Neck Pain Overview

Neck pain is a common effect of aging. It may begin with a faint twinge on one side of the neck or in the shoulder upon waking in the morning, and often worsens as the day goes on. The pain may spread down the arm to the hand. Over-the-counter pain relievers, rest, and heat applied to the area may help.

There are several causes of neck pain. One of the most common causes is the constant turning, twisting, and bending of the neck, day after day, year after year. Contact between opposing surfaces in the spine may result in the development of small outgrows of bone, called osteophytes, or spurs.

The spinal cord, which is part of the central nervous system (CNS), conveys information to and from the brain and responds by itself to certain lower functions. Nerves originate in the spinal cord and exit through small foramen (canals). Basically, at each spinal level, nerves emerge from the spinal canal, exit through their respective foramen, and travel to distant locations in the body. When spurs develop near the foramen, they pinch the nerve that is trying to exit from that canal. Constant friction and pinching cause inflammation and pain, which may occur at the site of the friction or, more often, at a distant site, such as at the shoulder or down the arm.

Pinched nerves are only one cause of neck pain. As in the lower back, cervical disks can bulge, protrude, and herniate, which also can cause pain. Muscle pain usually will heal eventually, and pain from a pinched nerve may diminish temporarily, but other types of neck pain require treatment to reduce the risk for neurological damage (e.g., numbness, weakness).

Diagnosis of Neck Pain

Cervical spine x-rays are often used to detect small fractures or misalignment of the vertebrae. These x-rays generally include 3 standard views: AP (anteroposterior), or frontal view; lateral (side view); and a third view that allows the radiologist to see the structure (odontoid or dens) that comes from the second vertebra and fits into the socket formed by the back of the first vertebra. To see this important structure, the mouth is open to eliminate shadows from the teeth and the x-ray is directed to the back of the throat. This is called an “open mouthed” view and it is key in detecting fractures of the dens, which are very serious.

To diagnose arthritis, 2 additional views (called oblique views) are necessary. In a lateral x-ray, the appearance of the disc space is fairly evident and the radiologist can diagnose arthritis, if it is present, but many structures of the neck appear superimposed on each other. Turning the head a bit during this view “opens up” the view of the foramen through which the nerves exit the spinal column.

In patients below the age of 20, there usually is no degeneration. In patients in their 30s and 40s, spurs often start to develop, especially in the lower cervical spine. Cervical x-rays may indicate the degree of degeneration, but they do not provide very much information about the discs themselves. X-rays are unable to diagnose other conditions of the cervical spinal cord or its linings. In some cases, MRI scan or a special type of CT scan is necessary.

MRI scan is noninvasive and does not involve radiation, but it does require the patient to remain very still. The MRI shows the spinal cord, the nerves, and the discs, in many different planes.

CT scan by itself is not used to diagnose neck pain. In some cases, a contrast dye is injected into the spinal canal, which encompasses the spinal cord. This test, which is called a CT myelogram, provides a much better picture of what is causing the problem. CT myelogram is often considered the “gold standard” in cervical imaging. This test involves substantial radiation, however, and is invasive.

Neck Pain Treatment

In many cases, neck pain can be treated effectively using conservative measures, such as medication and heat. A cervical collar and physical therapy may be used to gently pull the spaces between the vertebrae slightly apart. During the day, a cervical collar also supports the neck and prevents excess movement, but overuse may lead to diminished muscle strength in the neck. Wearing a collar when sleeping can also be helpful. Depending on how the patient sleeps, movement during the night can cause spur damage.

Tips to Improve Sleep and Prevent Neck Pain

If you have neck pain or wake from sleep with a painful stiff neck, suspect your pillow. People can sleep peacefully on pillows of varying thicknesses, but incorrect sleeping position is a common cause for neck pain. Here are some tips to help you sleep better and prevent neck pain.

  • Don’t sleep on too fat a pillow or too many pillows, or without a pillow, if that causes your neck to flex. A pillow should help keep your neck aligned with your spine.
  • If you sleep on your back or side, a pillow should just fill up the contour of the neck. Pulling the edge of the pillow down between your chin and shoulder will help support your neck.
  • A softer pillow is usually better for sleeping on your back, a firmer one if you sleep on your side.
  • Putting another pillow under your knees may be helpful if you sleep on your back—or put it between your knees if you sleep on your side. A cervical roll (a small cylindrical pillow) can give good neck support. Some pillows with special contours can also help.
  • Sleeping on your stomach rotates your neck and is not recommended. If you do sleep this way, use a thin soft pillow so your head is level.
  • If your mattress is soft, choose a fatter pillow; if your mattress is firm, a thinner one.
  • Pillows wear out faster than you think. If your pillow feels thin, lumpy, and lifeless, replace it.

Words to the wise: Be skeptical about pseudo-medical claims regarding pillows with “memory foam,” layers of water or gel, and “magical” herbal fillers, as well as copper cases that are supposed to make you look younger. A pillow is only a pillow—your comfort is what counts. Reasonably priced pillows can be just as good as the high-ticket items.