinds of activities can lead to neck strain, a spasm of the neck muscles, or swelling of the neck joints.

Neck pain can also be caused by an injury. A fall from a ladder or whiplash from a car accident can cause neck pain. Some less common medical problems can also lead to neck pain, such as:

• An infection in the neck.
• Narrowing of the spinal canal in the neck (cervical spinal stenosis).
• Rheumatoid arthritis.

What are the symptoms?

You may feel a knot, stiffness, or severe pain in your neck. The pain may spread to your shoulders, upper back, or arms. You may get a headache. You may not be able to move or turn your head and neck easily. If there is pressure on a spinal nerve root, you might have pain that shoots down your arm. You may also have numbness, tingling, or weakness in your arm.

If your neck pain is long-lasting (chronic), you may have trouble coping with daily life. Common side effects of chronic pain include fatigue, depression, and anxiety.

How is neck pain diagnosed?

Your doctor will ask questions about your symptoms and do a physical exam. He or she may also ask about any injuries, illnesses, or activities that may be causing your neck pain.

During the physical exam, your doctor will check how well you can move your neck. He or she will also look for tenderness or numbness, tingling, or weakness in your arms or hands.

If your pain started after an injury, or if it doesn't improve after a few weeks, your doctor may want to do more tests. Imaging tests such as an X-ray, an MRI scan, or a CT scan can show the neck muscles and tissues. These tests may be done to check the neck bones, spinal discs, spinal nerve roots, and spinal cord.

How is it treated?

The type of treatment you need will depend on whether your neck pain is caused by activities, an injury, or another medical condition. Most neck pain caused by activities can be treated at home.

For neck pain that occurs suddenly:

• Reduce pain by putting an ice pack on the sore area and taking aspirin, ibuprofen, or another anti-inflammatory medicine. Acetaminophen (such as Tylenol) can also help relieve pain.
• Avoid more injury to your neck by changing activities and habits, such as how you sit or sleep.
• Try exercises or physical therapy to help you move your head and neck more easily.

To treat chronic neck pain, your doctor may prescribe medicine to relax your neck muscles. Or you may get medicines to relieve pain and help you sleep. You might also try massage or yoga to relieve neck stress.

Surgery is rarely done to treat neck pain. But it may be done if your pain is caused by a medical problem, such as pressure on the spinal nerve roots, a tumor, or narrowing of the spinal canal.

Can you prevent neck pain?

You can avoid neck pain caused by stress or muscle strain with some new habits. Avoid spending a lot of time in positions that stress your neck. This can include sitting at a computer for a long time.

If your neck pain is worse at the end of the day, think about how you sit during the day. Sit straight in your chair with your feet flat on the floor. Take short breaks several times an hour.

If your neck pain is worse in the morning, check your pillow and the position you sleep in. Use a pillow that keeps your neck straight. Avoid sleeping on your stomach with your neck twisted or bent.

Neck pain can be caused by an activity or injury that harms the neck or by another medical condition.

Activities that cause neck pain

Most neck pain is caused by activities that result in repeated or prolonged movements to the neck's muscles, ligaments, tendons, bones, or joints. This can result in a strain (an overstretched or overused muscle), a sprain (injury to a ligament), a spasm of the neck muscles, or inflammation of the neck joints.

These activities include:

• Holding your head in a forward or odd position for long periods of time while working, reading, watching TV, or talking on the telephone.
• Sleeping on a pillow that is too high or too flat or doesn't support your head, or sleeping on your stomach with your neck twisted or bent.
• Spending long periods of time resting your forehead on your upright fist or arm ("thinker's pose").
• Work or exercise that uses the upper body and arms, such as painting a ceiling or other overhead work.

Stress and focusing intensely on a task can contribute to neck pain. Tension may develop in one or more of the muscles that connect the head, neck, and shoulders. They may feel tight and painful.

Injuries that cause neck pain

The spine consists of interlocking bones (vertebrae) and discs that separate the vertebrae. The portion of the spine that runs through the neck is known as the cervical spine. Muscles and ligaments in the neck hold the cervical spine together. Injury to any of these structures may result in neck pain.

See illustrations of the neck and the vertebrae and discs.

Minor injuries may occur from tripping or falling a short distance or from excessive motion of the cervical spine. Severe neck injuries may occur from whiplash in a car accident, falls from significant heights, direct blows to the face or the back or top of the head, sports-related injuries, a penetrating injury such as a stab wound, or pressure applied to the outside of the neck, such as strangulation.

Pain from an injury may be sudden and severe. Bruising and swelling may develop soon after the injury. Sudden (acute) injuries can result in:

• A strain or a sprain in the neck.
• A break or dislocation of the spine. This may cause a spinal cord injury that may lead to lack of movement and feeling (paralysis). It is important to immobilize and move the injured person correctly to reduce the risk of further injury. For more information, see first aid for a spinal injury.
• A ruptured disc (herniated disc) in the cervical spine. If the rupture is large enough, the jellylike material inside the spinal disc may leak out and press against a spinal nerve. A herniated disc in the cervical spine can also occur as part of aging. See an illustration of a herniated disc.

Medical conditions that cause neck pain

Neck pain may be caused by or related to another medical condition. This can include:

• Conditions associated with increasing age, such as the narrowing of the spinal canal (cervical spinal stenosis) and arthritis of the neck (cervical spondylosis).
• Illnesses such as meningitis, which causes inflammation around the tissues of the brain and spinal cord, and the flu (influenza). When neck pain is caused by flu, the neck and the rest of the body tend to ache all over, but there is no severe neck stiffness.
• Chronic conditions such as fibromyalgia, rheumatoid arthritis, or ankylosing spondylitis.
• Torticollis (wryneck). Torticollis is caused by severe muscle tightness or a shortened muscle on one side of the neck, causing the head to be tilted to one side. Torticollis is usually a symptom of another medical problem.
• Referred pain. Referred pain occurs when a problem in one place in the body causes pain in another place. For example, a problem with your jaw (temporomandibular disorder) or your heart (such as a heart attack) can cause neck pain.
• Infection or a tumor in the neck area.

Side effects of some medications include neck pain.

Characteristics of neck pain include:

• Pain that occurs from the bottom of your head to the top of your shoulders. Pain may spread to the upper back or arms.
• Pain that is worse with movement.
• Limited head and neck movement. The neck may be stiff or tender.
• Headaches. These are common and may persist for months.

Nerve-related symptoms caused by pressure on the spinal nerve roots or spinal cord include:

• Numbness, tingling, or weakness in the arm or hand.
• A burning feeling when touched on the skin of the arm or hand.
• A shocklike pain that extends into the arm or hand.
• Leg numbness or weakness, and loss of the ability to control urination (bladder control). This occurs when there is considerable pressure or injury to the spinal cord.

If your neck pain is long-lasting (chronic), it may be difficult to cope with daily life. Common side effects of chronic pain include fatigue, depression, and anxiety. For more information, see the topic Chronic Pain.

Most cases of neck pain caused by activities, such as computer use or sleeping position, improve within 4 to 6 weeks with treatment that includes taking steps to relieve pain, modifying activities, and doing exercises or physical therapy.¹

Neck pain caused by injuries, such as a fall resulting in a herniated disc, usually improves within 3 months with nonsurgical treatment. Neck pain caused by an injury such as whiplash may take longer but usually improves within 6 to 12 months with occasional recurring pain.¹

Neck pain may become long-lasting (chronic) when it occurs in combination with other health conditions, such as conditions associated with increasing age. These include narrowing of the spinal canal (cervical spinal stenosis) and arthritis of the neck (cervical spondylosis). In some cases, chronic neck pain can be caused by repeated and prolonged movements, such as long hours working at a computer.

Chronic neck pain may result in increased irritability, fatigue, sleep disturbances, and poor quality of life. If treatment fails, neck pain may lead to depression, chronic pain syndrome, or drug dependence. For more information, see the topic Chronic Pain.

Risk factors for neck pain that you cannot control include:

• Age. People older than 50 are more likely to have breakdown (degeneration) of discs or joints, as well as bone spurs in the vertebrae of the neck (cervical spondylosis).
• Recent injury or history of injury. A common injury to the neck is whiplash caused by a car accident.
• Conditions that affect the bones and soft tissues of the neck and back, such as rheumatoid arthritis, a narrowing of the spinal canal (cervical spinal stenosis), or a severely curved spine (scoliosis).
• A history of having headaches.

Risk factors that you can control include:

• Awkward positions that put stress on the neck.
• Stress and poor posture, at home or at work.
• Heavy physical work.
• Boredom at or unhappiness with work.
• Depression.
• Smoking.
• Drug abuse.
• Poor physical condition and lack of exercise.

Call 911 or other emergency services immediately if you have been injured and you have:

• A severe neck injury, such as an injury caused by a:
  • Serious car accident.
  • Fall from a height of 15 ft (4.6 m) or more.
  • Major sports-related injury.
  • Very forceful blow to the head or neck.
  • High-energy strike on top of the head.
  • Penetrating injury, such as a stab or gunshot wound.

• Signs of a spinal cord injury, such as:
  • Weakness or inability to move the arms or legs.
  • Continuous numbness of one or both arms or legs.
  • Loss of bowel or bladder control.

• Neck pain that occurs with chest pain and other symptoms of a heart attack. These include:
  • Chest pain that is crushing or squeezing or feels like a heavy weight on the chest.
  • Chest pain that occurs with:
    • Sweating, shortness of breath, nausea, or vomiting.
    • Pain that spreads from the chest to the back, neck, or jaw, or one or both shoulders or arms.
    • Dizziness or lightheadedness.
    • A fast or irregular pulse.

Call your health professional immediately if you have:

• A stiff neck and/or severe headache, fever, vomiting, confusion, and/or difficulty staying awake or alert.
• Neck pain and severe arm pain.
• Neck pain and suddenly developing numbness, tingling, or weakness in one or both of your arms.
• Severe neck pain following an injury.
• Severe neck pain with no known cause.
• A new weakness in your arms and legs.
• A new loss of bladder or bowel control.

Call your health professional today if you have:

• Severe restriction of neck movements.
• Neck pain or stiffness after starting a new medication.
• Constant numbness or tingling in one arm or hand.
• Constant weakness in one arm.
• Moderate pain following an injury.
• Arm weakness, numbness, or tingling that has become worse since you were evaluated by your health professional.
• Ongoing (chronic) pain that is getting worse.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. Most neck pain does not require medical care. In general, pain relief and neck movement should improve after a couple of days of home treatment that includes:

• Limiting activities that increase neck pain.
• Taking nonprescription pain relievers and using ice to reduce pain.
• Doing gentle exercises to keep the neck flexible.

If you have severe neck pain that has not gone away after 1 or 2 days and you are not able to do your normal daily activities, call your health professional.

Who To See

Health professionals who can evaluate and treat neck pain include:

• Emergency medicine doctors.
• Primary care providers. This includes:
  • Internists.
  • Family medicine doctors.
  • Nurse practitioners.
  • Physician assistants.

If your neck pain is severe or long-lasting, health professionals who can treat you include:

• Physical therapists.
• Orthopedists.
• Rheumatologists.
• Neurologists.
• Osteopathic doctors.
• Physiatrists.

Alternative health professionals who can provide care include:

• Acupuncturists.
• Certified massage therapists.
• Chiropractors.

To prepare for your appointment, see the topic Making the Most of Your Appointment

Initial testing

Neck pain is usually evaluated with a medical history and physical examination. Your health professional will ask about your symptoms, injuries or illnesses, any previous treatment, and habits and activities that may be causing your neck pain. During the physical exam, your health professional will check your neck's range of motion and check for pain caused by movement. He or she will look for areas of tenderness and any nerve-related changes, such as numbness, tingling, or weakness in the arm or hand.

Blood tests may be done to check for an illness or infection.

If you have no signs of a serious condition or recent injury, imaging tests, such as X-rays, may not initially be needed.

Imaging, electromyogram, and nerve conduction tests

If, after a period of treatment, your neck pain does not improve, you may need imaging tests, particularly when:

• You have signs of nerve damage.
• Another serious problem is suspected.
• Neck pain is chronic (lasting more than a few weeks) and has not improved with treatment.
• The cause of your condition cannot be clearly identified.
• Your health professional is asked to provide documentation of your condition, such as when legal or compensation issues arise from a neck injury.

In some cases, imaging test results do not correspond to symptoms or the findings of a physical exam. For example, test results may be normal, yet you may have severe symptoms. However, imaging tests provide useful information and are commonly used. Imaging tests that may be used to evaluate neck pain include:

• X-rays, which help to evaluate the bones and joints of the neck.
• Magnetic resonance imaging (MRI), which helps to evaluate the spinal cord and nerve roots. MRI is helpful in identifying a herniated disc and nerve root impingement (pinched nerve).
• Computed tomography (CT) scan, which helps to evaluate the bone and spinal canal.
• Myelogram, which can provide further detail of the spinal canal and nerve roots.

Tests that are done to check the spinal cord and nerves in the neck include electromyogram and nerve conduction studies. These tests can help identify the location and nature of a nerve problem that is causing pain, numbness, or weakness in the arm or hand.

Treatment for neck pain consists of reducing the pain with ice and medication, improving neck movement and flexibility with exercises or physical therapy, and avoiding further neck injury by changing activities and body mechanics, such as how you sit or sleep. The specific treatment may depend on whether your neck pain is caused by activities, an injury, or another medical condition. Home treatment is often all that is needed for neck pain.

Because most neck pain is caused by repeated or prolonged movements to the neck's muscles, ligaments, tendons, bones, or joints, nonsurgical treatment is usually effective. Most cases of neck pain caused by activities resolve within 4 to 6 weeks.¹

Acute neck pain

For sudden (acute) neck pain:

• Place an ice pack or cold pack over painful muscles for 24 to 48 hours. This will help decrease any pain, muscle spasm, or swelling. If the problem is near the shoulder or upper back, ice the back of the neck. If you prefer, try ice massage. Massage the painful area with ice for 2 to 7 minutes, long enough to numb the pain. Ice frozen in a Styrofoam cup works well. Be sure not to damage your skin (frostbite).
• Avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages, for the first 48 hours after an injury. After 48 to 72 hours, if swelling is gone, apply heat. Use a warm pack or heating pad set on low. Some experts recommend alternating between heat and cold treatments.
• Return to your normal daily activities as soon as possible. Research suggests that continuing normal activities after a neck-strain injury helps resolve some symptoms faster than taking time off from work and using neck immobilization.²
• Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain. Nonprescription creams or gels, such as Bengay, may provide pain relief.
• Take pain relievers. Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve), can help relieve pain and reduce inflammation. Do not give aspirin to anyone younger than 20 because of the risk of Reye's syndrome. Acetaminophen (such as Tylenol) can help relieve pain.

For severe pain or muscle spasm, your doctor also may prescribe:

• Muscle relaxants, which treat severe pain spasms when neck pain begins. They include diazepam (Valium), cyclobenzaprine (Flexeril), and carisoprodol (Soma).
• Narcotic pain relievers, which are used short-term for severe neck pain. They include codeine, acetaminophen and hydrocodone (Vicodin, Lortab), aspirin and oxycodone (Percodan), and acetaminophen and oxycodone (Percocet).

The treatment that is right for you may be different from the treatment for someone else with neck pain. Some treatments have been studied more than others. Many treatments for neck pain haven't been very well researched, even if they are used a lot. A review of multiple studies shows that exercise and manual therapy, used either separately or together, are likely to be beneficial in the treatment of uncomplicated neck pain.²

Your health professional may recommend that you wear a cervical collar to support your neck. Cervical collars may reduce neck pain, but they should be used only for a day or two. See an illustration of a cervical collar.

Chronic neck pain

For long-lasting (chronic) neck pain, you can use the same treatment used for acute pain, although you do not have to worry about swelling. Your health professional may prescribe other medications, such as antidepressants. These include doxepin (Sinequan) and amitriptyline (Elavil, Endep).

You can aid healing and prevent further injury by:

• Having physical therapy. For home treatment, you can use heat and massage. A physical therapist can teach you exercises to do at home. These can keep your neck flexible and strong and prevent stiffness.
• Changing or avoiding any activities that may be causing your neck pain, such as prolonged computer work or overhead work.
• Maintaining good health habits. If possible, reduce stress and tension at work and home. Stop smoking; smoking slows healing because it decreases blood supply and delays tissue repair. Exercise regularly, including aerobic exercise such as walking. For more information, see the topics Stress Management, Quitting Tobacco Use, and Fitness.
• Trying manual therapy. A trained practitioner may use slow twisting, pulling, or pushing movements. When slow, measured movements are used, it is known as "mobilization." Avoid rapid, forceful movements, which are known as "manipulation." Talk to your doctor before trying manual therapy.

Surgery

Surgery is rarely required for neck pain. It may be considered to treat neck pain caused by pressure on the nerve roots or spinal cord, a severe injury that has broken a neck bone (vertebra), a tumor, infection, or a spinal condition such as narrowing of the spinal canal (cervical spinal stenosis) or arthritis of the neck (cervical spondylosis). Surgical options include:

• Discectomy (with or without fusion). For more information on discectomy, see the Surgery section of the topic Herniated Disc.
• Cervical spinal fusion, in which selected bones in the neck are joined (fused) together.
• Spinal decompression, in which pressure is reduced on the spinal cord or spinal nerve roots by removing part of a bone or disc.

What To Think About

A review of studies reports that:²

• Exercise reduced pain better than medication for muscle pain or spasm, stress management, or no exercise.
• There is not enough evidence to determine whether medications, transcutaneous electrical nerve stimulation (TENS), ice and heat, soft cervical collars, or special pillows are helpful for neck pain.

In one small study, women with chronic neck pain were taught and used neck endurance and strengthening exercises for 1 year. Compared with people who had chronic neck pain and were not using the exercises, the exercise group had less pain and disability.³

Keeping your neck moving improves its function and helps it heal. In general, cervical collars are only used after a surgery or for a day or two after a neck sprain.

People who have chronic pain syndrome and its associated problems, such as depression or drug dependence, may respond to treatment more slowly. Counseling in addition to medical treatment may help in recovery.

Neck pain caused by stress or muscle strain can often be prevented by using good posture, getting regular exercise, and avoiding long periods in positions that stress the neck, such as prolonged computer work or painting a ceiling.

• If neck pain is worse at the end of the day, evaluate your posture and body mechanics.
  • Avoid slouching or a head-forward posture. Sit straight in your chair with your lower back supported, feet flat on the floor, and shoulders relaxed. Avoid sitting for long periods without getting up or changing positions. Take short breaks several times an hour to stretch your neck muscles.
  • If you work at a computer, adjust the monitor so the top of the screen is at eye level. Use a document holder that puts your work at the same level as the screen. See an illustration of using a computer workstation. For more information, see the topic Office Ergonomics.
  • If you use the telephone a lot, consider using a headset or speaker phone. Do not cradle the phone on your shoulder.
  • Adjust your car seat to a more upright position that supports your head and lower back. Make sure that you are not reaching for the steering wheel while driving. Your arms should be in a slightly flexed, comfortable position.
  • Use proper lifting techniques. Lifting with your knees, not your back, can also help prevent neck pain.
• If neck pain is worse in the morning, check your pillow and sleeping posture.
  • Use a pillow that keeps your neck straight, neither too high nor too flat. Special neck support pillows called cervical pillows or rolls may relieve neck stress. You can also fold a towel lengthwise into a pad that is 4 in. (10 cm) wide, wrap it around your neck, and pin it in position for good support.
  • Use a pillow that doesn't force your head forward when you lie on your back and that allows you to align your nose with the center of your body when you lie on your side.
  • Avoid sleeping on your stomach with your neck twisted or bent.
  • If you read in bed, prop the book up so you are not using your arms to hold it up and bending your neck forward. Consider using a wedge-shaped pillow to support your arms and keep your neck in a neutral position.
• If stress is contributing to your neck pain, practice muscle relaxation exercises. Consider getting a massage. For more information, see the topic Stress Management.
• Strengthen and protect your neck by doing neck exercises once a day.

You can also help prevent neck pain by maintaining a healthy body weight.

Even if you need medical treatment such as prescription medications for your neck pain, the following home treatment measures will help speed your recovery.

For sudden (acute) neck pain:

• Place an ice pack or cold pack over painful muscles for 24 to 48 hours. This will help decrease any pain, muscle spasm, or swelling. If the problem is near the shoulder or upper back, ice the back of the neck. If you prefer, try ice massage. Massage the painful area with ice for 2 to 7 minutes, long enough to numb the pain. Ice frozen in a Styrofoam cup works well. Be sure not to damage your skin (frostbite).
• Avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages, for the first 48 hours after an injury. After 48 to 72 hours, if swelling is gone, apply heat. Use a warm pack or heating pad set on low. Some experts recommend alternating between heat and cold treatments.
• Return to your normal daily activities as soon as possible. One study found some evidence that continuing normal activities after an acute whiplash injury helps heal some symptoms faster than taking time off from work and using neck immobilization.²
• Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain. Nonprescription creams or gels, such as Bengay, may provide pain relief.
• Take pain relievers. Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve), can help relieve pain and reduce inflammation. Do not give aspirin to anyone younger than 20 because of the risk of Reye's syndrome. Acetaminophen (such as Tylenol) can help relieve pain.

For long-lasting (chronic) pain, you can use the same pain relief measures used for acute pain, but you do not have to worry about swelling.

You can aid healing in both acute and chronic neck pain and prevent further injury by:

• Doing stretching and strengthening exercises for your neck to keep your neck flexible and strong and prevent stiffness.
• Avoiding or modifying any activities that may be causing your neck pain, such as prolonged computer work or overhead work.
• Maintaining good health habits. Try to reduce stress and tension at work and home. Practice muscle relaxation exercises and consider getting a massage. Stop smoking; smoking slows healing because it decreases blood supply and delays tissue repair. Exercise regularly, including aerobic exercise such as walking. For more information, see the topics Stress Management, Quitting Tobacco Use, and Fitness.

You can help prevent future neck pain by paying attention to how you move and hold yourself (body mechanics). This includes:

• Avoiding slouching or a head-forward posture. Sit straight in your chair with your lower back supported, feet flat on the floor, and shoulders relaxed. Avoid sitting for long periods without getting up or changing positions. Take short breaks several times an hour to stretch your neck muscles.
• Adjusting your workstation if you work at the computer. Keep the monitor so the top of the screen is at eye level. Use a document holder that puts your work at the same level as the screen. For more information, see the topic Office Ergonomics.
• Using a headset or speaker phone if you use the telephone a lot. Do not cradle the phone on your shoulder.
• Adjusting your car seat to a more upright position that supports your head and lower back. Make sure that you are not reaching for the steering wheel while driving. Your arms should be in a slightly flexed, comfortable position.
• Using a pillow that keeps your neck straight, neither too high nor too flat. Special neck support pillows called cervical pillows or rolls may relieve neck stress. You can also fold a towel lengthwise into a pad that is 4 in. (10 cm) wide, wrap it around your neck, and pin it in position for good support. Avoid sleeping on your stomach with your neck twisted or bent. See an illustration of proper sleeping positions.
• Having the right posture when reading in bed. Prop the book up so you are not using your arms to hold it up and bending your neck forward. Consider using a wedge-shaped pillow to support your arms and keep your neck in a neutral position.
• Using proper lifting techniques. Lifting with your knees, not your back, can also help prevent neck pain.

Your health professional may recommend that you wear a cervical collar to support your neck. Cervical collars may reduce neck pain, but they should be used only for a day or two. Once the pain begins to get better, start doing gentle neck exercises. See an illustration of a cervical collar.

Medications can relieve neck pain and reduce inflammation of the soft tissues. Pain relief will allow you to move your neck gently, so you can begin easy exercises and start the healing process.

Although pain relievers, muscle relaxants, and antidepressants are commonly used for neck pain, none are well-proven treatments.²

Nonprescription pain relievers include:

• Creams or gels, such as Bengay, that are rubbed into the neck.
• Nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve), that can help relieve pain and reduce inflammation. Do not give aspirin to anyone younger than 20 because of the risk of Reye's syndrome.
• Acetaminophen, such as Tylenol, which reduces pain.

Prescription pain relievers include:

• Muscle relaxants, which are used to treat severe neck pain and spasms when neck pain begins (acute neck pain). They include diazepam (Valium), cyclobenzaprine (Flexeril), and carisoprodol (Soma).
• Narcotic pain relievers, which are used to treat severe short-term (acute) neck pain. They include codeine, acetaminophen and hydrocodone (Vicodin, Lortab), aspirin and oxycodone (Percodan), and acetaminophen and oxycodone (Percocet).
• Antidepressants, which are used to treat long-lasting (chronic) pain. They include doxepin (Sinequan) and amitriptyline (Elavil, Endep).

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory to patients, families, and health professionals to closely monitor adults and children taking antidepressants for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.

The FDA also advises that patients be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania. It is most important to watch for these behaviors in children who may be less able to control their impulsivity as much as adults and therefore may be at greater risk for suicidal impulses. The FDA has not recommended that people stop using antidepressants, but simply to monitor those taking the medications and, if concerns arise, to contact a health professional.

Surgery is not necessary for most cases of neck pain, which are typically caused by repeated or prolonged movements to the neck's muscles, ligaments, tendons, bones, or joints.

Surgery may be considered when neck pain is caused by:

• Traumatic injury to the neck that results in a fracture or abnormal motion (instability). Surgery may be done to stabilize the spine and prevent a bone fracture from causing instability and possible paralysis.
• Pressure on the spinal nerve roots or spinal cord that results in pain, numbness, or arm, hand, or leg weakness or that causes severe pain that persists for months despite treatment. However, even neck pain caused by pressure on the nerve roots will usually get better without surgery.⁴
• Narrowing of the spinal canal (cervical spinal stenosis) or arthritis of the neck (cervical spondylosis).

Surgery Choices

Surgeries used to treat neck pain caused by pressure on the nerve roots or by injury or illness include:

• Discectomy (with or without fusion). For more information on discectomy, see the Surgery section of the topic Herniated Disc.
• Cervical spinal fusion, in which selected bones in the neck are joined (fused) together.
• Spinal decompression, in which pressure is reduced on the spinal cord or spinal nerve roots by removing part of a bone or disc.
• Disc replacement with an artificial disc. Some people can consider this surgery instead of spinal fusion. Disc replacement surgery removes a spinal disc that is severely damaged and then replaces it with an artificial disc. This surgery is currently just for carefully selected patients, and it is done by specially trained surgeons. Doctors have not yet done long-term studies to know how well this works over time.

What To Think About

Surgery that is done to relieve neck pain caused by pressure on the nerve roots (especially from a herniated disc) is successful in relieving pain about 80% to 90% of the time.⁵

A minor surgical technique called percutaneous radiofrequency neurotomy has been used for some people with chronic facet joint pain. The facet joint is a portion of the spine in the neck that is sometimes responsible for neck pain after whiplash. One small study suggests that this surgery offers short-term relief for chronic neck pain. Almost 60% of people with whiplash said they were pain-free more than 6 months after treatment.² It is a difficult surgery that requires a highly skilled staff. And the pain will most likely come back over time.

Other types of treatment for neck pain may help relieve your symptoms, restore movement, and strengthen the muscles around your spine to help prevent further injury.

Other Treatment Choices

Other types of treatment include:

• Physical therapy. At home, you can use heat and massage to improve blood flow. A physical therapist can teach you stretching and strengthening exercises that you can also do at home. Physical therapy can also include treatments like heat therapy to improve blood circulation (ultrasound). For more information, see the topic Physical Therapy.
• Cervical (neck) collars, which may be used for short periods of time to help reduce pain by restricting neck movement. See an illustration of a cervical collar.
• Traction, a technique used to stretch the neck and relax the spinal nerve root openings. This may be used if there is no risk of instability in the neck.

Complementary and alternative treatments

Complementary and alternative treatments are sometimes used to relieve pain and restore neck mobility. They include:

• Manual therapy, such as that found in massage and physical therapy and in chiropractic and osteopathic treatments. The goals of manual therapy include relaxation, decreased pain, and increased flexibility.
• Yoga, a program of exercises to help improve flexibility and breathing, decrease stress, and maintain health. The basic components of yoga are proper breathing and posture.
• Acupuncture, which is done by inserting very thin needles into the skin. Acupuncture is used to relieve pain and to treat many health conditions.

What To Think About

Although the effectiveness of these treatments has not been proven, they seem to be helpful for some people and may relieve stress and improve quality of life.²

Organizations

• Chronic Pain
• Herniated Disc
• Neck Problems and Injuries
• Physical Therapy
• Stress Management

Citations

1. American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2005). Cervical sprain. In LY Griffin, ed., Essentials of Musculoskeletal Care, 3rd ed., pp. 746–750. Rosemont, IL: American Academy of Orthopaedic Surgeons.

2. Binder A (2005). Neck pain, search date May 2005. Online version of Clinical Evidence (14): 1–22.

3. Ylinen J, et al. (2003). Active neck muscle training in the treatment of chronic neck pain in women. JAMA, 289(19): 2509–2516.

4. Lenz FA (2003). Neck pain. In LR Barker et al., eds., Principles of Ambulatory Medicine, 6th ed., pp. 1049–1056. Philadelphia: Lippincott Williams and Wilkins.

5. Nakano KK (2005). Neck pain. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 1, pp. 537–556. Philadelphia: Elsevier Saunders.

Other Works Consulted

• Lord SM, et al. (1996). Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. New England Journal of Medicine, 335(23): 1721–1726.