Neck Pain, Explained

Besides a headache, neck pain is another torture that is felt by many people particularly those who work on the computer. We, again, contacted famous neurologist from Hinduja Hospital, Mumbai, Dr. P P Ashok to shed some light on the problem. Excerpts from an interview:

When we think of neck pain, would it be all around the neck or the nape only (where the spinal cord is located)?

The neck is a term we use to refer the structure that connects the head to the trunk and is a vulnerable structure as it does not have too much support unlike the rest of the body and hence becomes prone to injuries. Some have long necks and others have a very short neck.

Our neck essentially is made up of 7 vertebral bones that extend from the skull to the torso and is supported by muscles and ligaments. Also, between these individual vertebral bones, there are cartilaginous discs, which absorb shock between the bones. Together, this anatomy helps in the mobility of the neck in all possible directions.

Can we say neck pain is because of pressure on some nerves? Or is it something more beyond this?

This part of our body is vulnerable to injuries and disease due to the above. Some of these ailments are very trivial like a muscular strain to more life-threatening problems. It is important therefore to know the various causes of any pain in this area the neck.

Neck Sprain: This is the commonest we all experience in our day to day lives. Bad posture, working at a desk for long hours especially a computer without changing posture, sleeping with the neck in bad positions or in the gym while jerking the neck while exercising or lifting weights can cause neck pain.

Neck Injuries: Here the muscles and ligaments are forced to move outside their normal range depending on the severity of the injury. Fractures of the vertebral bones or tearing of the ligaments can happen. Whiplash is a common injury especially after a car collision due to a sudden flexion/extension strain and needs immediate medical attention

Cervical Spondylitis: This is a wear and tear of the cartilages and bones of the neck and is present in 85% of above 60 years’ population although some, who have it never experience any symptom. Others may experience chronic severe pain and stiffness. Some may show bony spurs which are overgrowths in the bones which sometimes press upon the delicate nerves and spinal cord giving rise to pains. In some, the discs which lie between the bones can dry up and shrink. The gel-like material can dry and make the adjacent bones to rub against each other and can be painful. These herniated discs can also compress the spinal cord and result in weakness of the limbs needing surgical removal. Neck injuries in the past often predispose people to get early cervical spondylitis.

Tension Headache: Sometimes neck pain can be a part of a tension headache where there is a headache as well as the neck pain and not exclusively in the neck.

Wry Neck (Torticollis) happens when the neck is twisted and tilted, which can be from birth or acquired due to muscle injury or local lymph nodes.

Rheumatoid Arthritis and Ankylosing Spondylitis: Here the joints of the body are affected and the neck joints could be participating in that process.

Meningitis: Because of infection in the brain, the coverings of the brain and spinal cord (meninges) can be inflamed (swollen) and that can manifest as severe neck pain with fever. This is a medical emergency and needs immediate hospitalization.

Subarachnoid Hemorrhage: Due to bleeding in the brain, it will irritate the meninges and cause severe acute neck pain. This is a surgical emergency and needs immediate hospitalization to identify the causative aneurysm and surgery, thereafter.

Heart Attack: Sometimes a heart attack can present as only a neck pain, associated sweating and breathlessness if present can be the clue.

What are the different modalities that are used to diagnose the internal problem?

A simple X-ray cervical spine can be enough in most of the mild cases. In those with suspected severe compression, MRI of the cervical spine will be diagnostic. In suspected meningitis, a lumbar spinal Cerebrospinal Fluid (CSF) tap will be needed. If it is subarachnoid bleed, then a brain angiogram to rule out an aneurysm is indicated.

What kind of treatments works on a neck pain beside balms and pills? Any diet and lifestyle changes are required? Can neck pains be completely avoided?

Since the causes are different management is also variable. Simple muscle strains may settle with ice packs and fomentation. Muscle relaxants can be tried either as Over The Counter (OTC) or a physician’s prescription.

Physiotherapy can be done for the more intractable ones where shortwave diathermy/mild cervical traction (rarely used these days) and programmed neck exercises, all after a proper evaluation by the therapist.

In those with severe disc protrusions, which compress the nerve root or spinal cord, may need decompression surgery.