When Should I Worry About...

Chronic Neck Pain: When To Seek Help

June 1, 2023 - Kim Rivera Huston-Weber

There's a reason "pain in the neck" is an old saying for "annoying." Neck pain can affect anyone, and it can wreak havoc on your day. But when does the occasional annoying ache become chronic neck pain, and when should you seek help?

What is chronic neck pain?

According to Dr. Cole Fitzgerald, a pain medicine specialist with Houston Methodist, chronic neck pain is defined as pain lasting more than three months.

Neck pain can live up to its name and exist solely in the neck (axial neck pain) or shoot into the shoulders and arms (radicular neck pain). The pain can be described as a constant ache, stabbing or burning sensation. Headache, stiffness or a pins-and-needles feeling may accompany the neck pain. People with neck pain may also have trouble turning and moving their heads.

What causes chronic neck pain?

Age-related conditions such as arthritis or herniated discs can cause inflammation, leading to lingering neck pain.

"A lot of what we see is myofascial pain, or muscle pain, strain, and spasm," Dr. Fitzgerald said. "We see a lot of chronic degenerative conditions, whether that be osteoarthritis of the joints in the neck or degenerative changes of the discs. Any of those things can lead to chronic pain."

If you're reading this on your phone, take note. Bad habits with posture and electronics can also cause issues. Anything from sleeping wrong (think tensing your shoulders up to your ears), slouching over a work desk or looking down at our phones too much can kick-start pain, according to Dr. Fitzgerald. Stress, which can cause some to tighten their muscles unknowingly, can also be a factor.

While we might be more prone to aches and pains as we age, neck pain can affect anyone at any time.

Dr. Fitzgerald said, "We see a wide range of ages coming in with neck pain."

When to seek help

Since the causes of neck pain can vary, Dr. Fitzgerald suggests that people experiencing symptoms such as tingling, numbness, weakness, or changes in bowel/bladder function should seek treatment right away to get any imaging and care they may need. Those symptoms may indicate a nerve or spinal cord-related issue, which may require imaging tests such as magnetic resonance imaging (MRI) or electromyography (EMG).

Neck pain can resolve on its own with time and self-care. But if it lingers, don't suffer in silence.

"Neck pain can develop into chronic pain," Dr. Fitzgerald said. "You want to be somewhat aggressive in treating it when it's still in the acute phase. If you're not getting better within a few weeks, you probably should seek treatment. We can assist with conservative management, including physical therapy, and hopefully help break it before it progresses to chronic pain. Once pain becomes chronic, it's harder to treat."

Before seeking care, you might rely on over-the-counter pain relievers. While they can help with occasional aches and pains, taking pain relievers long-term isn't the best plan to manage pain.

"Chronic use of anti-inflammatories like naproxen or ibuprofen can lead to ulcers, kidney problems or cardiovascular problems," Dr. Fitzgerald said. "So we typically don't recommend that people take these medications for months and months."

How is chronic neck pain treated?

Treatment will depend on symptoms and can vary from conservative treatments, such as at-home stretching, to more advanced treatments including injections, all the way up to surgery.

According to Dr. Fitzgerald, at-home exercises, physical therapy, massage and ice and/or heat are often the first line in treating neck pain. Typically, most people will find relief and get better using these methods in a matter of months. However, as pain lingers, treatment becomes more advanced.

"If patients complete conservative therapy and still have ongoing neck pain or nerve symptoms, then we look at more advanced treatment options like injections," Dr. Fitzgerald said. "Injections can range from trigger point injections, where we inject directly into the muscle, or epidural steroid injections for nerve pain."

Other treatments can include a facet injection or medial branch block, which are injections of local anesthesia directly into a joint in the spine (facet injection) or near a nerve outside the joint (medial branch block). Another treatment is radiofrequency ablation, a procedure in which an electrothermal needle is inserted near the cervical facet joint, targeting and damaging the medial branch nerves, in order to stop them from sending pain signals to the brain.

Surgery may be used to repair or replace a herniated disc or correct a spinal malformation if needed. Spinal cord stimulation may be considered in refractory surgical cases.

Can I prevent chronic neck pain?

There are some actions you can take to prevent neck pain from developing. Practicing good posture, so you're not slouching or straining your neck during the day (and night!) is key.

Actions that can help improve posture include modifying your electronics use (spend less time looking down at your phone and keep your work station at eye level) and adjusting your car seat to keep your back straight while commuting. Also, try to limit the amount you carry heavy laptops or travel bags over your shoulders.

At night, use a pillow to help keep your neck and head aligned with your body as you sleep. If you're a back sleeper, you can place a pillow under your knees to relieve pressure in your lower back.

"You don't want to be flexing or extending all day, the goal is to maintain a neutral posture," Dr. Fitzgerald said.

While practicing good posture can help, preventing neck pain from becoming chronic comes down to getting the care you need. According to Dr. Fitzgerald, most patients with acute pain get well within a few months. But he says that once neck pain becomes chronic, it can be a whole different ball game to treat.

"It may no longer be just the arthritis or the disc pain or the muscle strain," Dr. Fitzgerald said. "It may become multifactorial. It may be central sensitization, where the nerves have been retrained within the spinal cord or brain and become more refractory to treatment. There's different management strategies for acute and chronic pain."

"Neck pain left untreated can be a setup for chronic pain," Dr. Fitzgerald warns. "And there's a chance that it's lifelong. You may see waxing and waning symptoms over a lifetime. And then you've got to find management strategies for that."

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