The neck and the lower back lie at opposite ends of the spinal column, but they have much in common. They both support heavy loads, and they both tend to hurt. According to a recent report in the Annals of Internal Medicine, roughly 13 percent of American adults suffer from neck pain at any given time. Half of all adults can at least remember a time when their neck felt sore and stiff.

Like back pain, neck pain can be extremely frustrating. It tends to come on quickly and go away slowly. That's also the good news: For most people, it does go away. All it usually takes is a little self-care, a lot of patience, and, perhaps, some help from a doctor.

The muscles and ligaments in the neck are strong and flexible, but they have their limits. If you stretch your neck too far or twist it too quickly, you can develop painful sprains or strains: minor injuries to muscles and ligaments. If your pain is at its worst during the morning, you may be straining your neck while you sleep. Sprains and strains are also very common after falls and car accidents.

Arthritis is another common cause of neck pain. Both rheumatoid arthritis and osteoarthritis can damage the joints in the neck, causing pain and stiffness.

As with back pain, some cases of neck pain can be traced to the disks that cushion the joints between vertebrae. The disks in the neck can wear thin with age, putting extra stress on the joints. And, like disks in the lower back, disks in the neck can become herniated or "ruptured." The jelly-like center can ooze out of the disk and press against a nerve, causing neck pain along with pain, numbness, or tingling in one arm.

Very rarely, neck pain is a symptom of a life-threatening disease, such as meningitis (a brain infection) or cancer.

In most cases, time is the best remedy for neck pain. If you can avoid further straining your neck, the pain should gradually fade. Be patient: According to the National Institutes of Health, the healing process might take as long as several weeks. Over-the-counter pain relievers such as aspirin or ibuprofen can make the wait much more bearable. You can also try loosening tight muscles with a hot shower or a heating pad. If your neck hurts in the morning, a firm mattress and flat pillow (or no pillow at all) might help speed relief and prevent future problems.

The NIH recommends calling a doctor any time neck pain lasts for more than a week. You should also seek help if you have painful or swollen neck glands; pain that doesn't respond to over-the-counter pain relievers; or pain, numbness, tingling, or weakness in one arm. Get help right away if your neck is extremely stiff and you have a fever along with a severe headache. These symptoms are the hallmarks of meningitis.

A doctor's first job is to find the source of pain. Here are some of the questions he or she might ask:

•Is it a muscle strain? If so, is it due to chronically tense muscles in the back or neck as a result of stress, poor posture, or trauma?

•Is it related to a bony injury? (If so, ask your doctor whether you need to get x-rays.)

•Is there pain or numbness radiating down the arms or to other parts of the body? If so, your doctor will decide whether you need an MRI to rule out nerve impingement, or whether a soft collar and anti-inflammatory agents would be worth trying in the short run to see if your neck gets better on its own.

•Do you have any allergies to antiinflammatory medications or muscle relaxants?

If your neck pain seems to be a simple case of overexertion, your doctor will advise you to move your neck as little as possible until the pain goes away. You may need to wear a neck brace for a while to keep your neck still. Your doctor may also prescribe prescription pain relievers or muscle relaxants. In rare cases, if you have other symptoms that raise red flags, your doctor may suspect a systemic illness such as meningitis or spinal cancer.

Chronic neck pain calls for a different approach. According to the American Academy of Orthopaedic Surgeons, motion -- not rest -- is often the best remedy for lingering neck pain. Your doctor or physical therapist may recommend specific exercises to help keep your neck strong and flexible. Exercise can be especially valuable for people with arthritis.

A very small number of people need surgery to relieve their neck pain. If a herniated disk in your neck is causing nerve damage, a surgeon may need to remove part of the disk to relieve pressure on your nerves.

When traditional medicine can't offer any quick answers to pain, many people look elsewhere for relief. It's no surprise that millions of Americans with neck pain have sought help from acupuncturists or chiropractors. For some, it just might have been the right move.

Two recent studies suggest these popular alternative remedies can help relieve neck pain. A study published in the May 21, 2002, issue of the Annals of Internal Medicine found that 68 percent of patients with neck pain felt better after six weeks of chiropractic treatment. For comparison, only 36 percent of patients who underwent simple self-care reported relief six weeks later. A separate study published in the June 30, 2001, issue of the British Medical Journal found that five sessions of acupuncture brought more immediate relief to neck pain patients than five sessions of massage. The effect was fleeting, however: Three months later, patients who received acupuncture were no better off than other patients.

It's always a good idea to consult with your doctor before trying an alternative treatment, especially chiropractic. As reported in the December 2002, issue of Neurosurgical Focus, chiropractic manipulation of the neck has the potential to make a herniated disk worse, and it might even cause a herniation in the first place.

In addition, there's another, even more serious risk: In 2002, a group of Canadian neurologists warned that vigorous chiropractic treatment for neck pain can cause strokes, some of which are fatal. Although such complications are rare, the neurologists ranked chiropractic manipulation of the neck as one of the leading causes of strokes in people under 45.

A study published in a peer-reviewed chiropractic journal, The Journal of Manipulative Physiological Therapy, found that the incidence of stroke following manipulation was low, but concluded that "there seems to be sufficient evidence to justify a firm policy statement cautioning against upper cervical rotation as a technique of first choice."

Neck pain may be frustrating, but it's almost never an emergency. Take the time to find the right treatment for you, and prepare yourself for a long healing process. Whether it takes weeks or months, relief is worth the wait.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive and was a staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the Northern California Society of Professional Journalists.

References

First published September 22, 2004
Last updated January 23, 2007
Copyright © 2004 Consumer Health Interactive

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