Pain Conditions
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      2. Pain Conditions

      Chronic Neck Pain

      Brief Overview: Chronic neck pain (cervicalgia) refers to persistent pain, stiffness, or discomfort in the cervical spine region lasting >3 months. It may result from degenerative changes, poor posture, muscle strain, or prior trauma. Pain may be localized or radiate into the shoulders, arms, or head, and can lead to functional decline, sleep problems, and reduced quality of life in older adults.

      Etiology:

      • Degenerative arthritis (cervical spondylosis)
      • Disc herniation or bulging in cervical spine
      • Muscle strain or ligament injury
      • Poor posture (especially prolonged computer or phone use)
      • Trauma (whiplash, falls)
      • Spinal stenosis or nerve compression

      Risk Factors:

      • Older age (degenerative changes)
      • Female
      • Occupations/hobbies with repetitive neck motion or prolonged sitting
      • Poor posture, weak core/neck muscles
      • Prior neck injury or surgery
      • Osteoporosis (vertebral fractures)
      • Smoking (accelerates disc degeneration)

      Commonly Associated Conditions:

      • Cervical spondylosis (arthritis)
      • Herniated or bulging cervical disc
      • Cervical spinal stenosis
      • Tension-type headaches, occipital neuralgia
      • Shoulder or upper back pain
      • Depression, anxiety, sleep disturbances

      Common Medications:

      • Acetaminophen, topical NSAIDs
      • Oral NSAIDs: ibuprofen, naproxen (short-term; caution in some)
      • Neuropathic agents: gabapentin, pregabalin, duloxetine (if nerve involvement)
      • Muscle relaxants: short-term only; avoid long-term in seniors
      • Topical agents: lidocaine patches, capsaicin cream, diclofenac gel
      • Opioids: last resort, short-term, specialist-managed
      • Steroid injections: epidural or facet joint injections in select cases

      Common Labs, Imaging, and Tests:

      • Not always needed
      • X-ray, MRI, CT

      Common Symptoms:

      • Persistent neck pain (dull, aching, or sharp)
      • Stiffness, especially after sleep or prolonged sitting
      • Limited range of motion
      • Pain radiating to shoulders, arms, or head
      • Numbness, tingling, or weakness in arms/hands (if nerve compression)
      • Headaches, especially tension-type or occipital
      • Sleep disturbance, fatigue

      Common Treatments:

      • Non-Pharmacologic:
        • Physical therapy: stretching, strengthening, posture correction
        • Heat therapy: warm compresses, showers for stiffness
        • Ergonomic adjustments: computer/phone setup, supportive pillow, good mattress
        • Exercise: low-impact activity (walking, yoga, tai chi)
        • Stress management: relaxation, mindfulness, breathing exercises
      • Pharmacologic:
        • Stepwise use of acetaminophen, NSAIDs, neuropathic agents, topical therapies
        • Muscle relaxants short-term
        • Corticosteroid injections in refractory cases
      • Interventional:
        • Epidural steroid injections, facet joint injections, or radiofrequency ablation for persistent pain
        • Surgery (rare; only for severe compression with neurological deficits)

      Physical Findings:

      • Local tenderness in cervical muscles/joints
      • Limited neck range of motion
      • Muscle spasm or tightness
      • Abnormal posture (forward head)
      • Neurological deficits if nerve involvement: weakness, sensory loss, reduced reflexes in upper extremities

      Potential Complications and Contraindications:

      • Complications:
        • Chronic disability, functional decline
        • Falls (if nerve compression affects balance/strength)
        • Depression, anxiety, sleep disturbance
        • Opioid or NSAID overuse
        • Neurological impairment if untreated nerve compression
      • Contraindications:
        • Long-term NSAID use in patients with GI, renal, or cardiac disease
        • Muscle relaxants: risk of sedation, confusion, falls
        • Chronic opioid therapy (dependence, confusion, falls)
        • Repeated steroid injections: risk of cartilage/bone weakening

      General Health and Lifestyle Guidance:

      • Encourage daily stretching and gentle range-of-motion exercises
      • Maintain good posture (ergonomic chairs, monitor at eye level)
      • Use supportive pillow and avoid sleeping on stomach
      • Stay active — avoid prolonged rest. Ask your healthcare provider what exercises are recommended for you.
      • Manage stress with relaxation techniques
      • Maintain a healthy weight and avoid smoking
      • Apply heat or cold packs as needed for comfort

      Suggested Questions to Ask Patients:

      • How long have you had neck pain? Is it constant or intermittent?
      • Does the pain radiate into your arms, shoulders, or head?
      • What activities make your pain better or worse?
      • Do you notice numbness, tingling, or weakness in your arms or hands?
      • Do you take pain medications? How often, and do they help?
      • Have you tried physical therapy, stretching, or posture adjustments?
      • Does neck pain affect your sleep, mood, or daily activities?
      • Have you experienced red flag symptoms (sudden weakness, fever, unexplained weight loss)?

       

      Suggested Talking Points:

      • Neck pain is very common, especially with aging or poor posture.
      • Most people will see improvement with stretching, posture correction, and gentle activity.
      • We want to avoid overusing medications like NSAIDs or opioids — safer long-term strategies exist.
      • Physical therapy and ergonomic changes can make a big difference in pain and mobility.
      • If pain suddenly worsens or you notice arm weakness or numbness, it’s important to notify your provider. Ask your healthcare provider for other warning signs and advice on when you should seek urgent/emergency care.

      Sources:

      This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.