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Introduction:
Neck pain is common and can have many reasons. About 20% of people experience
acute neck pain. Chronic neck pain that lasts more than 3 months occurs in about
10% of people. Despite many studies the real causes of acute or chronic neck pains
are poorly understood. However, there is enough evidence to delineate the more
common mechanical neck pain from the more serious systemic neck pain.
Mechanical
neck pain:
As can be seen from the table above, there are
a number of causes of mechanical neck pain. Some common causes are compression
fractures, degenerative changes of the facet joints or of the intervertebral discs.
Automobile accidents or personal injuries that jar the neck are also frequently
causing mechanical neck pain. Non-specific
chronic muscle spasm: Chronic muscle spasm in the neck region
is getting more common. Fibromyalgia
is one distinct form of this, which has been dealt with under this link. Here
specific trigger points are found that make it possible to classify it separately.
In a bout 20% of traffic accident victims with whiplash associated disease there
is a "posttraumaic fibromyalgia", which is well described in the literature,
and should be medically diagnosed early so that it can be treated accordingly.
Often sleep disturbances are associated with this. Myofascial
pain syndrome is a less specific chronic painful muscle spasm that
develops from disuse after an injury in he neck or arm region. Once the patient
is dysfunctional, because of pain issues secondary muscle atrophy (loss of muscle
mass) develops, and this predisposes the patient to more frequent muscle spasms.
When this pain becomes chronic,the condition of post traumatic myofascial
pain syndrome is established. It is extremely difficult to treat and often
tends to be chronic (Ref. 1, P.7). Complex
regional pain syndrome I and II (formarly called "RSD"
or reflex sympathetic pain syndrome, and causalgia) are two regional pain syndromes,
which are fairly well defined, but need early diagnosis (2 to 3 month after the
initial trauma) to be treated effectively. Bone scans and thermography can help
in the early diagnosis. Treatment may involve a sympathetic nerve block, corticosteroid
epidural blocks and very intensive re-activation physiotherapy. For spinal malalignments
(which the chiropractors call "subluxations of the facet joints") gentle
chiropractic manipulation and then active re-activation phyiotherapy may be needed.
Here is a link to a site
with more info on CRPS. Summary
Regarding Neck Pain: As we have seen, there can be a multitude
of reasons why a person may experience neck pain or pain in the cervical spine.
Diagnostic tests need to be utilized to pinpoint the cause as accurately as possible.
Treatment needs to then concentrate on early reactivation. Sometimes a home TENS
machine can be used to reduce pain, which in turn may allow those to get reactivated
who could otherwise not have done this because of too much pain. Difficult
cases may have to be referred to a neurosurgeon for surgical problems and to a
physiatrist for the more chronic problems. The patient must get used to a much
more active role as we have learnt that often the minor problems of an injury
are aggravated by inactivity while awaiting tests and specialist referrals. Most
of the time the specialist finds that nothing seriously is wrong, but that the
patient should have been rehabilitated much earlier. |
