Chronic neck pain
There are many conditions that can cause chronic neck
pain. The following information describes symptoms
of some of the more common causes of chronic neck
pain.
Neck pain that radiates down the arm
Pain that radiates down the arm, and possibly into
the hands and fingers, is frequently caused by a cervical
herniated disc or foraminal stenosis pinching
a nerve in the neck. The pain may be accompanied by
numbness or tingling in the arms and/or hands. The symptoms
may start suddenly or develop over time.
The approach to treatment for a cervical disc herniation
is guided by how long the pain lasts, pain intensity
and the degree to which the cervical nerve and/or spinal
cord are affected. Most commonly, the symptoms are temporary
and can be treated successfully with conservative care
(such as medication, physical therapy, manipulations).
If the pain does not respond within 6 to 12 weeks of
conservative treatments, then surgery may be recommended.
Neck pain that is related to certain activities
or positions
Pain that develops slowly (often over a number of
years) and tends to occur during or after certain activities
or neck positions is frequently caused by cervical
foraminal stenosis. Usually, impingement of one
nerve root on one side of the spine causes most of the
symptoms.
The condition is caused by wear or aging related changes
in the joints of the neck (facet joints) or at the margins
of the discs. These changes may be diagnosed by either
an MRI or a CT scan with a myelogram. As with a herniated
disc, the mainstay of treatment is medical care (medicine,
therapy, exercise, injections, etc.). If the pain is
severe or prolonged, or the functional impairment is
sufficient, surgery may be recommended to open up the
disc space and give the nerve root more room.
Arm pain with lack of coordination
Pain that radiates down the arm, along with symptoms
such as lack of coordination in the arms and legs, difficulty
with fine motor skills, and occasional intermittent
shooting pains, is commonly caused by cervical stenosis
with myelopathy.
These symptoms, which are caused by either a herniated
disc or degenerative changes in the joints that can
cause pressure on the spinal cord, generally develop
slowly. Symptoms may not progress for years, and then
the patient may notice progression of the coordination
difficulties, only to be followed by another long period
where there is no progression.
Conservative treatments may help relieve the
chronic
arm pain,
but the definitive treatment option for the spinal
cord compression (which causes the coordination difficulties)
is surgery to decompress the spinal canal.
Neck pain that persists for more than a few months
and may fluctuate
Neck pain that is often characterized by a low level
of chronic pain that sometimes “flares” and
gets worse, is made worse by certain positions or activities,
and may be accompanied by arm pain, may indicate symptomatic
cervical disc degeneration.
While cervical disc degeneration is virtually ubiquitous
in humans, symptoms from this “gray hair of the
spine” are less common and often short-lived. However,
there may be an event, such as a twisting injury to
the disc space, which precipitates the onset of symptoms
and, in a subset of such people, may lead to chronic
neck pain. Such symptoms are often proportional to the
person’s level of activity; that is, the more the
shoulders, arms and neck are used, the more they hurt.
Neck pain that is worse in the morning and at the
end of the day
Paradoxically, there are also patients who feel
their worst when they first rise in the morning and
at the end of the day. These people often feel best
when they are moving their neck, and they often prefer
warm, sunny days to cool, rainy or overcast days. Such
symptoms parallel those experienced by patients with
osteoarthritis of the weight-bearing joints
(e.g., hips and knees). It is presumed that arthritic
changes
in the facet joints play a role in these people.
Degeneration in the cartilage of the facet joints
can produce pain and tends to occur in older adults
(over 60 years old). The facet joints are designed
to move against smooth surfaces, but as the cartilage
degenerates it develops a lot of friction and there
is accompanied loss of motion. Often the chronic pain
is worst first thing in the morning …Range of
motion exercises, physical therapy, traction, and manipulations
can all help preserve motion and lessen chronic pain.
In addition to the above conditions, there are a number
of other less common cervical conditions. These cervical
conditions can cause shoulder pain, wrist pain, elbow
pain, or headaches. For a review of these conditions,
see Miscellaneous
causes of upper extremity pain.
By: John
Heller, MD
April 17, 2001
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