Up to my neck in pain!

PAIN MANAGEMENT

Neck pain usually starts suddenly. But it often begins to feel better after a few days and is usually gone after a week or so. If it doesn't go away or it gets worse, you may have a more serious problem that needs treating.

Neck pain can happen because of a problem in any part of your neck. This includes the muscles, the nerves, the bones in the neck (vertebrae) and the discs in between these bones. Discs are round pads of spongy tissue. They cushion the bones in your spine to stop them getting damaged or rubbing together. Neck pain usually starts suddenly.

There are different types of neck pain. Each has different causes.
* Simple (or uncomplicated) neck pain:
This is the most common type of neck pain. You might never know the exact reason for your neck pain, but it might be due to:
* Bad posture (for example, when working at a computer)
* Tension from stress, anxiety or depression
* A strain in your neck muscles or ligaments (the strands of tissue that hold bones together). Perhaps you slept in an awkward position or jarred your neck while exercising
* A twisted neck causing muscles on one side to tighten painfully (spasm). Doctors call this torticollis.
* Wear and tear of the bones in your neck (called the cervical vertebrae) and the shock-absorbing discs between them. This is a common cause of neck pain in older people. Doctors sometimes call this cervical spondylosis or cervical osteoarthritis.
* Whiplash
You can get whiplash if your head is suddenly jolted backwards and forwards. It's common after car crashes or sports injuries. Your neck muscles and ligaments stretch more than normal and they may get sprained.

Cervical radiculopathy
This is when the root of a nerve is squashed or injured as it comes out between the bones in your neck (the cervical vertebrae). It can happen when a bone or disc in your neck presses on a nerve. This is similar to what happens when a disc in your back tears and the jelly-like centre presses on a nerve, causing low back pain (this is called a slipped disc).

Cervical radiculopathy can cause a lot of pain. Your arm might also feel numb or weak or have 'pins and needles'.

Other causes
Sometimes neck pain is due to more serious injuries or rare causes. An accident or fall can lead to severe neck injuries such as a broken bone or a dislocated bone (when a bone moves out of place). Rheumatoid arthritis, fibromyalgia, bone disorders and cancers also can cause neck pain. A stiff neck can also be a sign of meningitis or a condition called polymyalgia rheumatica, which causes bad aches and stiffness in the upper arms, neck and thighs.

If your neck pain lasts just a few days or weeks, your doctor may say you have acute or short-term neck pain. Neck pain that lasts more than three months is often called chronic neck pain.

Your doctor can rule out serious causes of neck pain by examining your neck. He or she may also order some tests. You might have an X-ray of your neck, a CT scan or an MRI scan. Sometimes doctors do blood tests to look for inflammation or more serious causes.

Symptoms
Your neck will be sore and painful, especially when you try to move it. The pain may spread. Your symptoms will depend on the cause of your painful neck and how serious it is. Most neck pain starts suddenly and usually improves after a couple of days. This is known as acute (short-term) neck pain. The pain begins in your neck and may spread to your head and shoulders, or down an arm.

Your arm or hand may also feel numb, weak or tingling. You should tell your doctor if you get these symptoms, as they may mean you have a problem with a nerve in your neck.

You might also have a slipped disc (one of the spongy pads between the bones in your neck may be pressing on a nerve). Or a muscle spasm might be pinching a nerve.

Some people get neck pain that doesn't go away. This is called chronic (long-term) neck pain. The pain may get worse from time to time. For some people, the pain is so bad that it keeps them awake at night.

Sometimes people get neck pain that is caused by something more serious. You should see your doctor straight away if
* You have a high temperature
* You lose weight for no reason
* You feel dizzy and have blackouts
* You get nerve symptoms, such as weak and clumsy hands
* Your pain gets worse
* Your neck feels more stiff in the morning.

Neck pain usually goes away within days or weeks. But for some people, it can come back or last for a long time.  There are lots of different treatments for neck pain.

You can take painkillers you buy in a pharmacy and apply heat or ice when you first get a sore neck. Hands-on treatment by a physiotherapist, osteopath or chiropractor probably works better than other physical treatments, such as putting heat on the painful area.

Keeping active and exercising is likely to improve neck pain and stiffness in the long run. But you shouldn't overdo it. You might want to try improving your posture and using only one or two pillows at night. But we didn't find any research on whether these things help.

Treatments
Mobilisation (often done by a physiotherapist): Treatment by a physiotherapist to improve the movement of your neck joints will probably reduce your neck pain and stiffness. There are several movement-based treatments for neck pain, and there are some similarities between them. The type we talk about here usually involves fairly gentle movement. Below, we've also looked at manipulation done by a chiropractor, which may involve sharper, faster movements of the bones in your neck.

Exercise
Strengthening exercises may help long-term neck pain. Several studies on exercise (randomised controlled trials) looked mostly at people with long-term (chronic) neck pain. They found that people were likely to have less pain if they did exercises to strengthen their neck muscles and improve their flexibility. The studies looked at different sorts of exercise programmes, such as those that you do at home and those that you do with help from a physiotherapist. Exercise worked better than just having the usual care, such as drug treatment or help with managing stress.  It's very unlikely that an exercise programme will harm you if you do it with help from an expert, such as a physiotherapist. But the studies don't give much information about risks.

BMJ Group

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