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Anatomy
Understanding the neck’s anatomy is critical for properly diagnosing and treating the source of your pain.
Bony structures:
The anatomy and physiological function of the neck is the key in evaluating a person with neck pain. The bony spine is
positioned so that individual vertebrae (bones of the spine) provide a flexible support structure while also protecting the
spinal cord.
Vertebral Discs:
Separating each individual vertebrae are discs that act as cushions to minimize the impact that the cervical spinal column
receives. Since the discs are designed to be soft and provide support, they have a tendency to herniate posterior
“collapse backwards” through ligaments and cause irritation to adjacent nerves or even the spinal cord. Disc disease is
one of the most common causes of neck pain and one of the most common reasons for surgery. Disc disease may be
acute, resulting from trauma, or more commonly, chronic pain caused by degeneration. Degenerative disc disease is a
process, which is due to a thinning and dehydration of the discs over time that can lead to compression of other nearby
structures.
Spinal Ligaments and Muscles:
There are ligaments that attach to each vertebra and provide strength and mobility to the cervical spine as well as many
muscles that are responsible for movement. Spinal nerves are attached to the cervical spinal cord and exit the spine to
innervate the skin, muscles, and surrounding structures of the neck and upper extremities. Muscles and ligaments have a
tendency to become strained and irritated during strenuous lifting and excessive use and can cause local nerve irritation.
Myofascial (muscle related) and ligament injury accounts for the majority of neck pain. Trigger point injections,
acupuncture, and physical therapy are extremely successful in alleviating this type of pain.
Structurally, the cervical spine is composed of seven small vertebrae, as well as the associated muscles, ligaments, joints
and nerves. The cervical spine has many important functions, which include providing support and mobility to the head
and neck as well as protection of the spinal cord emerging from the brain. The cervical spine provides generous amounts
of movement of the head it is considered the most flexible portion of the spine, and is therefore readily strained.
The Atlas and Axis are the top two cervical vertebrae and are responsible for the majority of the head’s rotational
movement. These vertebrae form joints as they support the head and connect to the spine. They are also involved in
coordination and balance for the rest of the body.
Because the cervical spine is considered the most flexible portion of the spinal cord, it is also the most vulnerable to
injury. The first through the third cervical nerves that exit from the cervical vertebrae provide sensory to the head and
face. When these nerves are involved and become compressed or inflamed, they will cause pain and other sensory
deficits in particular regions of the head and face. When the Greater and Lesser Occipital Nerves are involved, this can
cause significant radiating pain to the face and head. The other nerves located lower in the cervical spine combine to
form a large plexus of nerves, which provides motor and sensory support to the upper extremities. Involvement of these
nerves can cause weakness, pain, loss of feeling, or other symptoms in the arms.
Pathology
There are many causes of neck pain but the most common causes are due to:
• Muscle strains
• Trauma or injury (damage to the muscles, tendons, and/or ligaments)
• Herniated cervical disk
• Stress
Overuse of the muscles and falling asleep in awkward positions for extended periods of time often produces muscle
strains. The neck muscles located in the back of the neck become tense. When the neck muscles are continuously or
frequently strained a chronic pain syndrome can develop.
A well-known cause of neck pain, referred to as "Whiplash", occurs in motor vehicle accidents, specifically in rear-end
collisions. This hyperextension of the neck often results in stretching of the soft tissues of the neck producing local
inflammation, muscle tension, and ligament strain. When ligaments and tendons become inflamed or damaged, they can
cause persistent pain that intensifies with particular movements.
In addition to neck muscle strains, the neck facet joints are also commonly involved in painful neck conditions. Cervical
Spondylosis (neck arthritis) is caused by degenerative changes of the cervical vertebrae and adjacent facet joints. The
symptoms typically present around the age of forty, but can present earlier with trauma. The arthritis continues to
progress and pain typically worsens with extending the head backwards. Degenerative disc changes occur as a person
ages and the disc can decay or herniate, producing local nerve root irritation or compression of the spinal cord.
Another frequent cause of neck pain is Spinal Stenosis, which is a narrowing of the central spinal canal. This narrowing
can compress the spinal cord and surrounding nerves roots. This compression can cause cramping pain, shooting pain,
or numbness in the legs, back, neck, shoulders or arms. The symptoms typically depend on the area of the spine that is
affected. In cervical spinal stenosis, the upper extremities and shoulders are most commonly affected.
Depression, anxiety and stress tend to exacerbate chronic pain syndromes. Worsening neck pain is a common
manifestation of these emotional stressors.
Dr. Rubin of the Mayo Clinic recently published a statement saying, “Low back and neck pain is a common problem and
one of enormous social, psychological, and economic burden. It is estimated that 15% to 20% of adults have back pain
during a single year and 50% to 80% experience at least one episode of back/neck pain during a lifetime. Low back pain
afflicts all ages, from adolescents to the elderly, and is a major cause of disability in the adult working population. Risk
factors for developing spine pain are multidimensional; physical attributes, socioeconomic status, general medical health
and psychological state, and occupational environmental factors all contribute to the risk for experiencing pain” (Rubin
2007).
It is extremely important to not only treat the physical symptoms, but the emotional stressors as well. Massage,
acupuncture, biofeedback, and behavioral therapy can all be extremely beneficial in patients suffering from chronic pain
worsened by depression, anxiety, and/ or stress.
Central Sensitization is a common complication associated with chronic pain of all kinds. This is a development involving
both the peripheral nervous system (PNS) and the central nervous system (CNS). Local tissue injury and inflammation
activate the PNS, which sends signals through the spinal cord to the brain. Central sensitization occurs when there is an
increase in the excitability of neurons within the CNS at the level of the spinal cord and higher. Eventually normal inputs
from the PNS begin to produce abnormal responses. Low-threshold sensory fibers activated by very light touch of the skin
activate neurons in the spinal cord that normally only respond to painful stimuli. As a result, an input that would normally
produce a harmless sensation now produces significant pain.
Less common causes of neck pain include vertebral compression fractures, spinal cord disorders, tumors, and infection.
Metastatic tumors (cancer spread from another organ system) are the most common type of malignant lesions of the
spine. Some 5 to 10% of patients with a primary cancer suffer spinal metastases. Breast, lung, prostate, and renal cell
carcinomas are the most common tumors that metastasize to the spine, whereas myeloma, lymphoma, and
gastrointestinal carcinoma can also invade the vertebral column (James 2003). Oropharyngeal cancers of the oral
cavities and neck may also present with neck pain.
All of these causes require immediate professional attention and seeing a physician should not be delayed. Symptoms
that indicate a possible emergency situation and should receive immediate medical attentions include neck pain with
altered level of consciousness, sudden blindness, paralysis, weakness, bowel/bladder changes, vision/ hearing/ taste
change, severe vomiting, recent weight changes, or fever.
Diagnosis
Diagnosis of neck pain can be difficult and the Pain Physicians at Arizona Pain Specialists have received extra training to
examine and diagnose your painful condition. The physician may perform a physical exam demonstrating tenderness
over certain areas of the spine as well as assessing the various limitations in movement. The physician may also order
radiological imaging such as x-ray, CT scan, MRI, or bone scan depending on his clinical suspicion and the history
obtained.
Common complaints of people experiencing neck pain are:
• Neck pain
• Reduced range of motion in the neck
• Headaches
• Upper Extremity pain, weakness, or sensory changes.
• Coordination and balance difficulty
Treatments Options:
Management of neck pain depends on the etiology of the pain. Minimally invasive procedures are numerous and can be
the most helpful to control pain and improve daily functioning. In the past few years there has been an abundance of
research surrounding non-surgical procedures and their effectiveness in treating neck pain. Some of the current
treatments offered are:
• Pharmacotherapy - NSAIDs (Ibuprofen like drugs), Acetaminophen (Tylenol), muscle relaxants, and membrane
stabilizing medications are often effective in treating low back pain.
• Cervical Epidural Steroid Injections - Epidurals are frequently used for pain syndromes due to common conditions such
as degenerative disc disease. The method involves injecting a steroid into the epidural space of the spinal cord, where
the irritated nerve roots are located. The medicine then spreads to other levels and portions of the spine, reducing
inflammation and irritation.
In another recent analysis, Cervical Epidural Steroid Injections (CESIs) in patients with spinal stenosis and associated
neck pain were studied. These resulted in a 72% effectiveness in relieving neck pain. The study concluded that the use
of CESIs is a “safe and effective” method in treating patients with cervical neck pain and cervical radiculopathy (Kwon
2007). CESI are an injection made up of a combination of a corticosteroid and local anesthetic (like lidocaine). The
procedure is minimally invasive, and can provide great pain relief. The benefits of CESIs increases with multiple injections
and usually a series of three are initiated.
• Cervical Medial Branch Blocks/Denervation – A widely used treatment by pain specialists in treating neck pain. Medial
Branch Blocks (MBBs) are a minimally invasive non-surgical treatment that are used for arthritis related neck and back
pain. The injections work by reducing the inflammation and irritation in the facet joints of the spine that is causing your
pain. A specific nerve, the Medial Branch, innervates the facet joints and can be blocked with the injection of medication
into a specific area of the body with a nerve-numbing substance or anesthetic. Facet joints are located on the back of the
spine, where one vertebra slightly overlaps another. These joints guide and restrict the spines movement.
In a recent double-blind, randomized, controlled trial performed in 2006, it was noted that significant pain relief (³ 50%),
and functional status improvement was observed at 3 months, 6 months and 12 months in patients treated with Cervical
Medial branch nerve blocks. The study showed that the use of therapeutic cervical medial branch nerve blocks, may
provide effective management for chronic neck pain of facet joint origin” (Manchikanti 2006).
In addition to blocking the Medial Branch nerves, the nerves can also be destroyed for longer durations. The procedure
is called Radiofrequency ablation and uses similar techniques, but typically takes longer to perform.
• Cervical Lysis of Adhesions - Also known as the “Racz Procedure,“ this procedure has proven effective in removing
excessive scar tissue in the epidural space when conservative treatment has failed. This procedure is used in vertebral
body compression fractures, post-laminectomy syndrome, radiculopathy, and disc disease.
• Infusions Techniques- The procedure involves inserting a small catheter through a needle into the epidural space or
directly next to affected nerves. Local anesthetic and other medicines are often given through the catheter for extended
time periods. When the nerves are blocked continuously with an infusion, pain relief can be dramatic and long lasting.
• Cervical Spinal Cord Stimulation (SCS) – This method involves tiny electrodes being placed within the epidural space
close to the spinal cord. The electrodes release a small electrical current to the spinal cord that inhibits pain
transmission. This inhibition of pain signals allows for pain relief. Cervical SCS is currently used for treating chronic pain
syndromes such as complex regional pain syndrome, chronic neck pain, diabetic neuropathy, post herpetic neuralgia,
peripheral ischemia, and other conditions that are resistant to more conservative treatments (Vallejo 2007). Patients
reported significant (70-90%) reductions in neck and upper extremity pain, when treated by Cervical SCS. Several of the
patients in this particular study also benefited with a decrease in associated headache and lower extremity pain.
• Occipital Nerve Blocks - this method involves an injection of local anesthetic and corticosteroid over the Occipital Nerves
(back of head). The blocks can dramatically improve pain increase the quality of your life.
• Occipital Nerve Stimulation - this method involves tiny electrodes being placed close to the Occipital nerves (back of
head). The electrodes release a small electrical current that inhibits pain transmission and causes pain relief.
• Transcutaneous Electrical Nerve Stimulation (TENS) - is a technique that relieves pain by applying mild electric current
to the skin at the site of the pain. The electric impulses interfere with normal pain sensations and alter perceptions that
were previously painful.
• Trigger Point Injections – can be an effective treatment for muscle spasms. The procedure involves injecting a local
anesthetic and steroid into a “Trigger Point.”
• Botox – used in treating neck pain is an exciting new treatment that is widely accepted among modern medicine. In
2005 “Botulinum toxin Type A (BtA) became the first line therapy for the treatment for cervical dystonia.” Although a
single injection of BtA is effective, multiple injection cycles seem to work better for patients (Costa 2005). Botox injections
have also been found to be effective in patients with whiplash injuries. Along with reductions in pain patients were found
to have improved range of motion ((Juan 2004).
• Biofeedback - is a treatment that teaches a patient to become aware of processes that are normally thought to be
involuntary inside of the body (such as blood pressure, temperature and heart rate control). This method enables you to
gain some conscious control of these processes, which can influence and improve your level of pain. A better awareness
of ones body teaches one to effectively relax and this can help to relieve pain.
• Physical Therapy - In order to decrease or prevent functional limitations, physical therapy and occupational therapy are
recommended as well as medical treatments. Physical therapy aims to increase range of motion and muscular strength.
• Acupuncture – Small needles are inserted into the skin. These needle cause your body to release hormones called
“endorphins“, which are your body’s natural pain reliever. Acupuncture can also help you relax; decreasing stress,
tension, and muscular spasm. There is adequate proof that acupuncture is more effective in treating neck pain than
inactive treatments. Acupuncture has been shown to be very helpful in those with chronic pain, helping to relieve
symptoms (Trinh 2007).
• Nutrition and Exercise - Exercise improves neck pain by increasing flexibility and range of motion. Another benefit is the
releases hormones called “endorphins,“ which are your body’s natural pain reliever. Nutrition and healthy eating may be
powerful treatments to combat nutritional deficits.
• Massage - Gentle focal rubbing of the tender areas may help relieve muscle spasms or contractions and improve the
discomfort associated with it. Massage can also help you relax, decreasing stress and tension.
• Chiropractic Manipulations – targeted “adjustments” especially combined with other modalities may significantly reduce
neck pain. Manipulations are undertaken in order to allow correct nerve transmission.
• Prolotherapy – also known as Regenerative Injection Therapy is a technique of injecting irritating substances into
painful ligaments and tendons. The procedure is used to initiate the bodies healing of a damaged ligament or tendon.
Articles
Cervical intralaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors.
Skeletal Radiol. 2007 May;36(5):431-6. Epub 2007 Mar 6
Kwon JW, Lee JW, Kim SH, Choi JY, Yeom JS, Kim HJ, Kwack KS, Moon SG, Jun WS, Kang HS. PMID: 17340166
Epidemiology and risk factors for spine pain Neurol Clin. 2007 May;25(2):353-71 Rubin DI. PMID: 17445733
Botulinum toxin type A therapy for cervical dystonia Cochrane Database Syst Rev. 2005 Jan 25;(1):CD003633. Costa J,
Espírito-Santo C, Borges A, Ferreira JJ, Coelho M, Moore P, Sampaio C. PMID: 15674910
Use of botulinum toxin-A for musculoskeletal pain in patients with whiplash associated disorders BMC Musculoskelet
Disord. 2004 Feb 13;5:5. Juan FJ PMID: 15018625
Therapeutic cervical medial branch blocks in managing chronic neck pain: a preliminary report of a randomized, double-
blind, controlled trial: clinical trial NCT0033272. Pain Physician. 2006 Oct;9(4):333-46 Manchikanti L, Damron K, Cash K,
Manchukonda R, Pampati V. PMID: 17066118
Neuromodulation of the cervical spinal cord in the treatment of chronic intractable neck and upper extremity pain: a case
series and review of the literature.Pain Physician. 2007 Mar;10(2):305-11 Vallejo R, Kramer J, Benyamin R. PMID:
17387353
Acupuncture for neck disorders. Spine. 2007 Jan 15;32(2):236-43. Trinh K, Graham N, Gross A, Goldsmith C, Wang E,
Cameron I, Kay T. PMID: 17224820
Cervical Spinal Metastasis: Anterior Reconstruction and Stabilization Techniques After Tumor Resection
James K. Liu, M.D.; Ronald I. Apfelbaum, M.D.; Bennie W. Chiles Iii, M.D.; Meic H. Schmidt, M.D.
Neurosurg Focus 15(5), 2003. © 2003 American Association of Neurological Surgeons
Posted 12/17/2003
Understanding the neck’s anatomy is critical for properly diagnosing and treating the source of your pain.
Bony structures:
The anatomy and physiological function of the neck is the key in evaluating a person with neck pain. The bony spine is
positioned so that individual vertebrae (bones of the spine) provide a flexible support structure while also protecting the
spinal cord.
Vertebral Discs:
Separating each individual vertebrae are discs that act as cushions to minimize the impact that the cervical spinal column
receives. Since the discs are designed to be soft and provide support, they have a tendency to herniate posterior
“collapse backwards” through ligaments and cause irritation to adjacent nerves or even the spinal cord. Disc disease is
one of the most common causes of neck pain and one of the most common reasons for surgery. Disc disease may be
acute, resulting from trauma, or more commonly, chronic pain caused by degeneration. Degenerative disc disease is a
process, which is due to a thinning and dehydration of the discs over time that can lead to compression of other nearby
structures.
Spinal Ligaments and Muscles:
There are ligaments that attach to each vertebra and provide strength and mobility to the cervical spine as well as many
muscles that are responsible for movement. Spinal nerves are attached to the cervical spinal cord and exit the spine to
innervate the skin, muscles, and surrounding structures of the neck and upper extremities. Muscles and ligaments have a
tendency to become strained and irritated during strenuous lifting and excessive use and can cause local nerve irritation.
Myofascial (muscle related) and ligament injury accounts for the majority of neck pain. Trigger point injections,
acupuncture, and physical therapy are extremely successful in alleviating this type of pain.
Structurally, the cervical spine is composed of seven small vertebrae, as well as the associated muscles, ligaments, joints
and nerves. The cervical spine has many important functions, which include providing support and mobility to the head
and neck as well as protection of the spinal cord emerging from the brain. The cervical spine provides generous amounts
of movement of the head it is considered the most flexible portion of the spine, and is therefore readily strained.
The Atlas and Axis are the top two cervical vertebrae and are responsible for the majority of the head’s rotational
movement. These vertebrae form joints as they support the head and connect to the spine. They are also involved in
coordination and balance for the rest of the body.
Because the cervical spine is considered the most flexible portion of the spinal cord, it is also the most vulnerable to
injury. The first through the third cervical nerves that exit from the cervical vertebrae provide sensory to the head and
face. When these nerves are involved and become compressed or inflamed, they will cause pain and other sensory
deficits in particular regions of the head and face. When the Greater and Lesser Occipital Nerves are involved, this can
cause significant radiating pain to the face and head. The other nerves located lower in the cervical spine combine to
form a large plexus of nerves, which provides motor and sensory support to the upper extremities. Involvement of these
nerves can cause weakness, pain, loss of feeling, or other symptoms in the arms.
Pathology
There are many causes of neck pain but the most common causes are due to:
• Muscle strains
• Trauma or injury (damage to the muscles, tendons, and/or ligaments)
• Herniated cervical disk
• Stress
Overuse of the muscles and falling asleep in awkward positions for extended periods of time often produces muscle
strains. The neck muscles located in the back of the neck become tense. When the neck muscles are continuously or
frequently strained a chronic pain syndrome can develop.
A well-known cause of neck pain, referred to as "Whiplash", occurs in motor vehicle accidents, specifically in rear-end
collisions. This hyperextension of the neck often results in stretching of the soft tissues of the neck producing local
inflammation, muscle tension, and ligament strain. When ligaments and tendons become inflamed or damaged, they can
cause persistent pain that intensifies with particular movements.
In addition to neck muscle strains, the neck facet joints are also commonly involved in painful neck conditions. Cervical
Spondylosis (neck arthritis) is caused by degenerative changes of the cervical vertebrae and adjacent facet joints. The
symptoms typically present around the age of forty, but can present earlier with trauma. The arthritis continues to
progress and pain typically worsens with extending the head backwards. Degenerative disc changes occur as a person
ages and the disc can decay or herniate, producing local nerve root irritation or compression of the spinal cord.
Another frequent cause of neck pain is Spinal Stenosis, which is a narrowing of the central spinal canal. This narrowing
can compress the spinal cord and surrounding nerves roots. This compression can cause cramping pain, shooting pain,
or numbness in the legs, back, neck, shoulders or arms. The symptoms typically depend on the area of the spine that is
affected. In cervical spinal stenosis, the upper extremities and shoulders are most commonly affected.
Depression, anxiety and stress tend to exacerbate chronic pain syndromes. Worsening neck pain is a common
manifestation of these emotional stressors.
Dr. Rubin of the Mayo Clinic recently published a statement saying, “Low back and neck pain is a common problem and
one of enormous social, psychological, and economic burden. It is estimated that 15% to 20% of adults have back pain
during a single year and 50% to 80% experience at least one episode of back/neck pain during a lifetime. Low back pain
afflicts all ages, from adolescents to the elderly, and is a major cause of disability in the adult working population. Risk
factors for developing spine pain are multidimensional; physical attributes, socioeconomic status, general medical health
and psychological state, and occupational environmental factors all contribute to the risk for experiencing pain” (Rubin
2007).
It is extremely important to not only treat the physical symptoms, but the emotional stressors as well. Massage,
acupuncture, biofeedback, and behavioral therapy can all be extremely beneficial in patients suffering from chronic pain
worsened by depression, anxiety, and/ or stress.
Central Sensitization is a common complication associated with chronic pain of all kinds. This is a development involving
both the peripheral nervous system (PNS) and the central nervous system (CNS). Local tissue injury and inflammation
activate the PNS, which sends signals through the spinal cord to the brain. Central sensitization occurs when there is an
increase in the excitability of neurons within the CNS at the level of the spinal cord and higher. Eventually normal inputs
from the PNS begin to produce abnormal responses. Low-threshold sensory fibers activated by very light touch of the skin
activate neurons in the spinal cord that normally only respond to painful stimuli. As a result, an input that would normally
produce a harmless sensation now produces significant pain.
Less common causes of neck pain include vertebral compression fractures, spinal cord disorders, tumors, and infection.
Metastatic tumors (cancer spread from another organ system) are the most common type of malignant lesions of the
spine. Some 5 to 10% of patients with a primary cancer suffer spinal metastases. Breast, lung, prostate, and renal cell
carcinomas are the most common tumors that metastasize to the spine, whereas myeloma, lymphoma, and
gastrointestinal carcinoma can also invade the vertebral column (James 2003). Oropharyngeal cancers of the oral
cavities and neck may also present with neck pain.
All of these causes require immediate professional attention and seeing a physician should not be delayed. Symptoms
that indicate a possible emergency situation and should receive immediate medical attentions include neck pain with
altered level of consciousness, sudden blindness, paralysis, weakness, bowel/bladder changes, vision/ hearing/ taste
change, severe vomiting, recent weight changes, or fever.
Diagnosis
Diagnosis of neck pain can be difficult and the Pain Physicians at Arizona Pain Specialists have received extra training to
examine and diagnose your painful condition. The physician may perform a physical exam demonstrating tenderness
over certain areas of the spine as well as assessing the various limitations in movement. The physician may also order
radiological imaging such as x-ray, CT scan, MRI, or bone scan depending on his clinical suspicion and the history
obtained.
Common complaints of people experiencing neck pain are:
• Neck pain
• Reduced range of motion in the neck
• Headaches
• Upper Extremity pain, weakness, or sensory changes.
• Coordination and balance difficulty
Treatments Options:
Management of neck pain depends on the etiology of the pain. Minimally invasive procedures are numerous and can be
the most helpful to control pain and improve daily functioning. In the past few years there has been an abundance of
research surrounding non-surgical procedures and their effectiveness in treating neck pain. Some of the current
treatments offered are:
• Pharmacotherapy - NSAIDs (Ibuprofen like drugs), Acetaminophen (Tylenol), muscle relaxants, and membrane
stabilizing medications are often effective in treating low back pain.
• Cervical Epidural Steroid Injections - Epidurals are frequently used for pain syndromes due to common conditions such
as degenerative disc disease. The method involves injecting a steroid into the epidural space of the spinal cord, where
the irritated nerve roots are located. The medicine then spreads to other levels and portions of the spine, reducing
inflammation and irritation.
In another recent analysis, Cervical Epidural Steroid Injections (CESIs) in patients with spinal stenosis and associated
neck pain were studied. These resulted in a 72% effectiveness in relieving neck pain. The study concluded that the use
of CESIs is a “safe and effective” method in treating patients with cervical neck pain and cervical radiculopathy (Kwon
2007). CESI are an injection made up of a combination of a corticosteroid and local anesthetic (like lidocaine). The
procedure is minimally invasive, and can provide great pain relief. The benefits of CESIs increases with multiple injections
and usually a series of three are initiated.
• Cervical Medial Branch Blocks/Denervation – A widely used treatment by pain specialists in treating neck pain. Medial
Branch Blocks (MBBs) are a minimally invasive non-surgical treatment that are used for arthritis related neck and back
pain. The injections work by reducing the inflammation and irritation in the facet joints of the spine that is causing your
pain. A specific nerve, the Medial Branch, innervates the facet joints and can be blocked with the injection of medication
into a specific area of the body with a nerve-numbing substance or anesthetic. Facet joints are located on the back of the
spine, where one vertebra slightly overlaps another. These joints guide and restrict the spines movement.
In a recent double-blind, randomized, controlled trial performed in 2006, it was noted that significant pain relief (³ 50%),
and functional status improvement was observed at 3 months, 6 months and 12 months in patients treated with Cervical
Medial branch nerve blocks. The study showed that the use of therapeutic cervical medial branch nerve blocks, may
provide effective management for chronic neck pain of facet joint origin” (Manchikanti 2006).
In addition to blocking the Medial Branch nerves, the nerves can also be destroyed for longer durations. The procedure
is called Radiofrequency ablation and uses similar techniques, but typically takes longer to perform.
• Cervical Lysis of Adhesions - Also known as the “Racz Procedure,“ this procedure has proven effective in removing
excessive scar tissue in the epidural space when conservative treatment has failed. This procedure is used in vertebral
body compression fractures, post-laminectomy syndrome, radiculopathy, and disc disease.
• Infusions Techniques- The procedure involves inserting a small catheter through a needle into the epidural space or
directly next to affected nerves. Local anesthetic and other medicines are often given through the catheter for extended
time periods. When the nerves are blocked continuously with an infusion, pain relief can be dramatic and long lasting.
• Cervical Spinal Cord Stimulation (SCS) – This method involves tiny electrodes being placed within the epidural space
close to the spinal cord. The electrodes release a small electrical current to the spinal cord that inhibits pain
transmission. This inhibition of pain signals allows for pain relief. Cervical SCS is currently used for treating chronic pain
syndromes such as complex regional pain syndrome, chronic neck pain, diabetic neuropathy, post herpetic neuralgia,
peripheral ischemia, and other conditions that are resistant to more conservative treatments (Vallejo 2007). Patients
reported significant (70-90%) reductions in neck and upper extremity pain, when treated by Cervical SCS. Several of the
patients in this particular study also benefited with a decrease in associated headache and lower extremity pain.
• Occipital Nerve Blocks - this method involves an injection of local anesthetic and corticosteroid over the Occipital Nerves
(back of head). The blocks can dramatically improve pain increase the quality of your life.
• Occipital Nerve Stimulation - this method involves tiny electrodes being placed close to the Occipital nerves (back of
head). The electrodes release a small electrical current that inhibits pain transmission and causes pain relief.
• Transcutaneous Electrical Nerve Stimulation (TENS) - is a technique that relieves pain by applying mild electric current
to the skin at the site of the pain. The electric impulses interfere with normal pain sensations and alter perceptions that
were previously painful.
• Trigger Point Injections – can be an effective treatment for muscle spasms. The procedure involves injecting a local
anesthetic and steroid into a “Trigger Point.”
• Botox – used in treating neck pain is an exciting new treatment that is widely accepted among modern medicine. In
2005 “Botulinum toxin Type A (BtA) became the first line therapy for the treatment for cervical dystonia.” Although a
single injection of BtA is effective, multiple injection cycles seem to work better for patients (Costa 2005). Botox injections
have also been found to be effective in patients with whiplash injuries. Along with reductions in pain patients were found
to have improved range of motion ((Juan 2004).
• Biofeedback - is a treatment that teaches a patient to become aware of processes that are normally thought to be
involuntary inside of the body (such as blood pressure, temperature and heart rate control). This method enables you to
gain some conscious control of these processes, which can influence and improve your level of pain. A better awareness
of ones body teaches one to effectively relax and this can help to relieve pain.
• Physical Therapy - In order to decrease or prevent functional limitations, physical therapy and occupational therapy are
recommended as well as medical treatments. Physical therapy aims to increase range of motion and muscular strength.
• Acupuncture – Small needles are inserted into the skin. These needle cause your body to release hormones called
“endorphins“, which are your body’s natural pain reliever. Acupuncture can also help you relax; decreasing stress,
tension, and muscular spasm. There is adequate proof that acupuncture is more effective in treating neck pain than
inactive treatments. Acupuncture has been shown to be very helpful in those with chronic pain, helping to relieve
symptoms (Trinh 2007).
• Nutrition and Exercise - Exercise improves neck pain by increasing flexibility and range of motion. Another benefit is the
releases hormones called “endorphins,“ which are your body’s natural pain reliever. Nutrition and healthy eating may be
powerful treatments to combat nutritional deficits.
• Massage - Gentle focal rubbing of the tender areas may help relieve muscle spasms or contractions and improve the
discomfort associated with it. Massage can also help you relax, decreasing stress and tension.
• Chiropractic Manipulations – targeted “adjustments” especially combined with other modalities may significantly reduce
neck pain. Manipulations are undertaken in order to allow correct nerve transmission.
• Prolotherapy – also known as Regenerative Injection Therapy is a technique of injecting irritating substances into
painful ligaments and tendons. The procedure is used to initiate the bodies healing of a damaged ligament or tendon.
Articles
Cervical intralaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors.
Skeletal Radiol. 2007 May;36(5):431-6. Epub 2007 Mar 6
Kwon JW, Lee JW, Kim SH, Choi JY, Yeom JS, Kim HJ, Kwack KS, Moon SG, Jun WS, Kang HS. PMID: 17340166
Epidemiology and risk factors for spine pain Neurol Clin. 2007 May;25(2):353-71 Rubin DI. PMID: 17445733
Botulinum toxin type A therapy for cervical dystonia Cochrane Database Syst Rev. 2005 Jan 25;(1):CD003633. Costa J,
Espírito-Santo C, Borges A, Ferreira JJ, Coelho M, Moore P, Sampaio C. PMID: 15674910
Use of botulinum toxin-A for musculoskeletal pain in patients with whiplash associated disorders BMC Musculoskelet
Disord. 2004 Feb 13;5:5. Juan FJ PMID: 15018625
Therapeutic cervical medial branch blocks in managing chronic neck pain: a preliminary report of a randomized, double-
blind, controlled trial: clinical trial NCT0033272. Pain Physician. 2006 Oct;9(4):333-46 Manchikanti L, Damron K, Cash K,
Manchukonda R, Pampati V. PMID: 17066118
Neuromodulation of the cervical spinal cord in the treatment of chronic intractable neck and upper extremity pain: a case
series and review of the literature.Pain Physician. 2007 Mar;10(2):305-11 Vallejo R, Kramer J, Benyamin R. PMID:
17387353
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Cameron I, Kay T. PMID: 17224820
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Neurosurg Focus 15(5), 2003. © 2003 American Association of Neurological Surgeons
Posted 12/17/2003
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Arizona Pain Specialists can
help you just Click Here.
Neck Pain
by Nicole Berardoni M.D, Tory McJunkin M.D, and Paul Lynch
M.D
Neck pain is one of the most frequently reported complaints to
physicians. Neck pain is slightly more common in women, but
most people experience some form of neck pain at some point
in their life. There are many causes of neck pain and they can
generally be separated into "acute" causes and "chronic"
causes. If the pain is suddenly occurs and lasts less than
three months then it is considered "acute." Acute neck pain is
commonly caused by facet syndrome, acute muscle strain, or
traumatic injury like whiplash. If the pain persists more than
three months it is termed "chronic" neck pain. This pain can
be from multiple sources, but is often due to facet joints
irritation, discs, ligaments, and muscular sources.
by Nicole Berardoni M.D, Tory McJunkin M.D, and Paul Lynch
M.D
Neck pain is one of the most frequently reported complaints to
physicians. Neck pain is slightly more common in women, but
most people experience some form of neck pain at some point
in their life. There are many causes of neck pain and they can
generally be separated into "acute" causes and "chronic"
causes. If the pain is suddenly occurs and lasts less than
three months then it is considered "acute." Acute neck pain is
commonly caused by facet syndrome, acute muscle strain, or
traumatic injury like whiplash. If the pain persists more than
three months it is termed "chronic" neck pain. This pain can
be from multiple sources, but is often due to facet joints
irritation, discs, ligaments, and muscular sources.
At Arizona Pain specialists we've had
excellent success treating all types of Neck
Pain.
excellent success treating all types of Neck
Pain.
Book I - Pain Syndromes
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions