Treatment for Neck Pain

Overview and Pathophysiology

• 30-50% of people in the U.S. experience neck pain at any given year.
• Most neck pain is the result of cervical para-spinal muscle spasm. Identifying the exact anatomical source is often difficult.
• Traumatic neck pain is most commonly associated with hyperextension syndrome (whiplash) which leads to as many as 40% of chronic neck pain syndrome.
• Non-traumatic neck pain is most commonly caused by soft tissue disorders from poor posture, repetitive activities (staring at a computer monitor, carrying a heavy pulse or backpack on one shoulder, holding a phone between the shoulder and the ear).
• Acute neck pain usually resolves within days or weeks but may become chronic in about 10% of people.
• Nearly half of the people with chronic neck pain have mixed neuropathic-nociceptive symptoms or predominantly neuropathic symptoms.
• For cervical radiculopathy and facet arthropathy, weak evidence supports epidural steroid injections and radiofrequency denervation, respectively.
• Surgery is more effective than conservative treatment in the short term but not in the long term for most of these patients, and clinical observation is a reasonable strategy before surgery.
• A strong connection exists between soft tissue neck pain and emotional stress or mental states such as anxiety and depression.
• Metaphors: “a pain in the neck”, “stick our neck out for others”, and “go for the throat.”
• Risk factors for neck pain: depression and anxiety, increasing age, high job demands, obesity, low job satisfaction, work with exposure to unusual posture, history of headaches, smoking, drug abuse, heavy physical work and manual labor, and weight lifting.

Integrative Therapies

• Identify underlying causes.
• Modify lifestyle and risk factors
• Exercise and Movement: PT with active stretching and neck traction, Yoga, Pilates, Alexander techniques, and Feldenkrais are helpful.
• Mind-body therapies including hypnosis, relaxation exercises, and biofeedback are beneficial
• Aromatherapy and phytoantiinflammatory agents are occasionally helpful.
• Manual therapy: Osteopathic Manipulative Therapy (OMT), chiropractic therapy, massage, and trigger point therapy are also effective.
• Bioenergetic therapies, including acupuncture, therapeutic touch, and Reiki, are useful.
• Consider trigger point injections, Botulinium toxin A injection, prolotherapy or pletet rich plasma injection, facet joint injection, and epidural steroid injection in resistant cases.
• Pharmaceuticals including corticosteroids, NSAIDs, muscle relaxants, opioids, and antidepressants are relatively effective for both acute and chronic neck pain.
• Surgery such as cervical fusion may be necessary.

Acupuncture Treatment

• Local points: GB 20, BL 10, GV 14, 20
• Distal points: SI 3, BL 62, TH 5

Cupping Therapy

• Repetitive dry cupping is indicated for acute neck pain.
• Wet cupping is more effective for chronic neck pain
• Avoid cupping directly over carotid artery area.
• Neck cupping is an effective treatment for tension and migraine headache.
• Cupping over Ren 22 is indicated for dysphagia, coughing, GERD, and throat clearing.
• Cupping over Ren 23 is helpful for dysphagia, tonsilopharygitis, and tongue related problems, such as dysgeusia.
• Intensity of cupping: medium to moderately strong cupping.

Practical Recommendation

Acute neck pain:

1. Acupuncture using the local and distal points described as above for 10-15 minutes.
2. Repetitive dry cupping over the neck and upper thoracic region 4 to 5 times in the same visit. Leave cups on for 3 to 4 minutes per dry cupping application.
3. Gentle massage or OMT on cervical and thoracic region.
4. Apply heat every hour while awake.
5. Pain medication and/or muscle relaxant prn.
6. Add a high dose of corticosteroid if radiculopathy symptoms present unless contraindicated.

Chronic neck pain:

1. Wet cupping directly over the most painful area of the neck every 2 weeks for 4 visits.
2. Acupuncture treatment using the local and distal points as above.
3. Manual therapy twice a month.
4. Daily neck stretching exercise and emphasis on good ergonomic postures when working with computers.
5. Pain medications prn