Cervicalgia (neck pain)

The cervical spine is made up of seven vertebrae, which are separated by fibrocartilaginous cushions called intervertebral discs. From the age of 35 onwards, as a consequence of thousands of movements, including flexion, extension, and rotation, neck pain and/or discomfort may appear.

To keep the head in a normal position, the muscles in the back of the neck must work properly, since the head and neck do not come together at a central point, but rather, the neck supports the posterior part of the head. The muscular tension required to maintain the head in a correct position, as well as damage to the small joints between these cervical vertebrae (osteoarthritis), are common causes of neck pain.

Mechanical and postural causes are often responsible for cervicalgia. These changes can produce compression lesions on the nerve structures that pass through the cervical region. The intervertebral discs can slide forward or backward, and even herniate, affecting the nerve structures. 

Prevalence

Neck pain is one of the most frequent reasons for a visit to the doctor's surgery. We know that up to 70 % of the population will suffer from this problem at some point in their lives.

Bad posture, the use of new technologies, work habits, traffic accidents, population ageing, stress, and worry all contribute to this high incidence. 

Diagnosis

Diagnosing this condition is based on the characteristics and mechanisms of the pain, as well as the results of a physical examination.

Neck pain can be either mechanical or inflammatory in nature. Mechanical causes are the most common; this kind of pain gets worse with movement and improves with rest. This kind of pain is caused by wear, practising sport, some types of work that cause mechanical stress on the neck, previous trauma, and degenerative disorders.

Inflammatory-type pain suggests the presence of inflammation, infection, and/or tumours. It is a continuous pain that does not improve with rest nor medication. It is usually accompanied by other symptoms such as fever, impaired general condition, neurological symptoms, etc. The physician will evaluate the need to carry out any tests and determine which one is most suitable for each case. 

Typical treatment

Generally speaking, mechanical neck pain improves in 2-3 weeks. 

Treatment should include:

• Controlling posture and neck positions.
• Avoiding activities that produce pain.
• Doing exercises and gentle stretching at home.
• Applying dry heat to alleviate the pain.

Taking pain relievers like paracetamol can help control the pain. Other treatments, such as taking anti-inflammatory medications or muscle relaxers, will be prescribed as needed by your physician. If the pain persists or new or different symptoms appear, talk to your doctor.

It is important to keep your head in a good position and to correct your posture. For this, exercises that strengthen the posterior cervical muscles (the extensors) are very useful, as they will help you maintain a correct, straight posture. This will prevent the pain from reappearing or becoming chronic. 

Standard tests

Generally, acute neck pain does not require any diagnostic tests. With a conventional X-ray, the cervical vertebrae can be evaluated and a diagnosis can be made using just this, in most cases.

On another note, it is very common to find signs of osteoarthritis, such as impingement, on X-rays; these do not require any kind of treatment. 

If the clinical case warrants them, your physician will decide (based on the symptoms) whether to carry out neurological tests like a CAT (computerised axial tomography) scan, NMR (nuclear magnetic resonance) scan, or an EMG (electromyogram). These tests are intended to diagnose more severe injuries or to assess nerve damage in the cervical spine.