Neck pain

Neck pain is a very common musculoskeletal complaint that can arise from mechanical, neurological, vascular, or systemic causes. It can present as stiffness, aching, burning, sharp shooting pain, or as referred pain into the head, shoulders, or arms. The severity ranges from mild discomfort to disabling pain interfering with daily activities.

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Common Causes

• Musculoskeletal/Mechanical

  • Muscle strain from poor posture (e.g., prolonged computer or phone use).

  • Whiplash injuries.

  • Cervical spondylosis (degenerative changes in the cervical spine).

  • Herniated cervical disc.

  • Facet joint dysfunction.

• Neurological

  • Cervical radiculopathy (nerve root compression).

  • Spinal stenosis.

• Other Medical Causes

  • Infections such as meningitis (associated with fever, photophobia, stiffness).

  • Rheumatologic diseases (rheumatoid arthritis, ankylosing spondylitis).

  • Malignancies (rare, but must be considered in persistent unexplained pain).

  • Vascular causes such as carotid or vertebral artery dissection.

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Symptoms

• Localized pain and stiffness.

• Pain radiating to the shoulders, arms, or head.

• Limited range of motion.

• Neurological symptoms (numbness, tingling, weakness).

• Headaches.

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Red-Flag Signs (urgent medical attention needed)

• Sudden severe neck pain with neurological symptoms.

• Associated fever, night sweats, or unexplained weight loss.

• Trauma history (falls, accidents).

• Pain not improving or worsening progressively.

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Diagnosis

• History & Physical Examination: To determine onset, severity, aggravating factors, and associated symptoms.

• Imaging:

  • X-ray for alignment, degenerative changes, fractures.

  • MRI for soft tissue, disc, and nerve compression.

  • CT scan in trauma or suspected bony pathology.

• Laboratory Tests: Blood tests if infection, inflammation, or systemic disease is suspected.

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Treatment

1. Non-Pharmacological Approaches

• Rest and avoidance of aggravating activities.

• Heat or cold therapy (ice in acute injuries, heat for chronic stiffness).

• Physical therapy: stretching, strengthening, posture correction.

• Ergonomic adjustments at workplace.

• Soft cervical collar (short-term use only).

2. Medications

• Analgesics: Paracetamol (acetaminophen).

• NSAIDs: Ibuprofen, naproxen, diclofenac – reduce pain and inflammation.

• Muscle relaxants: E.g., cyclobenzaprine, methocarbamol – for muscle spasms.

• Neuropathic pain agents (if nerve involvement): Gabapentin, pregabalin.

• Corticosteroid injections: In severe cases with nerve compression.

3. Advanced Interventions

• Epidural steroid injections.

• Radiofrequency ablation for facet joint pain.

• Surgery: For severe herniated disc, spinal stenosis, or progressive neurological deficits.

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Preventive Measures

• Maintain good posture.

• Ergonomic work setup (monitor at eye level, chair with neck support).

• Avoid prolonged forward head posture (“text neck”).

• Regular exercise (neck stretches, strengthening, aerobic activity).

• Proper pillow and sleeping position.