Time to get rid of that pain in the neck!
Bernard Lee | Wed, 05/06/2009 9:35 AM | Body & Soul

Dr. Bernard Lee

Very often we hear the colloquial expression "a pain in the neck" being used to describe something that causes irritation and annoyance. Aptly stated, a real pain in the neck can be a very unpleasant experience. Deliberate on this - your neck holds up your head for approximately 16 hours a day, seven days a week, and is given a chance to rest only when you are lying down. During these 16 hours, your neck is held stiff at work, bent hard in an awkward position while watching television, reading, exercising or even talking on the phone. So it is not surprising that your neck is calling out for help!

Almost everyone experiences some sort of neck pain or stiffness at one time or another. Neck pain makes up half of all musculoskeletal conditions, and as a group (spine pain) they are the second most common presentation (after coughs and colds) at most general practitioners' clinics, and the number two cause of disability accounting for medical leave of absence.

Fortunately, most neck pain is not a grievous condition.

"Acute muscle sprain of the neck - acute *rine' neck, accounts for 50 to 60 percent of all neck pain. These generally improve with simple measures such as analgesia, rest and physical therapy. However, some pains are more serious than others," explains Dr. Bernard Lee M.K., director for interventional pain management services at the Singapore Pain Care Center.

"There are other conditions that can be life-threatening or cause great discomfort and create other related pains, such as headache, shoulder weakness, giddiness and lower back pain."

Even when the cause of the neck pain is benign, its presentation can be quite incapacitating. Therefore, we should not underestimate muscle pain from the neck, because a localized muscle sprain can progress to referred pain in the shoulders, arms and even fingers. Occasionally it can mimic atypical chest pain or shoulder blade pain.

Life-threatening conditions


These conditions need immediate treatment and stabilization.

Cervical disc conditions - This ranges from protrusion of disc compressing on nerves to causing critical stenosis of the spinal canal, rendering weakness of limbs and subsequently paralysis.

Fractures of the neck vertebrae - Such fractures will cause instability, with possibility of paralysis.

Infection of the surrounding organs within the neck

Spontaneous aneurysms of vertebral or carotid arteries - This occurs when the blood vessels in the neck spontaneously dilate.

Arthropathy and osteoarthritis - Pain arising from deterioration of facet joints.

If we break down neck pain categorically, the pain can arise either locally or referred from another area. Local causes of neck pain can be:

Nerves of the neck - compression or irritation of nerves


Ligament and muscle injury - sprain or whiplash


Spine of the neck - inflammation of the small joints (facets)


Bony skeleton - hairline fracture


Infections


The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders or arms.

For athletes and people with an active lifestyle, the likelihood of having neck problems is high. Prior traumas from falling, slipping to whiplashes in bike or car accidents that were not fully healed and corrected could also exacerbate your neck pain. A little pain medication ultimately relieves neck pain to a degree of tolerance, and most of us are content with that. However, if left untreated for a long period of time, the pain might turn acute. When a nagging neck pain does not go away after six weeks, you need to consult a doctor immediately.

What happens when left untreated? For a start, Dr. Lee advises treating acute neck pain to prevent it from becoming chronic, as it will then be harder to treat. Chronic neck pain can cause de-conditioning, muscle tightness, contracture (crooked neck) and stiffness. There will be decreased movement of the neck, and may even contort the entire body into a particular direction.*

Certain syndromes related to neck pain


Cervical disc protrusion - A slipped disc in the neck area can show up as persistent neck pain with constant stiffness and tightness of the surrounding neck and shoulder muscles. This pain can radiate to the shoulder blades and/or arms. Depending on the degree of protrusion, the spinal canal may be narrowed to a varying degree - leading to numbness and weakness of the hands.

Cervicogenic headache - Certain headaches are associated with neck pain. They occur spontaneously, sometimes so intense they wake patients from their sleep. The pain is often sharp, with each flare lasting from several minutes to several hours. This can be accompanied by numbness in the shoulders or hands.

Myofascial pain syndrome - Often, these patients have many tender trigger points over their shoulders, neck and upper back, in between their scapulae and subjective weakness in their arms. These types of pain may be relieved with massage or acupressure for short periods of time. They may be triggered by stress.

Fibromyalgia - Generalized muscle pain involving the neck, lower back, shoulders, buttocks and limbs. There is often involvement of severe fatigue, abdominal pain or psychological distress. Patients may have stiffness of joints in hands, feet and neck in the morning.

Rheumatoid arthritis - A systemic disorder involving polyarthritic inflammatory condition, involving hands and feet or neck pain.

Stress effects - When one is rushing to meet deadlines, unconsciously the neck muscles tighten and the neck shortens and causes the neck joints to compress. Studies have shown that stress reduces one's breathing (breath-holding), reducing oxygenation to certain muscle groups.

The remedies for neck pain


Before you decide on the cure, you first need to accurately assess what kind of neck pain you are experiencing. A trained pain specialist can certainly assess and treat acute and chronic neck pain. At the Singapore Pain Care Center (www.paincarecenter.com.sg), they have a multidisciplinary approach from various specialists with the necessary expertise and resources.

According to Dr. Lee, acute neck pain can be treated with medication and short bed rest (at most two days). If it is not a compressive cause or something serious, most pain will resolve spontaneously after a week. Any pain that lasts more than a month should be examined by a medical practitioner/specialist.

Traditionally, there are only two ends of the spectrum to choose a treatment from: conservative management with medication and physiotherapy at one end, and open surgery and decompression at the other end.

Now, a new way of treating spine pain via keyhole ballooning laser procedure is available. The principle of treatment (neuroplasty) is to free the nerves by pushing the "trapped nerve" away from the disc with a balloon, then free up the obstruction and open up the narrowed space, leading to a significant reduction in pain (It is essentially like a ballooning of the blocked heart vessels for heart diseases). Together with laser treatment, the nerves or degenerated disc can be "lasered" to stop the inflammation and allow recovery and regeneration. The significant advantages to patients are that it carries zero risk of paralysis and involves no cutting, hence much faster recovery.

These "specialized laser injections into the spine" are done under local anesthetic as day surgery. The procedures are safe, with few complications, and hospitalization is not required. There is no surgical wound and the procedure is almost painless, taking only one to two hours. With so little down time, patients are able to resume work almost immediately. Combined with good exercise or rehabilitative program, the pain may not recur.

Another treatment called Nucleoplasty, which is a keyhole laser shrinkage of disc for cervical disc protrusion. Under precise X-ray guidance, the laser is applied via an injection, accurately into the disc protrusion, causing excess disc material to vaporize. This in turn generates a vacuum and causes the surrounding tissue to retract and shrink the protrusion.