NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Informed Health Online [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-.

Cover of Informed Health Online

Informed Health Online [Internet].

Show details

What are the treatment options for non-specific neck pain?

Created: ; Next update: 2018.

It is often not clear what is causing neck pain. If no clear cause can be found, there are a lot of treatment options that can be tried out. These include applying heat or cold, doing neck exercises and taking painkillers. But only a few of these treatments have been shown to help in good-quality studies.

Neck pain usually goes away on its own within a few days or weeks. In most cases no clear cause can be found. It is then referred to as "non-specific neck pain." Sometimes neck pain lasts longer and may become chronic. It is considered to be chronic if it lasts longer than three months.

Although non-specific neck pain is very common, only a few good-quality studies have looked at the various treatment options. None of the treatment options have been clearly shown to provide long-term neck pain relief.

Self-care options

Many people use warm scarves, heating pads or heat packs to relieve tension and pain. Ice packs can also provide relief if the neck pain is being caused by irritated nerves. If you use any of these, it is important to make sure they aren't too hot or too cold, and to protect your skin by placing a towel on it.

Stretching and strengthening exercises can be done to relax and strengthen the muscles with the aim of preventing neck problems. You can usually do the exercises on your own at home after a doctor or physiotherapist has shown you how to do them.

There are two main types of neck-strengthening exercises, known as static (isometric) and dynamic exercises. In static exercises you tense your muscles without moving them. For example, you might stand with your back to a wall and consciously push the back of your head, your neck and your shoulders against the wall (as firmly as you can without it being uncomfortable) for about 20 seconds. In dynamic exercises you move your muscles against a force, such as your own body weight or objects like dumbbells and elastic exercise bands.

Studies have suggested that strengthening exercises can relieve chronic neck pain and improve the range of movement. The intensity and type of exercise training differed from study to study. The participants usually trained two to five time per week. In some studies the strengthening exercises were combined with stretching exercises or endurance training. Further good-quality studies are needed in order to be more sure about which neck exercises help and how often you should train.

Can physiotherapy help?

Various types of physiotherapy can be used in the treatment of neck pain, including the following:

  • Exercises (see above)
  • Traction
  • Manipulation or mobilization of the spine
  • Therapeutic massage

Traction

The aim of traction is to take pressure off the vertebrae (bones of the spine) and spinal disks by stretching the neck in a certain way. This can either be done manually by a skilled therapist or with the help of aids such as special neck braces. Studies so far have not found traction to be effective in the treatment of neck pain.

Manipulation or mobilization of the spine

Manipulation and mobilization are manual therapy techniques. The aim of these approaches is to relieve pain and improve joint mobility using certain hand movements. Mobilization involves slowly moving the joint as much as possible. In manipulation, additional short, sharp movements are used to push the joint beyond its active range of movement. This is also known as chiropractic adjustment. For the treatment of neck pain, manipulation and mobilization techniques can be used on both the neck (cervical spine) and the upper back (thoracic spine).

Research has found that manual therapy techniques applied to the neck or upper back can temporarily relieve chronic neck pain. But there are not enough good-quality studies to be able to draw any reliable conclusions about the effect of these techniques.

Manipulation of the spine can make the pain worse at first. It also sometimes causes temporary headaches or dizziness. There have been reports of blood vessel injuries and strokes following manipulation of the spine. But these serious complications are extremely rare. It is important to make sure that the physiotherapist or doctor treating you has had special training in manual therapy.

Therapeutic massage

The aim of therapeutic massage is to reduce muscular tension and relieve pain. It might temporarily relieve acute pain, but there are not enough good-quality studies to be able to say how effective it is in the treatment of neck pain. Because it involves applying pressure to the affected area, therapeutic massage can itself be painful.

Does physical therapy help?

Physical therapy is an umbrella term used to describe treatments that apply physical stimuli such as heat, cold, electricity and light. They are often carried out by physiotherapists.

Electrotherapy

Transcutaneous electrical nerve stimulation (TENS) and percutaneous electrical nerve stimulation (PENS) are types of electrotherapy. In these treatments, small electrical impulses are used to stop pain signals being sent to the brain and to stimulate the production of endorphins, the body's own pain-relieving hormones.

TENS involves placing electrodes on the skin to send electrical impulses across the skin (transcutaneously). In PENS, the electrical impulses are transmitted through acupuncture needles inserted into the skin (percutaneously). There are other types of electrotherapy too, such as interferential current therapy. The various types of electrotherapy differ in terms of things like the frequency of electricity used.

None of these approaches have been proven to relieve neck pain. In PENS, the small punctures in the skin may lead to minor bleeding or an infection. There were no reports of other side effects in the studies, but they cannot be ruled out.

Laser therapy

Sometimes a treatment approach known as low-level laser therapy is used to relieve neck pain. This involves exposing the affected area of skin to light rays of a specific wavelength. Low-level laser therapy is sometimes also called cold laser therapy because – unlike with other types of laser therapy – the tissue doesn't become warm. Advocates of this treatment believe that the laser beams reduce inflammation, increase blood flow or stimulate the nerves. But no evidence has been found to support these theories.

Low-level laser therapy for neck pain was tested in a number of small studies. The studies didn't find any proof that this treatment provides noticeable neck pain relief.

How good is acupuncture?

Acupuncture is a traditional Chinese treatment in which thin needles are inserted into specific points on the skin. According to traditional beliefs, energy pathways (meridians) run through your body and can influence your body functions. It is thought that medical conditions can arise if these channels become blocked. To treat them, acupuncture needles are inserted into specific points along the meridians. But there is no scientific proof that these energy pathways exist. There is also some disagreement about where exactly the needles should be inserted – and whether it even makes a difference.

No good-quality studies have shown that acupuncture helps people who have neck pain. The risk of side effects is small. Inserting the acupuncture needles sometimes causes minor bleeding or bruising. To avoid infection, it is important to use sterile disposable needles.

How effective is medication?

Different kinds of medication can be used to treat neck pain. Many people try to relieve acute pain with over-the-counter or prescription painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen or diclofenac. Some also use acetaminophen (paracetamol). But there are hardly any good-quality studies on the effect of these medications in the treatment of neck pain. So it is difficult to say for sure whether they work and how effective they are.

NSAIDs can cause stomach aches and – if taken over long periods of time – increase the likelihood of developing a stomach ulcer. NSAIDs are not very suitable for people with renal insufficiency (kidney failure). Although acetaminophen (paracetamol) is well tolerated, it isn't suitable for people with impaired liver function because it is broken down in the liver.

Diclofenac and ibuprofen are often used as topical painkillers in the form of gels applied to the skin. There is a lack of good-quality research in this area too. One advantage of applying painkillers in this way is that gels have fewer side effects than tablets. They sometimes irritate the skin, causing side effects such as redness, dryness or itching.

Prescription medications

If the pain is very severe, your doctor might prescribe an opioid painkiller. These drugs are used in the treatment of conditions like cancer, severe nerve pain (for instance, in people with shingles) and a slipped disk. They are only considered as a treatment option for neck pain if the pain is acute and very severe. Typical side effects include constipation and feeling nauseous, drowsy, dizzy and sleepy.

Medications that relax the muscles (muscle relaxants) are sometimes used too. These drugs are usually sedatives that influence the central nervous system. They also have to be prescribed by a doctor and can have various side effects such as drowsiness.

Painkillers and muscle relaxants should generally not be taken over long periods of time, but rather be used for short-term treatment. To avoid accidents, people who take opioids or sedatives may have to refrain from driving and operating machinery.

Injections

Medications such as NSAIDs, steroids and the local anesthetic lidocaine can be injected directly into a muscle or the joints between the vertebrae (bones of the spine). There is also a lack of good research on local injections like these. NSAID injections are probably no more effective than NSAID tablets but can cause bleeding or inflammations at the site of injection.

Research has found that lidocaine might temporarily relieve neck pain when injected into muscle tissue. The effect wears off after a few weeks. It is not clear whether steroid injections can help.

Lidocaine injections can have several side effects such as a temporary increase in the pain, abnormal sensations like tingling or numbness, or a burning sensation at the site of injection. No serious side effects were reported in the studies.

Some studies have looked into the effect of botulinum toxin ("Botox") injections. They did not find any evidence that these injections work.

When is it a good idea to use a neck brace?

In the past, neck braces were often worn following a whiplash injury. This is not usually recommended nowadays, though. Wearing a neck brace weakens your neck muscles, possibly making the problem worse. If the pain is very severe, neck braces are still sometimes used for a short while to take some pressure off your neck or help you sleep better. To stop the muscles from becoming weaker, though, neck braces should only be worn a few hours a day, and not for longer than one to two weeks.

Can making changes at your workplace help?

Ergonomic adjustments may include things like correcting the height of your office chair, the position of the back of the chair, the distance between the chair and the keyboard, and the height of your computer monitor. There are also ergonomic tools such as special keyboards, mouse devices or mouse pads. These are meant to help avoid awkward postures at the workplace.

There have been a number of studies on ergonomic adjustments at the workplace, but none of them have found that these measures can prevent neck pain. A lot of the studies were too small to be able to provide conclusive results. So further research is needed to properly assess the effectiveness of these measures.

In the past there were fairly rigid guidelines concerning the "correct" seating position at the workplace. Nowadays occupational health specialists believe that incorporating regular movement is more important. This includes things like changing your seating position as often as possible throughout the day, and making sure you regularly get up and move around. Movement increases the blood flow to your muscles, spinal disks and other tissues in your body. It is also thought to prevent problems caused by your muscles getting tired when you stay in the same position for too long.

Sources

© IQWiG (Institute for Quality and Efficiency in Health Care)
Bookshelf ID: NBK338118

Views

Informed Health Links

Related information

  • PMC
    PubMed Central citations
  • PubMed
    Links to PubMed

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...