Chronic Neck Pain
Chronic neck pain is defined as neck pain that is lasting more than 3 months to the severity that one's activities of daily living are limited. Approximately 30% of adults have had chronic neck pain at some point in their lives. While the causes of chronic neck pain can be numerous, significant advances have been made over the last 20 years in the diagnosis and treatment of chronic neck pain so that one does not necessarily need to 'live with it' or consider 'drastic surgery'.
The causes of chronic neck pain very depending on the age of the patient. In a younger person (under the age of 50) chronic neck pain in the absence of nerve or spinal cord compression is usually due to disc degeneration or possible musculo-ligamentous strains. The nature of the neck pain and the factors that exacerbate/alleviate the neck pain - in addition to any causative factors such as car accidents or injuries - may help elucidate the nature of the neck pain. In addition to a thorough physical examination, advanced imaging such a CT or MRI may be helpful in determining the etiology of the neck pain. In most cases, a targeted a physical therapy program based on a proper diagnosis can help significantly in the management of this type of chronic neck pain. Occasional nonsteroidal anti inflammatories and other medications can be used but should not be necessary on a daily basis. The most important aspect of improving chronic neck pain in younger age patient is making the proper diagnosis so the physical therapy regimen can address this cause appropriately.
In older patients (over the age of 50) the cause of chronic neck pain is most commonly arthritic in nature. In addition to the disc degeneration, the patient may also have arthritis in the back of the spine known as facet arthritis or arthropathy. Again, the nature of the patient's neck pain and what aggravates/alleviates it can help determine what type of treatments may be helpful. If the patient's pain is worse when bending forward as opposed to bending backwards, this suggests disc degeneration as the main pain generator. However, if the patient's pain is worse when extending his/her neck backwards or rotating the head from side to side, this suggests facet arthritis a cause of the pain. Advanced imaging such a CT scan and/or MRI can be used to help confirm the clinical diagnosis and exclude spinal cord and/or nerve compression. Once the pain generator is identified, a physical therapy program based on the proper diagnosis can be helpful in the management of this chronic neck pain. While the chronic neck pain may never go away completely in the elderly patient, an exercise-based physical therapy program may make it more manageable. If physical therapy and occasional nonsteroidal anti-inflammatory medications are not significantly helpful in addressing the pain and the patient does not show any significant evidence on examination or imaging of nerve and/or spinal cord compression, advanced pain management techniques can be used to determine the pain generator as well as address the pain, at least temporarily. This includes such techniques as facet injections and dorsal rhizotomies. Surgery is very rarely indicated for chronic neck pain in the absence of spinal instability, spinal cord compression, or nerve compression.
Given the varying nature of chronic neck pain in elderly and in younger patients, it is important to discuss your specific situation with a fellowship trained orthopedic spine surgeon.