Conservative Medical Treatments for Neck Pain

Approximately seven out of 10 people will experience neck pain (cervicalgia) at some point in their lives. The causes of neck pain are varied and diverse. Pain ranges from mild to severe and can be acute (lasting days to weeks) or chronic (lasting longer than three months).

There are a number of conservative, or nonsurgical, treatments for neck pain. Treatment is dependent on symptoms and the cause of pain. Conservative treatments for neck pain include medications, injection therapy, physical therapy, soft collar neck bracing, and cognitive behavioral therapy.

Medications

Medication is a common treatment for neck pain. Medications that may be recommended or prescribed include the following:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
  Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can reduce inflammation and pain. If pain is not controlled by over-the-counter options, a health care provider may prescribe a higher-strength NSAID, such as celecoxib.
• Muscle relaxers
  If the cause of neck pain involves muscle tension or muscle spasms, muscle relaxers may be prescribed. Examples of muscle relaxers include baclofen and methocarbamol.
• Anticonvulsants
  If neck pain is caused by nerve damage or compression, anticonvulsant medication may be prescribed. Examples of anticonvulsants include gabapentin, pregabalin, and topiramate.
• Opioid pain medications
  Opioid medications, such as codeine, tramadol, or oxycodone, may be prescribed for severe pain.

Injection therapy

Depending on the cause of neck pain, injection therapy may be a treatment option.

• Cervical epidural steroid injection
  A cervical epidural steroid injection involves the delivery of corticosteroids into the epidural space via a syringe. Corticosteroids help reduce inflammation and pain. This type of injection therapy is quite helpful for conditions such as tendinitis, arthritis, and bursitis.
• Trigger point injection
  Trigger points are painful “knots” (hard, palpable nodules) that can form in muscles. They are sore or painful when pressed. Trigger points develop when a muscle is unable to relax. A trigger point injection involves injecting a local anesthetic or saline into the trigger point to decrease pain.
• Dry needling
  Dry needling is a treatment in which fine needles are inserted into the skin to help relieve pain. Nothing is injected into the body. The needles are typically inserted into knotted, painful areas in muscles (trigger points). Dry needling stimulates tissue to release knots and stop spasms. It may also improve flexibility and increase range of motion.
• Radiofrequency (RF) ablation
  If a facet joint is a confirmed area of pain, under x-ray guidance, a special needle can be placed near the facet joint’s sensory nerve to create a heat lesion that prevents pain signals from reaching the brain. Radiofrequency ablation can provide pain reduction that lasts for several months to several years.

Physical therapy

Physical therapy may be recommended as part of a comprehensive treatment plan for neck pain. A physical therapist can design and help implement a program of stretches and exercises for the neck that builds muscle strength and improves flexibility.

Soft neck collar

A health care professional may prescribe a specific type of collar to support the neck. Wearing a neck collar can help reduce pain by relieving pressure off the neck. It is important to follow the provider’s instructions when wearing a neck collar; if it is used for too long, neck muscles may begin to weaken.

Cognitive behavioral therapy

Neck pain, especially chronic neck pain, can be exceedingly frustrating. Treatment is often complex and may seem ineffectual. Cognitive behavioral therapy (CBT) can help reframe the way an individual thinks about challenges, which can help ease pain.

It’s important to note that neck pain accompanied by weakness or numbness in the extremities typically requires surgical treatment.