Neck pain

Reviewed by Dr John Pillinger, GP

Pain in the neck can be due to: injury, a mechanical or muscular problem, a trapped nerve caused by a bulge in one of the discs between the vertebrae or from arthritis of the neck.

It can range from mild discomfort to severe, burning pain.

If the pain is 'acute' – sudden and intense – it's called a crick in the neck, facet syndrome or muscular rheumatism.

If the pain has lasted more than three months, it's termed 'chronic' neck pain.

Neck pain is a common condition and is more frequently seen in women than men.

Most people will experience pain in the neck at some point in their life.

What causes neck pain?

Many things can trigger neck pain. These include:

trauma or injury

worry and stress

falling asleep in an awkward position

prolonged use of a computer keyboard.

There are several theories about why so many people suffer neck pain, but they are not supported by scientific proof. For most people, no specific reason for the pain can be found.

But in some cases it's possible to make a precise diagnosis. The underlying problem could be a slipped disc, brittle bones (osteoporosis), deformed natural curvature of the spine (scoliosis) and, very rarely, structural damage due to tumours or infection.

Finally, road traffic accidents involving whiplash injury may result in acute or chronic neck pain that takes several months to improve.

What does neck pain feel like?

General pain located in the neck area, as well as stiffness in the neck muscles.

The pain may radiate down to the shoulder or between the shoulder blades.

It may also radiate out into the arm, the hand or up into the head, causing a one-sided or double-sided headache.

The muscles in the neck are tense, sore and feel hard to the touch.

Acute pain can give rise to abnormal neck posture in which the head is forced to turn to one side. This condition is known as torticollis.

The pain at the base of the skull may be accompanied by a feeling of weakness in the shoulders and arms.

There may be a prickly or tingling sensation in the arms and fingers.

Danger signals associated with neck pain

In some cases, neck pain may be a symptom of meningitis.

If any of the the following symptoms occur, dial 999 or seek medical attention urgently.

A rash develops that doesn't fade when you press it with a glass tumbler or a finger.

The patient feels ill or is running a fever, as well as feeling neck pain.

It's so painful to bend the neck forward that the patient can't put their chin on their chest.

Light hurts the eyes.

Neck pain is accompanied by severe headache or continuous vomiting.

Neck pain is accompanied by severe pain in the back.

In some cases, neck pain can be a symptom of head injury or disc trouble in the neck.

If any of the following symptoms occur, dial 999 or seek medical attention urgently.

Neck pain is the result of a recent head injury and the person is becoming drowsy, confused or is vomiting.

Neck pain is accompanied by headache.

If there's pain behind one eye.

Vision, hearing, taste or balance are affected.

Severe vomiting.

The muscle power in arms or legs is reduced.

What can you do yourself?

Stay as active as possible. Try to go to work and keep up your normal everyday activities – bed rest isn't necessary.

If you're given a neck-collar, try not to use this for more than one or two days. Avoid driving if you're unable to turn your head quickly.

Remember that neck pain is rarely caused by a serious illness and will often disappear within a week.

If you have had pains in the neck for a longer period, it's a good idea to consult your GP or a physical therapist – such as a chiropractor or physiotherapist.

Also, the following symptoms may indicate a more serious underlying problem than simple mechanical neck pain and require that you seek further advice from your GP:

co-existing illness, such as unexplained weight loss

actual tenderness or pain in the neck bones (vertebrae)

the pain simply continues to get steadily worse despite treatment

if one or both of your arms become affected, eg persistent numbness, weakness or clumsiness.

How does the doctor or chiropractor make a diagnosis?

In most cases, a neck problem can be diagnosed by carrying out a thorough examination that may include all or some of the following:

testing the movement of the neck

testing for trapped nerves

examination of the muscles

examination of the movement of the joints of the spine, neck and hands

X-rays, scans or blood tests may be necessary to make a precise diagnosis.

How is neck pain treated?

Acute pain at the base of the skull may well disappear without treatment.

For short-term problems, manual treatment (chiropractic or physiotherapy) and pain-relieving medicine are recommended.

With longer-term pain (ie three months or more) there's the following choice of treatment:

chiropractic treatment

intensive muscle training

physiotherapy, including advice on posture and the use of a supportive pillow

acupuncture provides relief for significant numbers of people with chronic neck and shoulder pain, although this is not routinely available on the NHS.

What medication is given?

Painkillers taken on a regular basis, eg paracetamol, are often sufficient alone.

Medicine used in the treatment of mild muscle pain includes non-steroidal anti-inflammatory drugs (NSAIDs). These are generally effective in those who can tolerate them. But they may cause side-effects in patients with a past medical history of indigestion or asthma and be unsuitable for certain patients with kidney impairment, heart failure and high blood pressure.

Consult your doctor or pharmacist if you think this might apply to you.

Stronger painkillers, such as codeine phosphate, may be used if NSAIDs are not working well or are unsuitable. Sometimes a muscle relaxant (eg diazepam) may be prescribed on a short term basis of up to 1 to 2 weeks depending on progress.

Exercise

People with weak neck muscles are more prone to neck problems, and in such cases an exercise programme to strengthen the neck is a good idea.

Future prospects

This depends on the underlying cause of the pain. The prognosis is generally good, provided the patient remains active and obtains the correct treatment without delay.