Chronic Neck Pain

Chronic Neck Pain: What Condition is Causing My Neck Pain?
By: John Heller, MD

       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

Neck 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.

This type of spinal stenosis 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 for stenosis 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.

    * See cervical foraminal stenosis for more information about chronic neck pain

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 spinal stenosis with myelopathy.

These symptoms, which are caused by either a cervical 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.

    * See cervical stenosis with myelopathy for more information about chronic neck pain

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.

    * See cervical degenerative disc disease for more information about chronic neck pain

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.

    * See cervical osteoarthritis for more information about chronic neck 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.