Neck Pain Overview
The spine in the neck (cervical spine) consists of a row of bones (vertebral bodies) that are separated by cartilage discs (intervertebral discs). There are joints called facet joints between the vertebral bodies. These joints allow the neck to twist and bend.
The spinal cord runs downwards inside the spinal canal. The cord gives off branches (nerve roots) that pass out of the spine at the openings between the bones. These nerve roots blend together to form the brachial plexus of nerves. This plexus then divide up into the three nerves that supply the upper limb, hand and fingers (radial, ulnar and median nerves).
Neck Pain Causes
The bones and discs of the cervical spine develop 'wear and tear’ changes as a person gets older (osteoarthritis). The discs become flattened out and the facet joints become worn and less mobile. These changes cause the pain in the neck and shoulders (facet joint arthropathy).
The neck and shoulder pain is made worse with movement because the supporting muscles of the neck next to the joints become stiff and sore. The muscles often ‘seize up’ after a period of inactivity resulting in pain and stiffness when the joints are moved again.
Neck Pain Symptoms
A constant pain:
A dull background ache in the neck (cervical region). This can be on one or both sides.
Intermittent severe episodes of pain:
These can be unpredictable, and occur a few times per month or per year.
Pain radiating into the shoulder and upper back:
It often radiates into the shoulder blade region. It rarely radiates below the elbow.
Increased pain with movement:
The pain is made worse by bending the neck upwards or from side to side.
Muscle stiffness and neck pain on waking
Pain that is reduced in certain positions:
Lying down and resting often reduces the pain.
Tenderness to pressure over the side of the neck.
Neck Pain Diagnosis
The diagnosis of cervical facet joint pain is made from the patient’s description of their symptoms.
There are no specific clinical examination tests that will confirm cervical facet joint pain. Bending the neck upwards and from side to side might replicate the pain. Pressing over the muscles on the side of the neck may cause discomfort.
Magnetic resonance imaging (MRI) scan of the lumbar spine:
This uses radio waves and a strong magnetic field to create images of the body's structures. This investigation is commonly carried out. The scan will show the ‘wear and tear’ changes (osteoarthritis) that develop with the ageing process (lumbar spondylosis).
A conventional single X-ray picture of the cervical spine will also show these wear and tear changes. There is a poor correlation between the images shown on MRI scan and X-rays and the symptoms that a patient might describe.
Diagnostic medial branch nerve blocks:
This is the only way of making the diagnosis that the cervical facet joints are the main source of the neck pain.
The principle of these diagnostic blocks is similar to an injection carried out by a dentist. The nerve is blocked with a freezing solution (local anaesthetic), and it the toothache is relieved, then that identifies that nerve and tooth as the source of the pain.
(See PDF Cervical Diagnostic Medial Branch Nerve Blocks)
These test injections are carried out using X-rays to show up the bone and joints of the spine. A fine needle is then placed next to the nerve (medial branch nerve) and a small amount of local anaesthetic is injected. The patient is asked to keep a record of their symptoms (pain diary) after the procedure.
If these injections substantially relieve the pain afterwards, then this identifies the facet joints as the principal source of their symptoms. The local anaesthetic wears off after several hours, so the pain relief may be short lived. It is usual practice to carry out two diagnostic nerve block procedures to confirm the diagnosis.
Neck Pain Treatment
1. Conservative therapies: It is usual to try simple and conservative therapies first. These would involve:
Simple painkillers such (paracetamol and codeine) and the anti-inflammatory drugs (ibuprofen, naproxen).
Stronger morphine related painkillers (tramadol and morphine) should NOT be used. These can have distressing side effects and are potentially habit-forming.
Drugs to treat neuropathic pain (amitriptyline, gabapentin, and pregabalin)
(See Neuropathic Pain in the Conditions menu.)
Complementary and physical therapies:
Regular exercise and stretching
Topical therapies. These involve using the anti-inflammatory rubs or gels (Voltarol Emulgel, Mobilat, Ibulieve) and hot or cold pads.
A TENs machine
Joint supplements (Glucosamine)
2. Interventional therapies:
Cervical diagnostic medial branch nerve blocks: These nerve blocks are to identify the source of the neck pain. The next step is to destroy these nerves (ablation or rhizotomy) with a hot microwave current. (See below).
(See PDF Cervical Diagnostic Medial Branch Nerve Blocks)
Cervical radiofrequency nerve ablations (rhizotomy): This procedure involves burning the medial branch nerves using a hot microwave current. This destroys the nerve pathway and blocks the pain. The nerves do recover by growing back, but this takes 12 to 18 months to happen.
(See PDF Cervical Radiofrequency Nerve Ablations (Rhizotomy)
Cervical facet joint injections with steroid: This procedure involves injecting around or into the facet joints of the neck with local anaesthetic and steroid. It is carried out under X-ray control. The procedure is done on patients who are not suitable to have diagnostic nerve blocks carried out. These are patients who have excessive wear and tear changes of their neck that would make a nerve burning procedure technically difficult. These are usually elderly patients.
Search the Internet using the following key words:
Cervical facet joint pain
NHS medial branch nerve blocks
Diagnostic medial branch blocks
Cervical facet joint arthropathy