Adam Sewell MD


Neck pain is one of the most common medical complaints and occurs slightly more often in women than men. However, many people experience some level of neck pain in the course of their lifetimes, and most of the time, it isn’t serious and may occur as a result of stress, improper body mechanics, like poor posture, or muscle strain from unusual or awkward positions. 

Some serious symptoms that constitute a medical emergency that require immediate care include:

  • Loss of, or altered, consciousness
  • Changes in vision, such as blindness
  • Changes in bowel or urination
  • Nausea or vomiting
  • Fever
  • Weight Changes

The root cause or causes of neck pain can vary, but sudden severe pain, lasting less than three months, is classified as “acute.” Acute neck pain is commonly caused by facet syndrome (joint degeneration), muscle strain, or injuries, like whiplash. Pain lasting for more than three months, is classified as “chronic” neck pain and can originate from multiple locations, but is often from facet joints irritation, discs, ligaments, and muscles.


The cervical spine (neck) is complex and has many important functions, which include providing support and mobility to the head and neck, as well as protecting the spinal cord.

Bone structures

The cervical spine has seven small vertebrae and starts at the base of the skull. These small vertebrae provide a support structure that protects the spinal cord, the skull, and allows for movement.

Vertebral Discs

In between each of the vertebrae are jelly-like discs that cushion and minimize impact to the cervical spinal column. The same cushion that minimizes impact can cause discs to herniate “collapse backwards” or bulge through adjacent ligaments, nerves, or the spinal column itself. It’s this irritation or inflammation that leads to neck pain.

Spinal Ligaments and Muscles

Ligaments and muscles attach to each vertebra, providing support, mobility, and movement for the cervical spine. Spinal nerves are attached to the cervical spinal cord. These ligaments and muscles innervate the skin and surrounding structures of the neck and upper extremities (arms and hands). Damage to these structures is one of the major sources of neck pain.

Atlas and Axis

The Atlas and Axis are the first two cervical vertebrae, starting at the base of the head. These two vertebrae form pivot-type joints that support the head, control movement, and connect to the spine. They are part of the body’s coordination and balance system as well. The cervical spine is the most flexible portion of the spinal cord, and therefore, the most vulnerable to injury or trauma.If the first through third cervical nerves are compromised, compressed or inflamed, they cause neck pain and sensory issues in some head and face areas.

Greater and Lesser Occipital Nerves

If these nerves are injured, they can cause radiating pain to the face and head. The other nerves lower in the cervical spine form a large nerve group, which provides motor and sensory support to the upper extremities. Symptoms may include, weakness, pain, loss of feeling, or other issues in the arms, if they are damaged.


Cervical epidural steroid injections (CESIs)

This procedure involves injecting a steroid into the epidural space within the cervical spinal canal. Two medications are used to complete this process – a long-lasting steroid and a local anesthetic (lidocaine, bupivacaine). The steroid reduces inflammation and irritation, while the anesthetic interrupts the pain cycle.


Cervical steroid injections may provide immediate and longer-lasting pain relief and are considered simple and relatively painless.


Mainly considered a low-risk procedure, but with any procedure, there is the risk of infection


The most common causes of neck pain include:

  • Muscle strains
  • Trauma or injury
  • Herniated or bulging cervical disc
  • Stress

Muscle overuse, and sleeping in awkward positions, often produce neck pain.  When the muscles in the back of the neck tighten and become strained, chronic pain may develop. “Whiplash” is a common example of this kind of neck pain, and it occurs in motor vehicle accidents, most often in rear-end collisions. The pain results from the stretching and straining of soft neck tissues. This caused localized inflammation, muscle tension, and ligament strain. When ligaments and tendons become inflamed or damaged, they cause additional pain that worsens with certain movements. Neck facet joints are also commonly involved.


Myofascial (muscle related) and ligament injury are the most common cause of neck pain, as ligaments are susceptible to strain and irritation from strenuous lifting and prolonged overuse.

Degenerative disc disease (DDD)

In degenerative disc disease, the discs begin to fall apart or shrink. It’s one of the more common reasons for spinal surgery. Disc disease can be acute, but more often, it’s chronic and the pain is caused by a slow degeneration, occurring as part of the aging process. DDD is progressive disease that develops after spinal discs begin to from disc thin. This can lead to compression of the vertebrae, or adjacent structures, and cause neck pain.

Cervical Spondylosis (neck arthritis)

Cervical Spondylosisis caused by degenerative cervical vertebrae and nearby facet joints. Symptoms typically start around the age of 40, but may start earlier with trauma or is a person has a genetic predisposition to it. Arthritis is a progressive disease, and degenerative disc changes occur as a result of the aging process. The disc may decay, herniate, or bulge, causing local nerve root irritation or spinal cord compression. The pain is often worse when the head is extended backwards.

Spinal Stenosis

Spinal Stenosis is another common cause of neck pain that occurs, from a narrowing of the central spinal canal. It may cause the compression of surrounding nerves roots, and some symptoms may include, cramping or shooting pain, and numbness in the legs, back, neck, shoulders or arms. Symptoms typically depend on the area of the spine that is compromised.  In cervical spinal stenosis, the upper extremities (arms) and shoulders are most commonly affected.

Mental health

Mental health issues, like depression, anxiety and stress, all have a tendency to exacerbate neck pain and other chronic pain syndromes, and emotional issues often cause neck pain to grow worse. There are several identified risk factors in the development of spine pain. They include, but are not limited to, physical, socioeconomic status, general medical health and psychological state. Occupational environmental factors contribute to the risk for experiencing pain as well (Rubin 2007).

Central Sensitization

Central Sensitization (sensory hypersensitivity) is a common complication for those suffering from chronic pain syndromes. It involves both the peripheral nervous system (PNS) and the central nervous system (CNS) and occurs when a local tissue injury and inflammation activate the PNS. This action sends pain signals through the spinal cord to the brain. Central sensitization occurs when there is an increase in the excitability of neurons within the CNS at the level of the spinal cord and higher.

The once normal PNS signals begin to produce abnormal responses. Low-threshold sensory fibers activated by very light touch of the skin activate neurons in the spinal cord that should only respond to pain. Sensations that normally produce a harmless reaction now produce significant pain.

Other Conditions

Less common causes of neck pain include vertebral compression fractures, spinal cord disorders, tumors, and infection. Metastatic tumors (cancer spread from another organ system) are the most common type of malignant lesions of the spine, but are still very rare among the general population. Up to 10% of patients with a primary cancer suffer spinal metastases. Breast, lung, prostate, and renal cell carcinomas are the most common tumors that metastasize into to the spine. However, myeloma, lymphoma, and gastrointestinal carcinoma can also invade the vertebral column as well (James 2003). Oropharyngeal cancers of the oral cavities and neck may also cause neck pain.


To diagnose neck pain, a physician will perform a medical history and physical exam, looking over certain areas of the spine. He or she will perform various muscle tests, as well, to find any limitations in movement in the upper extremities.

The doctor will, also, most likely order some imaging like, X-ray, computerized magnetic resonance imaging (MRI) or a bone scan. MRI’s are considered the standard of care to detect the cause acute or chronic neck pain.


Before beginning any treatment, please consult a physician.

It’s vital to not only treat the physical symptoms, but the emotional stressors as well. Massage, acupuncture, biofeedback, and behavioral therapy can all be extremely beneficial those suffering from chronic neck pain.

Alternative or Complimentary Options

Alternative therapies offer very little risk and are successful in many individuals with chronic neck pain.

In acupuncture, the acupuncturist inserts small needles just under the skin. It’s thought that the needles trigger the release of hormones called “endorphins“, which are the body’s natural pain reliever. Acupuncture may aid in relaxation and decrease stress and tension.

Physical therapy is often helpful in reducing or alleviating neck pain as well.

Pain Relievers

Over-the-counter Pain relievers such as ibuprofen (like Motrin), or acetaminophen (like Tylenol) may provide neck pain relief.


May offer pain relief for mild to moderate neck pain caused by muscle or ligament strain


Prolonged and frequent use of over-the-counter medications may lead to gastrointestinal conditions, such as ulcers; or liver damage in the case of acetaminophen.

For more information about neck pain, or the pain relief options described, please see your pain physician.


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