A person with neck pain

The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The top three joints in the neck allow for most movement of the neck and head. The lower joints in the neck and those of the upper back create a supportive structure for the head to sit on. If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.

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Differential diagnosis

Neck pain may come from any of the structures in the neck including: vascular, nerve, airway, digestive, and musculature / skeletal or be referred from other areas of the body.

Major and severe causes of neck pain (roughly in order of severity) include:

• Carotid artery dissection
• Referred pain from acute coronary syndrome
• Head and neck cancer
• Infections: retropharyngeal abscess, epiglottitis, etc.
• Spinal disc herniation – protruding or bulging discs, or if severe prolapse.
• Spondylosis - degenerative arthritis and osteophytes
• Spinal stenosis – a narrowing of the spinal canal

The more common and lesser neck pain causes include:

• Stress – physical and emotional stresses
• Prolonged postures – many people fall asleep on sofas and chairs and wake up with sore necks.
• Minor injuries and falls – car accidents, sporting events and day to day injuries that are really minor.
• Referred pain – mostly from upper back problems
• Over-use – muscular strain is one of the most common causes
• Whiplash
• Herniated disc
• Pinched nerve

Although the causes are numerous, most are easily rectified by either professional help or using self help advice and techniques.

More causes include poor sleeping posture, torticollis, head injury, rheumatoid arthritis, Carotidynia, congenital cervical rib, mononucleosis, rubella, certain cancers, ankylosing spondylitis, cervical spine fracture, esophageal trauma, subarachnoid hemorrhage, lymphadenitis, thyroid trauma, and tracheal trauma.

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Treatment

Treatment of neck pain depends on the cause. For the vast majority of people, neck pain can be treated conservatively. Recommendations which help alleviate symptoms include applying heat or cold. Other common treatments could include medication, body mechanics training, ergonomic reform, and physical therapy.

Conservative treatment

Exercise plus joint mobilization and/or joint manipulation (spinal adjustment) has been found to be beneficial in both acute and chronic mechanical neck disorders. Both cervical manipulation and cervical mobilisation produce similar immediate-, and short-term changes; no long-term data are available. Thoracic manipulation may also improve pain and function. Low level laser therapy has been shown to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.

Medication

Analgesics such as acetaminophen or NSAIDs are recommended for pain. Muscle relaxants are often prescribed and are known to be effective. However, one study showed that one muscle relaxant called cyclobenzaprine was not effective for treatment of acute cervical strain (as opposed to neck pain from other etiologies or chronic neck pain). Over the counter topical creams and patches may be effective for some patients.

Surgery

Surgery is usually not indicated for mechanical causes of neck pain. If neck pain is the result of instability, cancer, or other disease process surgery may be necessary. Surgery is usually not indicated for "pinched nerves" or herniated discs unless there is spinal cord compression or pain and disability have been protracted for many months and refractory to conservative treatment such as physical therapy.

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