Neck pain
The neck has the crucial function of providing stability, support, and mobility to the head, but it can become painful. Similarly to low back pain, there does not need to be a specific cause or event — people can simply wake up with neck pain. The neck itself, also known as the cervical spine, is a coordinated network of muscles, bones, joints, discs and nerves. Any one of them or a combination of them can contribute to the development of pain.
Neck pain will usually resolve by itself, however if it persists, further evaluation is necessary. Symptoms such as fevers, chills, unintended weight loss, neck pain in the setting of trauma, neck pain in the current setting or a history of cancer, severe headache with stiff neck, radiating pain down an arm(s), numbness or tingling, arm weakness, dexterity issues (i.e. routinely dropping objects from your hands), bowel or bladder incontinence, or issues with your balance may signify a more significant underlying issue, and should prompt more immediate medical attention.
In addition to obtaining a complete history inquiring about your pain and associated symptoms, Dr. Garala will also perform a physical exam and order any necessary imaging studies. Treatment options consist of observation, activity modification, medications, manual treatment such as physical therapy, spinal injections (if indicated), and surgery (if indicated). Most patients opt for conservative treatment initially. This usually entails taking medications and starting a physical therapy program. The aim of medications is two-fold, to provide pain relief, and in some cases, to reduce any potential inflammation that can be contributing to the cause of the pain. Unless there is a medical contraindication, prescription medications like a Medrol dosepak, Naproxen, Mobic, Diclofenac, or over-the-counter medications like Ibuprofen or Aleve can help reduce inflammation. Extra Strength Tylenol (1000 mg every eight hours) can also be used to help with pain, even though it does not reduce inflammation. Cyclobenzaprine (5 – 10 mg at bedtime), a muscle relaxant, can help with sleep if the pain keeps one up at night. There are other medications that can be prescribed if the pain is still uncontrolled. Physical therapy can also be used to help alleviate pain via modalities, stretches and exercises, and to optimize your muscle health.
If a patient does not improve with medications and physical therapy, a spinal injection can be considered if there is a structure identified as the potential cause of the persistent pain. Spinal injections are unlike office injections involving the shoulder and the knee. They usually cannot be performed same day because they require specialized equipment (a special type of x-ray machine called a fluoroscope) as well as prior insurance approval. Furthermore, the decision to proceed with an injection needs to be correlated with the history, physical exam, as well as any imaging studies that may be ordered. There is no “one injection solves all” procedure that can be performed for neck pain. There are different types of injections/procedures (i.e., epidural steroid injections, facet joint injections, medial branch blocks, radiofrequency ablation) that are specific for the potential source of pain. An epidural steroid injection will not help with pain if it is stemming from the joints of the cervical spine. Similarly, a facet joint injection is not going to help if a herniated disc is causing the pain.