Chronic neck pain is defined as neck pain that is lasting more than 3 months to the severity that one's activities
of daily living are limited. Approximately 30% of adults have had chronic neck pain at some point in their lives.
While the causes of chronic neck pain can be numerous, significant advances have been made over the last 20 years
in the diagnosis and treatment of chronic neck pain so that one does not necessarily need to 'live with it' or
consider 'drastic surgery'.
The causes of chronic neck pain very depending on the age of the patient. In a younger person (under the age of 50)
chronic neck pain in the absence of nerve or spinal cord compression is usually due to disc degeneration or possible
musculo-ligamentous strains. The nature of the neck pain and the factors that exacerbate/alleviate the neck pain -
in addition to any causative factors such as car accidents or injuries - may help elucidate the nature of the neck
pain. In addition to a thorough physical examination, advanced imaging such a CT or MRI may be helpful in determining
the etiology of the neck pain. In most cases, a targeted a physical therapy program based on a proper diagnosis
can help significantly in the management of this type of chronic neck pain. Occasional nonsteroidal anti inflammatories
and other medications can be used but should not be necessary on a daily basis. The most important aspect of
improving chronic neck pain in younger age patient is making the proper diagnosis so the physical therapy regimen
can address this cause appropriately.
In older patients (over the age of 50) the cause of chronic neck pain is most commonly arthritic in nature. In
addition to the disc degeneration, the patient may also have arthritis in the back of the spine known as facet
arthritis or arthropathy. Again, the nature of the patient's neck pain and what aggravates/alleviates it can help
determine what type of treatments may be helpful. If the patient's pain is worse when bending forward as opposed
to bending backwards, this suggests disc degeneration as the main pain generator. However, if the patient's pain
is worse when extending his/her neck backwards or rotating the head from side to side, this suggests facet arthritis
a cause of the pain. Advanced imaging such a CT scan and/or MRI can be used to help confirm the clinical diagnosis
and exclude spinal cord and/or nerve compression. Once the pain generator is identified, a physical therapy program
based on the proper diagnosis can be helpful in the management of this chronic neck pain. While the chronic neck
pain may never go away completely in the elderly patient, an exercise-based physical therapy program may make it
more manageable. If physical therapy and occasional nonsteroidal anti-inflammatory medications are not significantly
helpful in addressing the pain and the patient does not show any significant evidence on examination or imaging of
nerve and/or spinal cord compression, advanced pain management techniques can be used to determine the pain
generator as well as address the pain, at least temporarily. This includes such techniques as facet injections
and dorsal rhizotomies. Surgery is very rarely indicated for chronic neck pain in the absence of spinal instability,
spinal cord compression, or nerve compression.
Given the varying nature of chronic neck pain in elderly and in younger patients, it is important to discuss your
specific situation with a fellowship trained orthopedic spine surgeon.
Mir H. Ali, MD,PhD
Director - Deerpath Spine Institute
Orthopedic Spine Surgeon - Rezin Orthopedics & Sports Medicine
Dr. Ali is a board certified orthopedic spine surgeon trained in the diagnosis as well as the treatment of
non-operative and operative spinal disorders. Dr. Ali practices in the far western and southwestern
suburbs of Chicago and utilizes surgery as a last resort when all other non-operative treatments have
failed to relieve pain and/or reduce risk of nerve damage/injury. All recommendations on this site are for
general situations and a particular situation requires evaluation before specific treatment recommendations
can be made.