CHRONIC CERVICAL PAIN

WHAT IS CHRONIC CERVICAL PAIN?

Chronic cervical pain

Chronic cervical pain, commonly known as “neck pain”, is a generic term describing the injuries to the cervical spine (neck). It is often the result of a traffic accident in which a vehicle is hit from behind by another, causing a sudden movement of the head in such a way that the neck is first extended and then flexed (bent). These sudden and violent movements often damage the neck’s and sometimes even the vertebrae’s soft tissue. Occasionally, the cervical spinal cord or its roots will be damaged.

Symptoms may include pain in the neck, stiffness and local inflammation, headache, dizziness, blurred vision and nausea. Sometimes the pain spreads to shoulders, inter-scapular region, arms, or up into the back of the head. The symptoms can appear immediately after the accident or 1-2 days after it.

Age and pre-existing conditions such as osteoarthritis may increase the severity of injuries. With increasing age, reaction time decreases, muscles lose flexibility and strength and the intervertebral discs and ligaments lose elasticity, so injuries are more common.

CERVICAL SPINE ANATOMY

There are 7 bones in the cervical spine (neck), which we name vertebrae. Between each two vertebrae there is a fibrous and elastic tissue, the intervertebral disc, which allows the movement of the spine. Finally, a system of ligaments, tendons and muscles help stabilise the spine and prevent excessive movement, for it could cause injury.

DIAGNOSIS OF A WHIPLASH INJURY

Whiplash injury

Physical examination usually reveals the existence of contracture and stiffness of neck muscles with pain when the neck is moved.

Radiographs, like cervical CT scans, do not usually show lesions. The best diagnostic technique in this case is MRI, because it can highlight the soft tissue injury.

Whiplash injury

 

CHRONIC CERVICAL PAIN TREATMENT

Cervical collar

Treatment usually starts with a cervical collar to immobilise the neck for 2-3 weeks together with the administration of anti-inflammatory agents and muscle relaxants.

If the pain persists, chiropractic therapies, physiotherapy and rehabilitation might be useful.

Depending on the evolution of the lesion, local heat, shortwave, ultrasound, laser and/or magnet therapy can be applied.

Cervical collar
 

In most patients, these conservative treatments are able to control the discomfort. There is, however, a small group of patients in which the pain persists, and in these cases it may be necessary to apply surgical treatments, such as a cervical facet joint denervation. This procedure does not require general anaesthesia, only sedation, and in it the small nerve branches of the neck joints are destroyed, thereby relieving the pain. It is carried out on an outpatient basis, so no admission to a hospital is required, and percutaneously, so it is performed using needles and does not, therefore, involve cuts in the skin.

On very rare occasions it may be necessary to perform a surgery to fuse two or more vertebrae or to disc replacement or by disc prostheses, but these cases are, however, exceptional.

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