Neck Pain Management

In 2014, Lisa was diagnosed with pulmonary hypertension and diabetes. She started experiencing significant pain all over her body, which intensified over the next five years. She went to her doctor when she began experiencing severe pain and spasming in her arms.

“It didn’t feel like my doctors were listening to me. It was so frustrating.” She was given another diagnosis, fibromyalgia, and put on a number of medications. Nothing took her pain away.

Finally, Lisa had tests done that indicated structural damage in her cervical spine and wrists. She decided to proceed with neck and wrist surgery.

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What is Neck Pain?

It’s likely you’ve experienced it yourself (and probably why you’re reading this article): a pain in your neck that might spread across your shoulders and upper back, as well as your chest and even your arms. It might also be accompanied by headaches. If you’ve struggled with this type of pain before, you know firsthand how debilitating and frustrating it can be, particularly when it’s chronic (lasting longer than six months).[a]

Some common features of neck pain are:

• Pain felt in the neck, upper back, shoulders, chest, and/or arms
• Feelings of muscle tension
• Muscle spasms and stiffness
• Headaches
• Paraesthesias (numbness or tingling in the arms)
• Limited ability to move your head

Neck pain that is caused by nerve compression may also include symptoms of tingling in the arms, hands, and/or fingers, feelings of weakness in the shoulders, arms, and/or hands, and sharp, radiating pain originating from the nerve that is being pinched.[b]

It’s believed that between 25% and 30% of people have to contend with neck pain every year (2). While in many cases this type of pain resolves on its own without any treatment, for many people like Lisa, it develops into a chronic condition that significantly affects one’s quality of life for a long time. Or the pain comes and goes, often for no obvious reason. Can you relate to this? If so, continue reading to learn more about this condition and how to find neck pain relief so you can move beyond this ‘pain-in-the-neck’ condition once and for all.

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Causes of Neck Pain

Neck pain may be either primary or secondary. Primary pain is the most common type of neck pain and refers to symptoms that are caused by sensitization of the nervous system. Secondary pain is less common and refers to pain that is linked to an injury or structural condition[1].

Because all pain is real, the physical sensations of primary and secondary pain are the same, but the causes are very different. While secondary pain is caused by tissue damage or injury, primary pain is caused by the brain being stuck in a state of high alert. This type of neck pain isn’t dangerous, but it still hurts! It is important to determine whether your pain is primary or secondary in order to adopt the correct treatment path. Here are some guidelines for distinguishing between the two:

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Secondary Neck Pain Indicators:

If your neck pain fits these criteria, it is likely that there is a structural cause to your pain. Note that in most cases, structural neck issues resolve themselves and are not a cause for concern.

• Pain onset was caused by an obvious injury (i.e. a car accident, a fall, an impact, or sometimes from just sleeping funny)
• The injury happened less than 6 months ago
• You have consistent pain that is always present in a specific part of your neck
• Your symptoms behave predictably and you can consistently reproduce them

If you have Secondary Neck Pain, your pain should resolve within a few months. In the next section, we’ll discuss how to promote healing and reduce pain during this period.

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Primary Neck Pain Indicators:

‍If, on the other hand, your neck pain is consistent with one or more of these indicators, it is likely that your pain is primary.

• Your neck pain has lasted for more than 6 months
• Pain onset was not caused by an obvious injury (i.e. a car accident, a fall)
• Pain started during a time of stress or change
• You have experienced similar neck pain before
• Your neck pain is inconsistent: it moves around your neck; arises only during certain activities or times of day; grows stronger during times of stress; and/or grows more manageable during times of calm or enjoyment.

If you have Primary Neck Pain, it is important to properly treat the root cause of your pain. This type of pain is not dangerous and is very treatable, even if you’ve had it for years. Read on to learn about recommended treatment.

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Neck pain treatment

The correct neck pain treatment plan will depend on whether your neck pain is categorised as primary, secondary, or a mix of the two. In this section, we’ll provide guidelines for each category of neck pain.

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Secondary neck pain treatment:

If you have experienced acute neck pain, meaning pain with sudden onset which resolves relatively quickly[2], then most likely your neck pain is not indicative of a dangerous injury. It means you either have a mild strain that will heal quickly, or your brain and nervous system have gone into a state of high-alert for a short period of time, with or without an injury.

To assess whether your acute neck pain does in fact require medical attention, check if your pain is consistent with the following red flags:

• consistent numbness and/or tingling in a particular part of the arm or hand
• atrophy of specific muscles and significant weakness
• significant swelling or another physical change
• changes in vision, balance, or concentration/focus
• Loss of motor control

If you notice any of these symptoms, meet with your doctor to rule out more significant injury. As long as your neck pain is not consistent with these “red flag” characteristics, there is generally no concern of significant injury, and your neck will heal naturally.

So, how can you reduce Secondary Neck Pain while you’re healing?

During the first 24-48 hours after acute neck pain arises, it is best to give your neck  relative rest. Gentle movement can help. While mild pain is safe, avoid movements that make the pain worse. Massage, chiropratic treatment, and stretching can make pain worse during the first 24-48 hours, as they can aggravate the injury or sensitize the nervous system. Over-the-counter medications such as Advil or Tylenol can help keep the pain down during this period.

After the first 24-48 hours, it is highly recommended to stay active and exercise (while avoiding movements that trigger too much pain). Gentle movement is almost universally helpful in speeding up the body’s natural healing process. Identifying sources of stress in your life and working to minimize them will also help to decrease your pain levels. Relatedly, it is beneficial to reinforce knowledge of your body’s healing abilities in order to counter fear associated with your pain. This is important because pain is directly related to fear, regardless of the pain’s cause.

In addition to staying active and reducing stress and fear, the following may be helpful short-term remedies as the neck heals:

• Over-the-counter medications such as Advil or Tylenol and/or other medications such as CBD
• Changing posture and positions more often
• Foam roll stretching of the shoulders and upper back
• Gentle neck isometric exercises
• Ice and/or hot pads
• Acupuncture
• Yoga or pilates
• Chiropractic adjustments or manipulation
• Physical therapy to encourage movement and apply manual therapies
• Other interventions include trigger point injections, radiofrequency ablations, botox injections, epidural steroid injections, and dry needling. However, these are best saved for pain that sticks around for more than a few days/weeks.
• Regenerative treatments including platelet rich plasma (PRP) and bone marrow stem cells are also sometimes helpful if pain is still present after a month or more.

You should note, however, that all of these treatments should be considered short-term treatments. They are designed to support your body healing effectively, rather than to become interventions that you depend upon. If your pain persists for more than six months, this is a strong indicator that you are experiencing primary pain, and your pain should be treated as such.

It is also important to note that surgery is generally discouraged for people with neck pain, and should only be done if all other options have been exhausted.

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Primary Neck Pain Treatment

If your neck pain symptoms are consistent with primary pain, then you’ll have better outcomes using brain-first techniques which dial down the pain signals being generated by the nervous system. Despite pain that is very real, these symptoms are being generated by your brain in the absence of any neck injury. Understanding how pain works and shifting belief is an important first step in reducing symptoms. Then helpful interventions include Pain Reprocessing Therapy (PRT)[3], Emotional Expression and Awareness Therapy (EAET)[4], and related techniques. These interventions help shift the nervous system from a state of high-alert to low-alert through reconceptualization of pain as non-dangerous, and have measurable effects on brain function and pain levels[5].

In addition, it is beneficial to adopt a holistic approach to Primary Pain by addressing your sleep, mood, stress levels, and anxiety. A professional qualified to treat Primary Pain will be able to guide you through such an approach.

As with Secondary Neck Pain, movement and stress-reduction techniques are almost always beneficial for those experiencing Primary Neck Pain. Additionally, while seeking care from a professional qualified to treat Primary Pain, some find it helpful to utilize other treatments in the short-term, including:

• Medication
• Physical therapy and other body work that helps to reduce fear
• Interventions that reinforce safety and healthy movement, including: regenerative treatments, chiropractic adjustments, massages, acupuncture, herbal remedies, yoga, and/or pilates.

Once again, these treatments should be considered short-term treatments that are secondary to the treatment of the root cause of Primary Pain, which is over-sensitization of the nervous system.

       In addition to Primary Pain treatment interventions, long-term strategies for calming the nervous system and supporting the resolution of Primary Pain include:

• Mindfulness meditation
• Self Care
• Social connection
• Meaningful and joyful movement
• Reducing stress by making meaningful life change
• Pain science education
• Having an ally to support you throughout the healing process

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Lisa’s Story

Lisa joined Lin Health right before having neck surgery. Her Lin Health Coach and Physical Therapist provided her with resources, guidance, and support during her surgery recovery – and with proven techniques to reduce pain in her neck and the rest of her body.

After multiple surgeries and numerous medications, Lisa is glad to have discovered the principles of Primary Pain treatment. In fact, Primary Pain treatment techniques have helped her effectively reduce pain she experiences in other parts of her body, including her hip and knees. Lisa has come to consider these techniques an effective, non-invasive alternative to medication and surgery.

If you, like Lisa, have tried numerous medical and/or surgical treatments for your neck pain, yet have not found lasting pain relief – Lin is for you. Lin Health can offer you the integrative treatment for Primary Pain that you need to live a life of less pain.