Neck Pain

What is it?

Neck pain is pain felt anywhere from the base of the skull to the shoulders and between the shoulder blades. It is very common and usually clears up on its own within a few days to a few weeks. In some people, however, it keeps coming back or lasts longer than three months and becomes chronic.

Pain may stay in the neck or spread to the back of the head, the shoulders or the arms. If arm pain comes with numbness or weakness, pressure on a nerve root is likely; this is covered in detail on the cervical disc herniation page. Pain that starts in the neck but is felt in the head is discussed under headache and facial pain.

What causes it?

The most common causes of neck pain are:

• Muscle strain and posture: long periods looking down at a screen or phone, an unsuitable pillow and desk work can tire the neck muscles.
• Age-related changes (cervical spondylosis): thinning discs, arthritis in the joints and bony outgrowths.
• Facet joint pain: pain from the small joints linking the vertebrae at the back of the neck, typically worse when tilting the head back or turning it. It is common after whiplash injuries in road traffic accidents.
• Myofascial pain: tender trigger points in the neck and shoulder muscles (myofascial pain syndrome).
• Disc herniation and nerve root compression: can cause pain, numbness and weakness spreading into the arm.

Stress, poor sleep and inactivity can make pain worse and more likely to persist. Less commonly, infections, inflammatory arthritis, fractures or tumours are responsible; if there is fever, weight loss or a history of injury, these possibilities are always investigated.

How is it diagnosed?

Diagnosis is based on the history and examination. The doctor asks when and how the pain started, which movements make it worse, whether it spreads to the arm or head, and how it varies through the day. The examination covers neck movement, tender spots in the muscles, arm strength, reflexes and sensation. Signs that might suggest spinal cord involvement, such as clumsy hands or unsteady walking, are specifically looked for.

Imaging is generally not needed for neck pain without warning signs. X-rays or CT are used after an injury, and MRI when the findings suggest pressure on a nerve root or the spinal cord. Age-related changes on scans are common in people without pain, so results are always interpreted alongside the examination. When facet joint pain is suspected, diagnostic blocks can be used to confirm the source.

Treatment options

Treatment is planned around the source of the pain and how long it has been present. Recent pain is usually managed first with simple measures, while long-standing pain needs a more detailed plan aimed at its source.

Conservative care

• Keeping active: rather than holding the neck completely still, keep up normal movements as far as the pain allows.
• Exercise and physiotherapy: programmes that strengthen the neck and upper back muscles and improve flexibility and posture form the basis of treatment.
• Ergonomics: a screen at eye level, a good sitting position and regular breaks while working.
• Medication: short courses of painkillers and, where needed, muscle relaxants.
• Stress and sleep: relaxation techniques and better sleep habits can help to reduce muscle tension.

Interventional pain treatments

For pain that persists for several months despite appropriate treatment and limits daily life, the following source-directed options may be considered:

• Facet joint injection: helps to confirm whether the pain is coming from the facet joints; some people also experience a period of relief.
• Radiofrequency treatment: applied to the small nerve branches that carry pain from the facet joints, once a diagnostic block has confirmed the source. It may be an option for persistent joint pain after a whiplash injury.
• Trigger point injection: may support an exercise programme when clear trigger points are present in the neck and shoulder muscles.

In suitable patients these procedures can provide a meaningful reduction in pain, but results vary from person to person and each procedure has its own risks. Because important nerves and blood vessels lie close by, procedures in the neck are performed under imaging guidance and planned with particular care.

When is surgery considered?

If there are signs of spinal cord compression (clumsy hands, unsteady walking), progressive weakness, or nerve root compression that does not respond to treatment, surgery is assessed together with a neurosurgeon or an orthopaedic spine surgeon.

When should you see a doctor?

See a doctor if your neck pain is not easing after a few weeks, keeps coming back, spreads into your arm or disturbs your sleep. An algology (pain medicine) specialist will assess the source of the pain and draw up a treatment plan with you; you can request an appointment through our contact page.