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Neck pain: Overview

Created: ; Last Update: December 17, 2015; Next update: 2018.

Introduction

Acute neck pain is very common and usually nothing to worry about. There is often a link between neck pain and tense muscles, for instance after working at a desk for a long time, being exposed to a draft, or sleeping in an awkward position. But neck pain may also arise without an identifiable cause. It usually goes away within about one to two weeks. In some people it comes back again in certain situations, such as after work or intensive sports.

It is rarely possible to find out exactly what is causing neck pain. Neck pain is often the result of a combination of different factors. Other factors influence how things continue: For instance, people who have chronic neck pain are often affected by psychological stress too. Neck pain is considered to be chronic if it lasts longer than three months. Wear and tear of the cervical spine (the neck area of the spine) doesn't usually play a decisive role.

Some people who have neck pain avoid doing physical activities for fear of making things worse or injuring themselves. But there is no need to worry as long as the pain is not accompanied by any warning signs of more serious problems. In the long run, it is even a good idea to stay active and carry on as usual despite the pain. Doing specific exercises to strengthen your neck can help to prevent future problems.

Symptoms

There are different kinds of neck pain. It often occurs in a specific area. The medical term for this is "axial neck pain." Radicular pain, on the other hand, is a type of pain that "radiates" along nerves – for example, up the back of the head or down into an arm. This can also affect reflexes and muscle strength in these areas and cause tingling or similar sensations. Radicular pain is usually caused by an irritated nerve root, for instance due to changes affecting a spinal disk.

Neck pain is only very rarely a sign of a more serious condition or an emergency. It is important to seek urgent medical attention if you have neck pain in the following situations or together with the following symptoms:

  • Nerve problems and signs of paralysis such as difficulties moving your arm or fingers
  • After an accident
  • Pain that stays the same, whether you're at rest or moving
  • Unintentional weight loss
  • Fever or chills
  • Loss of bladder or bowel control

Other symptoms that require medical attention include persistent tingling sensations ("pins and needles"), frequent numbness in your hands or legs, leg weakness, and trouble keeping your balance when walking.

Causes

Neck pain can have many different causes. These include:

  • Weak and overused neck muscles: sitting at a desk for a long time – particularly in awkward positions with slightly tensed muscles – can cause pain and stiffness in the neck or shoulder areas, and sometimes headaches too. If your neck and core muscles are weak, physical activities such as cycling or swimming breaststroke can also lead to muscle-related problems.
  • Wear and tear of the joints in the cervical spine: Over the course of a lifetime, different signs of wear and tear can arise in the neck area of the spine. For instance, the gaps between the vertebral bodies may shrink and small bone growths (spurs) may form along their edges. This is called osteochondrosis. Osteoarthritis of the joints between the neck vertebrae is called cervical spondlyosis. But wear and tear is generally a normal part of growing older. Although this can lead to reduced neck mobility, it rarely causes neck pain.
  • Spinal disk changes: Spinal disks are also subject to wear and tear. The tissue becomes brittle and less elastic, so it can't absorb pressure as effectively. Sometimes spinal disk tissue then bulges out or a "slipped disk" occurs.
  • Whiplash: Whiplash is an injury that might arise if someone drives into the back of you in a road accident. The impact of the collision causes the cervical spine, the tendons and muscles to jerk back and forth rapidly. This usually leads to small injuries in the muscle and connective tissue, painfully tense muscles, and limited mobility for several days. These symptoms typically go away completely after a short time.
  • Narrowing of the vertebral canal, or a slipped disk: If the vertebral canal is too narrow, or if spinal disk tissue bulges or leaks out and puts pressure on a nerve root, it can cause neck pain that radiates into a shoulder or an arm.

Neck pain also sometimes accompanies inflammatory conditions of the spine, jaw joint problems or severe headaches.

But it is often not possible to find a clear cause of neck pain: wear and tear can, but does not always, lead to pain. The bones, tendons, and nerves in the cervical spine are also usually too close together to be able to determine exactly what caused the symptoms in the first place.

If no specific cause can be found, it is called "non-specific neck pain." It is often particularly hard to determine the cause of chronic neck pain.

Illustration: Structure of the cervical spine: Bones, spinal disks and nerves

Structure of the cervical spine: Bones, spinal disks and nerves

Prevalence and outlook

Neck pain is very common. It is estimated that almost 1 in 3 people are affected once a year, women more often than men. The symptoms are usually harmless and go away on their own after a while. But they might keep coming back again. The pain becomes chronic in about 1 out of 10 people who have recurring neck pain.

The risk of neck pain problems becoming chronic generally increases with age. Neck pain is also often more persistent in people who have already had back pain or a slipped disk.

The severity of neck pain caused by whiplash will depend on factors like the impact of the collision. The problem often lasts longer and is more severe in people who are traumatized by the accident or worry a lot about the consequences.

Diagnosis

Your doctor will first ask you several questions, such as whether you have been in an accident, exactly where it hurts, and whether physical strain or mental stress might be playing a role.

They will then perform a physical examination in order to rule out any serious causes. This will include feeling ("palpating") your neck with their hands, and checking how well you can move your head, your reflexes and muscle strength.

Imaging techniques like x-ray examinations, CT scans or MRI scans are usually only done if your doctor thinks you may have been injured or have a serious condition. If that isn't the case, x-rays often don't help because people who don't have any neck pain often have irregularities in their bones or spinal disks. And some people who have neck pain don't have any visible irregularities, or only have a few. This makes it difficult or even impossible to find out what exactly is causing non-specific neck pain, even if x-rays or other imaging techniques are used.

Treatment

Non-specific neck pain can be treated with painkillers as well as stretching and strengthening exercises, massages, and heat and cold applications.

Surgery is only considered if a clear cause has been found and the procedure is likely to lead to an improvement. For instance, it can make sense to surgically remove spinal disk tissue that is squashing or "pinching" a nerve. But even the symptoms of a slipped disk can get better after a while, on their own or with the help of non-surgical treatment, so surgery may not offer any significant advantages. Spinal surgery in the neck area also carries risks, so it is important to carefully consider the advantages and disadvantages of surgery before deciding.

People who have chronic pain can benefit from additional pain management therapy. This is offered by doctors or psychotherapists who have specialized in helping people with chronic or severe pain. Pain management therapy can help you to deal with your symptoms so they no longer have such a big impact on your life.

Sources

  • Binder AI. Cervical spondylosis and neck pain. BMJ 2007; 334(7592): 527-531. [PMC free article: PMC1819511] [PubMed: 17347239]
  • Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Nackenschmerzen. June 2009 (AWMF Leitlinien; Band 053 - 007).
  • Deutsche Gesellschaft für Neurologie (DGN). Zervikale Radikulopathie. September 2012 (AWMF Leitlinien; Band 030 - 082).
  • Eubanks JD. Cervical radiculopathy: nonoperative management of neck pain and radicular symptoms. Am Fam Physician 2010; 81(1): 33-40. [PubMed: 20052961]
  • Walton DM, Carroll LJ, Kasch H, Sterling M, Verhagen AP, Macdermid JC et al.; ICON. An Overview of Systematic Reviews on Prognostic Factors in Neck Pain: Results from the International Collaboration on Neck Pain (ICON) Project. Open Orthop J 2013; (7): 494-505. [PMC free article: PMC3793581] [PubMed: 24115971]
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

© IQWiG (Institute for Quality and Efficiency in Health Care)
Bookshelf ID: NBK338120

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