By: Rukhsar Jabbar. M.Sc. Physiotherapy. Freelance Health Writer. Medical review by: Editorial support provided by the DLHA Team
A young black lady looking distressed and in pain, holding the left side of her neck
Musculoskeletal illnesses affect over 1.71 billion people worldwide and lead to significant health issues and disability. Neck pain is one of the most common musculoskeletal conditions, second only to low back pain. This complex disorder causes pain, disability, and a reduced quality of life. The financial impact of neck pain extends beyond those who suffer from it, affecting the entire community due to medical costs, insurance expenses, lost productivity and missed work. [1]
In sub-Saharan Africa, neck pain affects a lot of people—between 4.1% and 4.7% of men and between 6.0% and 6.8% of women. These rates are only surpassed by those in the USA, Western Europe, and East Asia. In the coming years, the prevalence of neck pain in Africa is probably going to be concerning unless effective preventative measures are put in place. Unfortunately, neck pain is rarely given the attention it deserves and is not as well-supported by research, maybe as a result of the high prevalence of serious illnesses like HIV/AIDS and malaria. [1]
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Acute neck pain is very common and usually not a cause for worry. Often, tense muscles are to blame—like after long hours on a computer, exposure to cold drafts, or sleeping in an awkward position. However, sometimes the cause isn't clear. Acute neck pain typically goes away within one to two weeks. Some people may experience it again in specific situations, such as after work or during strenuous activities. If the pain persists for more than three months, it's classified as chronic. Psychological stress often plays a role in chronic cases.
Some people with neck pain avoid physical activity, fearing it might worsen their condition. However, unless there are serious warning signs, it's generally safe to stay active. Neck-specific exercises can help prevent neck pain. [2]
Neck pain is categorised based on the duration of symptoms;
The pattern of pain can be;
The mechanism of neck pain is classified as;
These classifications/ categorisations help in understanding and treating neck pain effectively.
Neck pain, especially when chronic, can result from various factors including:
1. Biomechanical: These include things like intense physical activity or poor posture that strain the neck muscles.
2. Individual: Age, gender, body weight, and smoking habits can also play a role in neck pain.
3. Psychosocial: Stress, anxiety, and depression are often connected to neck pain and can make it worse.
Social, economic, cultural, and environmental factors also influence how neck pain develops and affects people differently, both between different groups and within the same population. [1]
Pain is the dominant symptom of neck pain. Its features may vary depending on the type of neck pain that you have,
1. Axial Pain: This is felt primarily in the cervical spine, which is the midline neck area, though it can sometimes spread to the shoulders.
Some people describe their pain as a constant, never-ending ache. Others feel a sharp, burning sensation that's hard to ignore. For some, the pain starts in the neck and shoots down their arms or shoulders, making daily activities difficult and affecting their quality of life. [4]
Other symptoms, such as headaches, may accompany neck pain.
Moving, twisting, or extending your cervical spine in any manner might increase the neck pain. [4]
2. Radiculopathy: This type of pain "radiates" along nerves, such as up the back of your head or down into one arm. It's often caused by irritated nerves, like when a spinal disc in the neck shifts and presses against a nerve. This can lead to sensations like tingling in your arms (often described as "pins and needles") or affect your arm reflexes and muscle strength. [2]
Pain is one of the nerve-based (neurological) signs of cervical radiculopathy that may spread down your neck. These incude:.
The effects of cervical radiculopathy can vary. You might experience any or all of the neurological symptoms mentioned. People often describe the pain as sharp or burning, and certain neck movements, like stretching or straining, can make it worse. Some find relief by placing their hands on top of their heads, which can temporarily reduce pressure on the affected nerve. [5]
History: When you first see a doctor for neck pain, they'll ask you several questions to understand your symptoms better. They'll inquire about when and how your pain started, where the pain is located, if you've had any recent accidents, whether physical or emotional stress could be contributing to your discomfort. and more.
Examination: To rule out any serious underlying causes, your doctor will perform a physical examination. This includes testing your reflexes, checking the strength of muscles in your shoulders and arms, checking for sensations in your upper limbs, and assessing your range of motion by gently touching and moving your neck. Watch video below to learn more..
Video: What to expect when your doctor performs a physical examination for your neck pain
Tests: Imaging tests like MRI, CT scans, or X-rays are usually only necessary if there's a suspicion of a specific cause or signs of a serious condition. However, these tests may not always provide useful information, especially when there are no clear indicators of a problem. Many people show normal signs of wear and tear in their necks, which may not be related to their pain. Additionally, people with neck pain often have minor or no abnormalities visible on these imaging tests. Therefore, these imaging tests may not pinpoint the exact cause of nonspecific neck pain. [2]
During your medical evaluation, doctors also look for "red flags" that could indicate serious issues. These might include fractures, problems with the spinal cord (like myelopathy), artery tears, spinal cord injuries, infections, cancers, or systemic diseases such as inflammatory arthritis. These signs help doctors identify potentially serious conditions in patients experiencing neck pain. [3]
When treating neck pain that radiates down the arm (called cervical radiculopathy), a systematic approach is crucial. Interestingly, there's no strong evidence suggesting that surgery is better than non-surgical treatments in urgent cases, even though surgery can provide significant relief. A large majority—over 85%—of acute cervical radiculopathy cases recover within 8 to 12 weeks without needing special treatment.
A. Non-surgical options
These focus on reducing nerve inflammation and easing radiculopathy symptoms. They include:
A well-designed physical therapy plan can be particularly effective in relieving symptoms. It helps speed up recovery after surgery too. Using supportive devices like cervical pillows at night can ease symptoms and improve sleep during recovery. Additionally, a soft cervical collar worn temporarily can also provide some relief. [6]
Oral anti-inflammatory medications
Medications like aspirin, ibuprofen, naproxen, celecoxib, etc are examples of non-steroidal anti inflammatory drugs (NSAIDS) that you may buy and use to relieve your neck pain without a doctor's order.
Paracetamol is another pain reliever that you can buy over the counter to relieve neck pain. It does not have anti-inflammatory properties like NSAIDS.
Be mindful that these drugs may have adverse side effects especially when used in high doses or too frequently or over a long duration. Talk with your doctor if you use any of these drugs and notice any untoward effects of indigestion like stomach pain, nausea, vomiting, heartburn or notice dark blood in your stool
Steroid injection
In conditions when physical therapy and NSAIDS fail to provide you relief from your neck pain, your doctor may decide to offer you anti-inflammatory steroid injection to relieve the pain of cervical radiculopathy. The steroid medication is injected into the painful area of your neck. It is a short procedure performed by healthcare providers properly trained in it.
The procedure is carried out in a hospital or doctor's office under special visual guidance (X-ray fluorscopy or CT scan) and involves injection of a long acting steroid medication into a space in the neck called the epidural space, where the steroid can spread around your nerves as they exit the bones of your neck. The steroid medication is sometimes also injected with a pain medication and it provides significant but temporay relief of pain in the majority of people who receive the treatment. It may need to be repeated between 2 to 6 times a year. Although it is a safe procedure, it is not without risk.
Surgery is considered in specific cases, such as when a spinal disc is pressing on a nerve and surgery can provide significant relief. However, most slipped discs heal on their own, so surgery rarely offers major benefits. It's important to consider the risks associated with neck surgery and weigh them carefully against the potential benefits before deciding on surgical treatment. [2]
The foloowing therapies are included in these options:
These include massage, acupuncture, and spinal manipulation. Acupuncture is effective in reducing symptoms when used alongside other treatments. Direct osteopathic manipulation or chiropractic care might worsen radicular symptoms, but indirect osteopathic methods can help relieve them. [7]Applying acupressure to neck muscles can reduce pain and spasms.
This can include going on an anti-inflammatory diet, turmeric, with self-observation and behavioral changes to control pain.
This can include engaging in such practices like yoga and tai chi, which are mindfulness-based practices that can help manage pain.
These can include the use of herbal medicine, meditation, music therapy, and other relaxation techniques
Most neck pain stems from wear and tear due to ageing and poor posture. Here are some simple adjustments to help prevent neck pain:
1. Maintain Good Posture: Keep your head directly above your spine and your shoulders in line whether sitting or standing. When using small-screen devices like phones or tablets, hold them up at eye level rather than bending your neck downward.
2. Take Regular Breaks: If you spend a lot of time at a computer or on long trips, take breaks to walk around and stretch your neck and shoulders.
3. Adjust Your Workspace: Ensure your computer monitor, desk, and chair are at eye level. Keep hips and knees slightly apart and use chair armrests for support.
4. Quit Smoking: Smokers are more prone to neck pain, so quitting can reduce your risk.
5. Lighten Your Load: Avoid carrying heavy bags over one shoulder, as this can strain your neck.
6. Sleep Well: Use a supportive pillow to keep your head and neck aligned while sleeping. Consider placing a small pillow under your neck to relax spinal muscles if lying on your back with your knees elevated.
7. Stay Active: Keep moving throughout the day to prevent stiffness and tension in your neck muscles. [8]
Neck pain can result from a variety of daily activities and behaviours. You may effectively avoid and manage neck discomfort by taking proactive measures once you are aware of its origins and symptoms. Maintain proper posture, stay active with frequent exercise and stretching, and set up a workspace which is easy for the people to use, to prevent and manage neck pain. Take breaks to stretch and decompress. If your discomfort is severe or chronic, get professional assistance. By putting these techniques into practice, neck pain can be considerably decreased and general well-being raised.
1. Mukhtar NB, Ibrahim AA, Mohammed JPrevalence of neck pain and its associated factors in Africa: a systematic review and meta-analysis protocol. BMJ Open 2023;13:e074219. doi: 10.1136/bmjopen-2023-074219. Available from here.
2. InformedHealth.Org. Overview: Neck Pain. [Internet. Last updated 2022 Dec. 12], Institute for Quality and Efficiency in Health Care (IQWiG), Cited July 3, 2024. Available from here.
3 Fandim JV, Nitzsche R, Michaleff ZA, Pena Costa LO, & Saragiotto B. The Contemporary Management of Neck Pain in Adults. Pain Management, (2022) 11(1), 75–87. Doi: 10.2217/pmt-2020-0046. (Abstract). Available from here.
4 Pietrangelo A. What causes neck pain? Healthline [Internet. Updated 2023 April 20]. Cited 2024 Jul 13. Available from here.
5 Cleveland Clinic. Cervical radiculopathy (Pinched nerve in neck): symptoms & treatment. [Internet. [Last updated 2022 March 29] Cited 2024 Jul 13. Available from here.
6.Warren Magnus W, Viswanath O, Viswanathan VK, Fassil B. Mesfin FB. Cervical Radiculopathy. StatPearls, [Internet. Last updated 2024 Jan 31]. StatPearls Publishing, 2024. Cited, July 3, 2024. Available from here.
7. Mayo Clinic. Neck Pain - Overview [Internet. 2022 Aug. 25]. Cited, 3 July 2024. Available from here.
8. Cleveland Clinic. Neck pain: 6 common causes and treatments. [Internet. Last updated 2022 Sept. 12]. Cited 2024 Jul 13. Available from here.
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